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Intraoperative mapping

Jesse J Liu, Jeffrey S Raskin, Fran Hardaway, Katherine Holste, Sarah Brown, Ahmed M Raslan
BACKGROUND: Delivery of higher value healthcare is an ultimate government and public goal. Improving efficiency by standardization of surgical steps can improve patient outcomes, reduce costs, and lead to higher value healthcare. Lean principles and methodology have improved timeliness in perioperative medicine; however, process mapping of surgery itself has not been performed. OBJECTIVE: To apply Plan/Do/Study/Act (PDSA) cycles methodology to lumbar posterior instrumented fusion (PIF) using lean principles to create a standard work flow, identify waste, remove intraoperative variability, and examine feasibility among pilot cases...
March 14, 2018: Operative Neurosurgery (Hagerstown, Md.)
Giovanni Raffa, Maria C Quattropani, Antonino Scibilia, Alfredo Conti, Filippo Flavio Angileri, Felice Esposito, Carmela Sindorio, Salvatore Massimiliano Cardali, Antonino Germanò, Francesco Tomasello
OBJECTIVES: Awake surgery and intraoperative monitoring represent the gold standard for surgery of brain tumors located in the perisylvian region of the dominant hemisphere due to their ability to map and preserve the language network during surgery. Nevertheless, in some cases awake surgery is not feasible. This could increase the risk of postoperative language deficit. Navigated transcranial magnetic stimulation (nTMS) and nTMS-based DTI fiber tracking (DTI-FT) provide a preoperative mapping and reconstruction of the cortico-subcortical language network...
March 11, 2018: Clinical Neurology and Neurosurgery
Shin-Ichi Oikawa, Kiyoto Shiga, Daisuke Saito, Katsunori Katagiri, Aya Ikeda, Kodai Tuchida, Jun Miyaguchi, Kazuyuki Ishida, Tamotsu Sugai
The present study aimed to investigate the usefulness of contrast-enhanced ultrasonography (CEUS) and a newly developed analysis software for the detection of microcapillary network distribution in lymph nodes of patients with head and neck cancer (HNC) by comparing the CEUS and histopathological findings. Patients that were diagnosed with HNC between February and September 2016 were enrolled. A total of five patients underwent resection of the primary tumor and neck dissection as their initial treatment. The cervical lymph nodes of these patients were analyzed by CEUS intraoperatively, and their surgical specimens were examined histopathologically...
April 2018: Oncology Letters
M Campos-Friz, U Hubbe
BACKGROUND: Complex spinal surgery in elderly patients mostly treats degenerative spine alterations. The use of multimodal intraoperative neuromonitoring (IONM) has proven to be a useful tool to recognize neural deterioration during such operations. Elderly patients often have preexisting neural impairment, which leads to difficulties in deriving some potentials or can even lead to not obtaining any potentials at all. PRACTICE AND PROSPECTS: For reliable benefits from IONM a combined use of monitoring and mapping methods as well as the right choice of methods according to the spine level to be treated and a definition of the neural structures in danger is needed...
March 13, 2018: Der Orthopäde
John Quan Minh Nguyen, Melanie McWade, Giju Thomas, Bryce T Beddard, Jennifer L Herington, Bibhash C Paria, Herbert S Schwartz, Jennifer L Halpern, Ginger E Holt, Anita Mahadevan-Jansen
Fluorescence imaging is a well-established optical modality that has been used to localize and track fluorophores in vivo and has demonstrated great potential for surgical guidance. Despite the variety of fluorophores currently being researched, many existing intraoperative fluorescence imaging systems are specifically designed for a limited number of applications. We present a modular wide-field fluorescence overlay tissue imaging system for intraoperative surgical guidance that is comprised of commercially available standardized components...
April 2018: Journal of Medical Imaging
Alberto A Mendivil, Lisa N Abaid, John V Brown, Kristina M Mori, Tiffany L Beck, Howard D Epstein, John P Micha, Bram H Goldstein
OBJECTIVES: The purpose of this study was to report on the feasibility of laparoscopic sentinel lymph node (SLN) staging using indocyanine green (ICG) in the management of endometrial cancer. STUDY DESIGN: We retrospectively evaluated the charts of presumed, clinical stage I endometrial cancer patients who underwent robotic-assisted surgery that incorporated mapping with ICG and SLN dissection from January 2016 until February 2017. Patient demographics, operative characteristics (e...
March 3, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Carolyn E Vasey, Siraj Rajaratnam, Gregory O'Grady, Mike Hulme-Moir
BACKGROUND: The optimal surgical management of splenic flexure cancer is debated, partly because of an incomplete understanding of the lymphatic drainage of this region. OBJECTIVE: This study aimed to evaluate the normal lymphatic drainage of the human splenic flexure using laparoscopic scintigraphic mapping. DESIGN: This was a clinical trial. SETTINGS: The study was conducted at a single tertiary care center. PATIENTS: Thirty consecutive patients undergoing elective colorectal resections without splenic flexure pathology were recruited...
April 2018: Diseases of the Colon and Rectum
François-Xavier Ferracci, Hugues Duffau
Radical glioma resection improves overall survival, both in low-grade and high-grade glial tumors. However, preservation of the quality of life is also crucial. Areas covered: Due to the diffuse feature of gliomas, which invade the central nervous system, and due to considerable variations of brain organization among patients, an individual cerebral mapping is mandatory to solve the classical dilemma between the oncological and functional issues. Because functional neuroimaging is not reliable enough, intraoperative electrical stimulation, especially in awake patients benefiting from a real-time cognitive monitoring, is the best way to increase the extent of resection while sparing eloquent neural networks...
March 9, 2018: Expert Review of Neurotherapeutics
Elisabeth M J P Mouws, Eva A H Lanters, Christophe P Teuwen, Lisette J M E van der Does, Charles Kik, Paul Knops, Ameeta Yaksh, Jos A Bekkers, Ad J J C Bogers, Natasja M S de Groot
BACKGROUND: The influence of underlying heart disease or presence of atrial fibrillation (AF) on atrial excitation during sinus rhythm (SR) is unknown. We investigated atrial activation patterns and total activation times of the entire atrial epicardial surface during SR in patients with ischemic and/or valvular heart disease with or without AF. METHODS AND RESULTS: Intraoperative epicardial mapping (N=128/192 electrodes, interelectrode distances: 2 mm) of the right atrium, Bachmann's bundle (BB), left atrioventricular groove, and pulmonary vein area was performed during SR in 253 patients (186 male [74%], age 66±11 years) with ischemic heart disease (N=132, 52%) or ischemic valvular heart disease (N=121, 48%)...
March 8, 2018: Journal of the American Heart Association
Daniel Coluccia, Tabitha Roth, Serge Marbacher, Javier Fandino
BACKGROUND: Resection of left hemispheric tumors (LH) is often complicated by the risks of causing language dysfunction. Although neurosurgeons' concerns when operating on the presumed dominant hemisphere are well known, literature evaluating laterality as a predictive surgical parameter in glioblastoma (GB) patients is sparse. We evaluated whether tumor laterality correlated with surgical performance, functional outcome, and survival. METHODS: All GB patients treated at our institution between 2006 and 2016 were reviewed...
March 3, 2018: World Neurosurgery
Atsuhiro Kojima, Isako Saga, Mami Ishikawa
BACKGROUND: Hypoglossal nerve deficit is a possible complication caused by carotid endarterectomy (CEA). The accidental injury of the hypoglossal nerve during surgery is one of the major reasons for permanent hypoglossal nerve palsy. In this study, we investigated the usefulness of intraoperative mapping of the hypoglossal nerve to identify this nerve during CEA. METHODS: Five consecutive patients who underwent CEA for the treatment of symptomatic or asymptomatic carotid artery stenosis were studied...
February 28, 2018: World Neurosurgery
N D Thimmappa, J V Vasile, C Y Ahn, J L Levine, M R Prince
Autologous breast reconstruction using muscle-sparing free flaps are becoming increasingly popular, although microvascular free flap reconstruction has been utilised for autologous breast reconstructions for >20 years. This innovative microsurgical technique involves meticulous dissection of artery-vein bundle (perforators) responsible for perfusion of the subcutaneous fat and skin of the flap; however, due to unpredictable anatomical variations, preoperative imaging of the donor site to select appropriate perforators has become routine...
February 27, 2018: Clinical Radiology
Yali Tian, Tianting Shi, Fang Wang, Yurui Wu
Objective: To analyze and compare the efficacy of laparoscopic modified Soave operation and open radical resection in the treatment of Hirschsprung's disease. Methods: Two hundred and sixteen children who suffered from Hirschsprung's disease and were admitted into the hospital from June 2015 to December 2016 were selected as research subjects. They were grouped into an observation group in which patients were treated by laparoscopic modified Soave operation and open radical resection and a control group in which patients were treated by open radical resection...
November 2017: Pakistan Journal of Medical Sciences Quarterly
John C Markley, Michaela K Farber, Nicola C Perlman, Daniela A Carusi
BACKGROUND: General anesthesia (GA) is often selected for cesarean deliveries (CD) with placenta previa and suspected morbidly adherent placenta (MAP) due to increased risk of hemorrhage and hysterectomy. We reviewed maternal outcomes and risk factors for conversion to GA in a cohort of patients undergoing CD and hysterectomy under neuraxial anesthesia (NA). METHODS: We performed a single-center, retrospective cohort study of parturients undergoing nonemergent CD for placenta previa with suspected MAP from 1997 to 2015...
February 23, 2018: Anesthesia and Analgesia
Marco Rossi, Luca Fornia, Guglielmo Puglisi, Antonella Leonetti, Gianmarco Zuccon, Enrica Fava, Daniela Milani, Alessandra Casarotti, Marco Riva, Federico Pessina, Gabriella Cerri, Lorenzo Bello
OBJECTIVE Apraxia is a cognitive-motor deficit affecting the execution of skilled movements, termed praxis gestures, in the absence of primary sensory or motor disorders. In patients affected by stroke, apraxia is associated with lesions of the lateral parietofrontal stream, connecting the posterior parietal areas with the ventrolateral premotor area and subserving sensory-motor integration for the hand movements. In the neurosurgical literature to date, there are few reports regarding the incidence of apraxia after glioma surgery...
February 23, 2018: Journal of Neurosurgery
Miran Skrap, Maria Caterina Vescovi, Giada Pauletto, Marta Maieron, Tomasino Barbara, Daniele Bagatto, Francesco Tuniz
BACKGROUND: Cavernous malformations (CMs) are congenital malformations and may be located anywhere in the brain. We present a series of CMs located close to or inside of the motor-sensory cortex or corticospinal tract (CST) with clinical onset due to hemorrhage or mass effect. In such cases, surgery becomes an acceptable option. OBJECTIVE: To evaluate the role of diffusion tensor imaging (DTI), functional-magnetic-resonance imaging (fMRI), intraoperative neurophysiological monitoring, neuronavigation, and brain-mapping and the clinical results of surgical treatment of CMs in this critical location...
February 16, 2018: Operative Neurosurgery (Hagerstown, Md.)
Marlena Hupalo, Rafal Wojcik, Dariusz J Jaskolski
BACKGROUND: Results of DBS of ATN in refractory epilepsy depend on accuracy of the electrode's location. We searched for characteristic intraoperative, intracerebral EEG recording pattern from anterior thalamic nuclei (ATNs) as a biological marker for verifying the electrode's position. METHODS: There were six patients with refractory epilepsy scheduled for deep brain stimulation (DBS) procedure. At surgery, to map the target, we recorded EEG from each lead of DBS electrodes...
February 6, 2018: Neurologia i Neurochirurgia Polska
Samuel H Hui, Ryan Folsom, Lois A Killewich, Joel E Michalek, Mark G Davies, Lori L Pounds
BACKGROUND: Duplex ultrasound (DUS) mapping of the veins and arteries of the upper extremity is a well-established practice in arteriovenous fistula creation for long-term hemodialysis access. Previous publications have shown that vein diameters varying from 2 to 3 mm are predictive of success. Regional anesthesia is known to result in vasodilation and thus to increase the diameter of upper extremity veins. This study compares the sizes of veins measured by preoperative DUS mapping with those obtained after regional anesthesia to determine whether intraoperative DUS results in increased vein diameters and thus changes in the operative plan...
February 13, 2018: Journal of Vascular Surgery
Rafael Teixeira Magalhaes Leal, Bruno Mendonça Barcellos, Jose Alberto Landeiro
BACKGROUND: Brain tumor surgery near or within eloquent regions is increasingly common and is associated with a high risk of neurological injury. Awake craniotomy with mapping has been shown to be a valid method to preserve neurological function while increasing the extent of resection. However, the technique used varies greatly among centers. Most count on professionals such as neuropsychologists, speech therapists, neurophysiologists or neurologists to help in intraoperative patient evaluation...
February 13, 2018: World Neurosurgery
Guillaume Herbet, Sylvie Moritz-Gasser, Hugues Duffau
OBJECTIVE: To identify the prefrontal cortical structures causally involved in verbal and nonverbal semantic cognition in both cerebral hemispheres. METHODS: We retrospectively screened the intraoperative brain mapping data of 584 patients who underwent neurosurgery for neoplastic tumor under local anesthesia with direct cortical electrostimulation. Patients were included if they were right-handed, recently diagnosed with a diffuse low-grade glioma, and had a positive language mapping for verbal (naming task) and nonverbal (visual semantic association task) semantic cognition in the prefrontal cortex (n = 49)...
February 14, 2018: Neurology
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