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Sedat Ulkatan, Ana Maria Jaramillo, Maria J Téllez, Robert R Goodman, Vedran Deletis
OBJECTIVE: To explore the feasibility of eliciting the brainstem H reflex in the masseter muscle in patients under general anesthesia. METHODS: We electrically stimulated the masseteric nerve, a branch of the trigeminal nerve, and recorded ipsilateral masseteric and temporalis muscle responses. We tested eight patients who presented with trigeminal neuralgia; one patient had a temporal bone tumor and one patient had a brainstem arteriovenous malformation. All responses were elicited when patients were under general anesthesia and before the initiation of surgery...
January 2017: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Vedran Deletis, Karl F Kothbauer, Francesco Sala, Kathleen Seidel
No abstract text is available yet for this article.
February 2017: Journal of Neurosurgery. Spine
Vedran Deletis, Isabel Fernández-Conejero
The risk of iatrogenic damage is very high in surgical interventions in or around the brainstem. However, surgical techniques and intraoperative neuromonitoring (ION) have evolved sufficiently to increase the likelihood of successful functional outcomes in many patients. We present a critical review of the methodologies available for intraoperative monitoring and mapping of the brainstem. There are three main groups of techniques that can be used to assess the functional integrity of the brainstem: 1) mapping, which provides rapid anatomical identification of neural structures using electrical stimulation with a hand-held probe, 2) monitoring, which provides real-time information about the functional integrity of the nervous tissue, and 3) techniques involving the examination of brainstem reflexes in the operating room, which allows for the evaluation of the reflex responses that are known to be crucial for most brainstem functions...
July 2016: Journal of Clinical Neurology
Sedat Ulkatan, Ana Maria Jaramillo, Maria J Téllez, Jinu Kim, Vedran Deletis, Kathleen Seidel
OBJECTIVE The purpose of this study was to investigate the incidence of seizures during the intraoperative monitoring of motor evoked potentials (MEPs) elicited by electrical brain stimulation in a wide spectrum of surgeries such as those of the orthopedic spine, spinal cord, and peripheral nerves, interventional radiology procedures, and craniotomies for supra- and infratentorial tumors and vascular lesions. METHODS The authors retrospectively analyzed data from 4179 consecutive patients who underwent surgery or an interventional radiology procedure with MEP monitoring...
June 24, 2016: Journal of Neurosurgery
Paolo Costa, Vedran Deletis
OBJECTIVE: Intraoperative electrical stimulation of the spinal cord evokes not only high amplitude cortical somatosensory evoked potentials (ScEPs: spinal cord-evoked potentials) recorded from the scalp but also early potentials. It has been postulated that the early potential recorded from the scalp could be generated by antidromic stimulation of the cortico-spinal tract (ACSP: Antidromic Corticospinal tract Potential or "anti D-wave"). In this study, we aimed to investigate the anti D-wave evoked by epidural stimulation in a population of neurologically uncompromised/compromised patients during spine and spinal cord surgery...
February 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
J Urriza, B Arranz-Arranz, S Ulkatan, M J Téllez, V Deletis
OBJECTIVE: The objective of this study was to provide evidence on the integrative action of axonal membrane in humans and its ability to integrate multipulse subthreshold stimuli and generate action potential. METHODS: The median nerve was stimulated at the wrist in six healthy subjects and 17 patients who underwent low spine surgery by means of percutaneous electrodes, with trains of one to nine near-threshold constant-current stimuli of 500-μs duration. The interstimulus interval between stimuli was 2 or 4 ms...
February 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Benjamin Verriere, Vanessa Ferreira, Eric Denis, Khaled Zahreddine, Emmanuelle Deletie, Denis Quinsat, Daniel Re
Azacitidine is a demethylating and cytotoxic drug for the treatment of adult patients with (1) myelodysplastic syndromes, (2) chronic myelomonocytic leukemia, and (3) acute myeloid leukemia who are not eligible for induction treatment or hematopoietic stem cell transplantation. Widely described in the literature, the main adverse events are hematotoxicity, digestive toxicity, asthenia, cutaneous toxicity, and infections such as neutropenic sepsis and pneumonia. The pivotal phase III comparative and supporting studies did not point out interstitial pneumonitis as a significant adverse event...
September 2016: American Journal of Therapeutics
P Costa, G Faccani, F Sala, E Montalenti, M L Giobbe, V Deletis
STUDY DESIGN: Prospective, observational study. OBJECTIVES: To assess the spinal cord function intraoperatively in subjects during spine stabilization for spinal cord trauma, by recording muscular (m-MEPs) and epidural motor evoked potentials (e-MEPs, D wave) along with cortical and epidural somatosensory evoked potentials (e-SEPs) and predicting the outcome of spinal cord injury (SCI). SETTING: Regional Trauma Center, Torino, Italy. METHODS: Fifty-five patients were intraoperatively studied during posterior spine stabilization surgery for traumatic SCI...
October 2014: Spinal Cord
Michael J Malcharek, Andrea Kulpok, Vedran Deletis, Sedat Ulkatan, Armin Sablotzki, Gerd Hennig, Jochen Gille, Stefanie Pilge, Gerhard Schneider
BACKGROUND: Methods for detecting intraoperative cerebral ischemia arising from internal carotid artery (ICA) cross-clamping during carotid endarterectomy (CEA) should be sensitive, specific, and rapid to prevent intraoperative stroke. We had 3 objectives pertaining to this: (1) investigation of the rates of success of multimodal evoked potential (mEP) monitoring using a combination of median nerve (m) somatosensory (SS) EPs, tibial nerve SSEPs (tSSEPs), and transcranial electrical stimulated motor EPs (tcMEPs); (2) evaluation of the rates of false-negative mEP results; and (3) analysis of the relationship between different time periods associated with ICA cross-clamping and the postoperative outcome of motor function in patients with significant changes in mEP monitoring...
June 2015: Anesthesia and Analgesia
Vedran Deletis, Maja Rogić, Isabel Fernández-Conejero, Andreu Gabarrós, Ana Jerončić
OBJECTIVE: The aim of this study was to identify neurophysiologic markers generated by primary motor and premotor cortex for laryngeal muscles, recorded from laryngeal muscle. METHODS: Ten right-handed healthy subjects underwent navigated transcranial magnetic stimulation (nTMS) and 18 patients underwent direct cortical stimulation (DCS) over the left hemisphere, while recording neurophysiologic markers, short latency response (SLR) and long latency response (LLR) from cricothyroid muscle...
September 2014: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Maja Rogić, Vedran Deletis, Isabel Fernández-Conejero
OBJECT: Until now there has been no reliable stimulation protocol for inducing transient language disruptions while mapping Broca's area. Despite the promising data of only a few studies in which speech arrest and language disturbances have been induced, certain concerns have been raised. The purpose of this study was to map Broca's area by using event-related navigated transcranial magnetic stimulation (nTMS) to generate a modified patterned nTMS protocol. METHODS: Eleven right-handed subjects underwent nTMS to Broca's area while engaged in a visual object-naming task...
May 2014: Journal of Neurosurgery
Sedat Ulkatan, Milton Waner, Beatriz Arranz-Arranz, Inanna Weiss, Theresa M J O, Mehra Saral, Vedran Deletis, Alejandro Berenstein
OBJECTIVE: To develop a more reliable methodology for monitoring the facial nerve in surgeries of vascular malformations where the extracranial segment of the nerve is at risk. METHODS: Our methodology comprises: (1) preoperative mapping to identify the anatomical location of the nerve branches, (2) continuous intraoperative monitoring of the compound muscle action potential (CMAP) by stimulating the facial nerve extracranially, in close proximity to where the trunk of the facial nerve exits the skull at the stylomastoid foramen, (3) intraoperative mapping to identify the nerve branches during surgical dissection and quantify the innervating contribution of each branch to the target muscle...
April 2014: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Thomas Picht, Sandro M Krieg, Nico Sollmann, Judith Rösler, Birat Niraula, Tuomas Neuvonen, Petri Savolainen, Pantelis Lioumis, Jyrki P Mäkelä, Vedran Deletis, Bernhard Meyer, Peter Vajkoczy, Florian Ringel
BACKGROUND: Navigated transcranial magnetic stimulation (nTMS) is increasingly used in presurgical brain mapping. Preoperative nTMS results correlate well with direct cortical stimulation (DCS) data in the identification of the primary motor cortex. Repetitive nTMS can also be used for mapping of speech-sensitive cortical areas. OBJECTIVE: The current cohort study compares the safety and effectiveness of preoperative nTMS with DCS mapping during awake surgery for the identification of language areas in patients with left-sided cerebral lesions...
May 2013: Neurosurgery
Maja Rogić, Ana Jerončić, Marija Bošnjak, Ana Sedlar, Darko Hren, Vedran Deletis
The aim of the present study was to provide normative data for the Croatian language using 346 visually presented objects (Cycowicz, Friedman, Rothstein, & Snodgrass Journal of Experimental Child Psychology 65:171-237, 1997; Roach, Schwartz, Martin, Grewal, & Brecher Clinical Aphasiology 24:121-133, 1996; Snodgrass & Vanderwart Journal of Experimental Psychology: Human Learning and Memory 6:174-215, 1980). Picture naming was standardized according to seven variables: naming latency, name agreement, familiarity, visual complexity, word length, number of syllables, and word frequency...
December 2013: Behavior Research Methods
M J Malcharek, S Ulkatan, V Marinò, M Geyer, E Lladó-Carbó, G Perez-Fajardo, B Arranz-Arranz, J Climent, F Aloj, E Franco, L Chiacchiari, A Kulpok, A Sablotzki, G Hennig, V Deletis
OBJECTIVE: This study was to investigate the utility of motor evoked potential monitoring elicited by transcranial electrical stimulation (tcMEP) during CEA in addition to the established median nerve somatosensory evoked potentials (mSSEPs). METHODS: We retrospectively reviewed data from 600 patients undergoing CEA under general anesthesia with monitoring of mSSEPs and tcMEPs in a multicenter study. MSSEP and tcMEP parameters were recorded during internal carotid artery (ICA) cross clamping and compared with the postoperative motor outcome, demographic and patient history data...
May 2013: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
John F Morrison, Jay L Shils, Vedran Deletis, Jeffrey E Arle
No abstract text is available yet for this article.
March 2013: Clinical Neurology and Neurosurgery
Josep Espadaler, Maja Rogić, Vedran Deletis, Alba Leon, Cesar Quijada, Gerardo Conesa
OBJECTIVES: To establish a methodology for mapping of primary motor cortex (M1) for cricothyroid (CTHY) muscles in a group of healthy subjects using three-dimensional (3D) magnetic resonance imaging (MRI) navigated transcranial magnetic stimulation (nTMS). METHODS: Two independent measurements were performed. Twelve right-handed healthy subjects were included in the study. In the first measurement, mapping of the abductor pollicis brevis (APB) muscle was followed by mapping of the M1 for CTHY...
November 2012: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Philip David Bamberger, Sedat Ulkatan, Estela Lladó Carbó, Vedran Deletis, Alan I Benvenisty
The cerebral metabolic and vascular effects of intravenous norepinephrine have been shown in an animal model using somatosensory-evoked potentials (SSEPs). A case of intravenous norepinephrine resulting in a decrease in SSEP amplitude (of greater than 50%) despite no significant change in blood pressure, prior to cross-clamping during a carotid endarterectomy is presented. This finding may have implications for the use of norepinephrine in the critical care unit as well as the operating room.
December 2011: Journal of Clinical Anesthesia
I Fernández-Conejero, S Ulkatan, C Sen, V Deletis
There is evidence that primary hemifacial spasm (HFS) in the majority of patients is related to a vascular compression of the facial nerve at its root exit zone (REZ). As a consequence, the hyperexcitability of facial nerve generates spasms of the facial muscles. Microvascular decompression (MVD) of the facial nerve near its REZ has been established as an effective treatment of HFS. Intra-operative disappearance of abnormal muscle responses (lateral spread) elicited by stimulating one of the facial nerve branches has been used as a method to predict MVD effectiveness...
January 2012: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Klaus Novak, Georg Widhalm, Adauri Bueno de Camargo, Noel Perin, George Jallo, Engelbert Knosp, Vedran Deletis
OBJECT: Thoracic idiopathic spinal cord herniation (TISCH) is a rare neurological disorder characterized by an incarceration of the spinal cord at the site of a ventral dural defect. The disorder is associated with clinical signs of progressive thoracic myelopathy. Surgery can withhold the natural clinical course, but surgical repair of the dural defect bears a significant risk of additional postoperative motor deficits, including permanent paraplegia. Intraoperative online information about the functional integrity of the spinal cord and warning signs about acute functional impairment of motor pathways could contribute to a lower risk of permanent postoperative motor deficit...
February 2012: Journal of Neurosurgery. Spine
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