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Neurophysiology intraoperative monitoring

Saleem I Abdulrauf, Peter Vuong, Ritesh Patel, Raghu Sampath, Ahmed M Ashour, Lauren M Germany, Jonathon Lebovitz, Colt Brunson, Yuvraj Nijjar, J Kyle Dryden, Maheen Q Khan, Mihaela G Stefan, Evan Wiley, Ryan T Cleary, Connor Reis, Jodi Walsh, Paula Buchanan
OBJECTIVE Risk of ischemia during aneurysm surgery is significantly related to temporary clipping time and final clipping that might incorporate a perforator. In this study, the authors attempted to assess the potential added benefit to patient outcomes of "awake" neurological testing when compared with standard neurophysiological testing performed under general anesthesia. The procedure is performed after the induction of conscious sedation, and for the neurological testing, the patient is fully awake. METHODS The authors conducted an institutional review board-approved prospective study of clipping unruptured intracranial aneurysms (UIAs) in 30 consecutive adult patients who underwent awake clipping...
October 21, 2016: Journal of Neurosurgery
Faisal R Jahangiri, Sami Al Eissa, Samir Sayegh, Fahad Al Helal, Shomoukh A Al-Sharif, Monerah M Annaim, Sheryar Muhammad, Tanweer Aziz
A 16-year-old male patient with Ehler-Danlos syndrome (EDS) and a back deformity since birth presented with severe kyphoscoliosis. The patient was neurologically intact but had respiratory and cardiac insufficiencies. A two-stage vertebral column resection (VCR) at T9-T10 with multiple level fusion with multimodality intraoperative neurophysiological monitoring (IONM) was planned.  During the first stage, pedicle screws were placed at multiple spinal levels above and below the VCR level. Upper and lower somatosensory evoked potentials (SSEP), transcranial electrical motor evoked potentials (TCeMEP), and electromyography were monitored continuously and showed no significant changes...
August 31, 2016: Curēus
Michael Pickell, Stephen M Mann, Rajesh Chakravertty, Daniel P Borschneck
BACKGROUND: This is a prospective observational study examining the use of a surgeon-driven intraoperative neurophysiologic monitoring system. Intraoperative neurophysiologic monitoring is becoming the standard of care for spinal surgeries with potential post-operative neurologic deficits. This standard applies to both adult and pediatric spinal surgery, but a shortage of appropriately trained and certified technologists and physiologists can compromise monitoring capabilities in some centers...
September 2016: J Spine Surg
Siavash S Haghighi, Donald J Blaskiewicz, Bertha Ramirez, Richard Zhang
BACKGROUND: C5 nerve root palsy is a known complication after cervical laminectomy or laminoplasty, characterized by weakness of the deltoid and bicep brachii muscles. The efficacy of intraoperative monitoring of these muscles is currently unclear. In the current prospective study, intraoperative monitoring through somatosensory (SSEPs), motor (TcMEPs) evoked potentials and real-time electromyography activity (EMG) were analyzed for their ability to detect or prevent deltoid muscle weakness after surgery...
September 2016: J Spine Surg
Barrett Cromeens, Jennifer L McKinney, Jeffrey Leonard, Lance Governale, Judy Brown, Christina Henry, Marc Levitt, Richard Wood, Gail Besner, Monica P Islam
Conjoined twins occur in up to 1 in 50,000 live births with approximately 18% joined in a pygopagus configuration at the buttocks. Twins with this configuration display symptoms and carry surgical risks during separation related to the extent of their connection which can include anorectal, genitourinary, vertebral, and neural structures. Neurophysiologic intraoperative monitoring (NIOM) for these cases has been discussed in the literature with variable utility. We present a case of pygopagus twins with fused spinal cords and imperforate anus where the use of NIOM significantly impacted surgical decision making in division of these critical structures...
October 1, 2016: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Ahmad Jabir Rahyussalim, Ifran Saleh, M Fajrin Armin, Tri Kurniawati, Ahmad Yanuar Safri
INTRODUCTION: Intraoperative neurophysiologic monitoring (IONM) had important role related to the complications in spinal surgery. Somatosensory Evoked Potential (SSEP), Transcranial electric Muscle Evoked Potentials (tceMEPs), and free run EMG are parameters used to asses functional integrity of the nervous system during surgical procedures. Once warning signal was recognized, surgeon have to make a precise decision to overcome that problem. PRESENTATION OF CASE: We present a 47-year old male with back pain due to compression fracture of thoracic vertebra T12 and lumbar vertebrae L1...
September 23, 2016: International Journal of Surgery Case Reports
Jeffrey E Keenan, Ehsan Benrashid, Emily Kale, Alina Nicoara, Aatif M Husain, G Chad Hughes
Circulatory management during replacement of the aortic arch is complex and involves a period of circulatory arrest to provide a bloodless field during arch vessel anastomosis. To guard against ischemic brain injury, tissue metabolic demand is reduced by systemically cooling the patient prior to circulatory arrest. Neurophysiological intraoperative monitoring (NIOM) is often used during the course of these procedures to provide contemporaneous assessment of brain status to help direct circulatory management decisions and detect brain ischemia...
October 4, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
Nicolas K Khattar, Robert M Friedlander, Rabih A Chaer, Efthymios D Avgerinos, Eric S Kretz, Jeffrey R Balzer, Donald J Crammond, Miguel H Habeych, Parthasarathy D Thirumala
BACKGROUND: Carotid endarterectomy (CEA) is the procedure of choice for reducing the risk of stroke in both symptomatic and asymptomatic carotid artery stenoses. Stroke is associated with significant morbidity and mortality peri-operatively (2-3 %). Our primary aim is to evaluate the etiology of these strokes after CEA and their impact on morbidity by comparing the length of stay in the hospital. METHODS: A total of 584 patients with documented neurological status evaluations who underwent CEAs were included in the study...
September 30, 2016: Acta Neurochirurgica
Graziano Taddei, Alfonso Marrelli, Donatella Trovarelli, Alessandro Ricci, Renato J Galzio
OBJECTIVE: Even though advances in surgical techniques have improved facial nerve outcomes, functional preservation is still an issue because injury to the facial nerve has significant physical and psychological consequences for the patient. We retrospectively review our data in VS surgery to compare the facial outcome in intraoperative facial monitored versus not-monitored patients. MATERIALS AND METHODS: 51 consecutive patients with unilateral vestibular schwannoma in the period from 2005 to 2010 were treated in our Institution...
October 2016: Asian Journal of Neurosurgery
Guofang Fang, Zihai Ding, Zhihui Song
BACKGROUND: Percutaneous endoscopic lumbar discectomy (PELD) is a standard technique for the treatment of lumbar disc hernia. Thus far, most surgeons have recommended local anesthesia. However, in clinical practice, some patients experience pain and are unable to cooperate with the surgery during intervertebral foramen hemp expansion. The use of general anesthesia may create a greater risk of complications because of nerve root anomalies; thus, intraoperative neurophysiological monitoring should be utilized...
September 2016: Pain Physician
Amer F Samdani, James T Bennett, Robert J Ames, Jahangir K Asghar, Giuseppe Orlando, Joshua M Pahys, Burt Yaszay, Firoz Miyanji, Baron S Lonner, Ronald A Lehman, Peter O Newton, Patrick J Cahill, Randal R Betz
BACKGROUND: Confidence in intraoperative neurophysiologic monitoring (IONM) data can allow scoliosis surgeons to proceed with surgery even after a monitoring alert, assuming the recovery of signals. We sought to determine the outcomes of surgical treatment of adolescent idiopathic scoliosis (AIS) after a notable IONM alert. METHODS: We identified 676 patients who underwent arthrodesis with use of IONM for the treatment of AIS. The patients were divided into 2 cohorts: those who experienced a lower-extremity IONM alert and those who did not...
September 7, 2016: Journal of Bone and Joint Surgery. American Volume
Emine Taskiran, Sema Brandmeier, Erdinc Ozek, Ramazan Sari, Fatihhan Bolukbasi, Ilhan Elmaci
AIM: Intraoperative neurophysiological monitoring (IONM) monitors the functional integrity of critical neural structures by electrophysiological methods during surgery. Multimodality combines different neurophysiological methods to maximize diagnostic efficacy and provide a safety margin to improve the outcomes of spinal surgery. Our aim was to share our intraoperative monitoring experiences with patients who underwent surgery because of spinal cord pathologies between September 2013 and January 2015...
December 28, 2015: Turkish Neurosurgery
Erhan Emel, Anas Abdallah, Özden Erhan Sofuoğlu, Ali Ender Ofluoğlu, Müslüm Güneş, Betül Güler, Bilge Bilgiç
AIM: Spinal schwannomas (SS) represent the most common intradural extramedullary lesions, accounting for approximately 24% of all nerve sheath tumors in adults. In this study, long-term outcomes of 49 consecutive SS have been presented. MATERIAL AND METHODS: Medical records were retrospectively reviewed in 371 cases of spinal tumors who underwent surgery between the years 2005 and 2014. Cases which confirmed as schwannoma histopathologically were included in this study...
October 22, 2015: Turkish Neurosurgery
Jennifer C Andrews, Richard B Stein, Kelvin E Jones, Douglas M Hedden, James K Mahood, Marc J Moreau, Eric M Huang, François D Roy
OBJECTIVE: To investigate whether low intensity transcranial electrical stimulation (TES) can be used to condition post-activation depression of the H-reflex and simultaneously monitor the integrity of spinal motor pathways during spinal deformity correction surgery. METHODS: In 20 pediatric patients undergoing corrective surgery for spinal deformity, post-activation depression of the medial gastrocnemius H-reflex was initiated by delivering two pulses 50-125ms apart, and the second H-reflex was conditioned by TES...
October 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Daniel San-Juan, Manuel Escanio Cortés, Martha Tena-Suck, Adolfo Josué Orozco Garduño, Jesús Alejandro López Pizano, Jonathan Villanueva Domínguez, Maricarmen Fernández Gónzalez-Aragón, Juan Luis Gómez-Amador
This paper reports the case of a patient with optic nerve schwannoma and the first use of neurophysiological intraoperative monitoring of visual evoked potentials during the removal of such tumor with no postoperative visual damage. Schwannomas are benign neoplasms of the peripheral nervous system arising from the neural crest-derived Schwann cells, these tumors are rarely located in the optic nerve and the treatment consists on surgical removal leading to high risk of damage to the visual pathway. Case report of a thirty-year-old woman with an optic nerve schwannoma...
September 1, 2016: Journal of Clinical Monitoring and Computing
Ozlem Korkmaz Dilmen
No abstract text is available yet for this article.
September 2016: Neurosurgical Focus
Florian Roser, Florian H Ebner, Marina Liebsch, Marcos S Tatagiba, Georgios Naros
OBJECT: Suboccipital decompression and duraplasty is considered the treatment of choice for Chiari-I-malformation. Several studies have shown improvement of neurophysiological parameters during decompressive surgery in pediatric patients. However, there is no evidence of the beneficial role of intraoperative neuromonitoring in adults. METHODS: A total of 39 consecutive patients (25 female, age 41.1±14.5 years [mean±SD]) underwent suboccipital decompression for the treatment of symptomatic Chiari-I-malformation senior neurosurgeon and his team...
November 2016: Clinical Neurology and Neurosurgery
Sung-Hoon Kim, Seok-Joon Jin, Myong-Hwan Karm, Young-Jin Moon, Hye-Won Jeong, Jae-Won Kim, Seung-Il Ha, Joung-Uk Kim
Although the elicited responses of motor evoked potential (MEP) monitoring are very sensitive to suppression by anesthetic agents and muscle relaxants, the use of neuromuscular blockade (NMB) during MEP monitoring is still controversial because of serious safety concerns and diagnostic accuracy. Here, we evaluated the incidence of unacceptable movement and compared false-negative MEP results between no and partial NMB during cerebral aneurysm clipping surgery. We reviewed patient medical records for demographic data, anesthesia regimen, neurophysiology event logs, MEP results, and clinical outcomes...
August 2016: Medicine (Baltimore)
Breno José Alencar Pires Barbosa, Artemisia Dimostheni, Manoel Jacobsen Teixeira, Marcos Tatagiba, Guilherme Lepski
INTRODUCTION: In the field of Glioma surgery, there has been an increasing interest in the use of assistive technologies to overcome the difficulty of preserving brain function while improving surgical radicality. In most reports, tumor localization has seldom been considered a variable and the role of intraoperative adjuncts is yet to be determined for gliomas of the insula. OBJECTIVES: To evaluate the efficacy of fluorescence-guided resection with 5-ALA, intraoperative neurophysiological monitoring (IOM), neuronavigation, and tractography in the Extent of Resection (EOR), functionality scores, overall survival (OS) and progression-free survival (PFS) in a retrospective cohort of insular gliomas...
October 2016: Clinical Neurology and Neurosurgery
James L Stone, Julian E Bailes, Ahmed N Hassan, Brian Sindelar, Vimal Patel, John Fino
Patients with severe traumatic brain injury or large intracranial space-occupying lesions (spontaneous cerebral hemorrhage, infarction, or tumor) commonly present to the neurocritical care unit with an altered mental status. Many experience progressive stupor and coma from mass effects and transtentorial brain herniation compromising the ascending arousal (reticular activating) system. Yet, little progress has been made in the practicality of bedside, noninvasive, real-time, automated, neurophysiological brainstem, or cerebral hemispheric monitoring...
August 2, 2016: Neurocritical Care
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