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Multimodal neuromonitoring

Brittany Staarmann, Kelly O'Neal, Mark Magner, Mario Zuccarello
BACKGROUND: Patients who undergo clipping of cerebral aneurysms face inherent risk for new postoperative neurological deficits. Intraoperative neuromonitoring (IONM) is used often for early detection of ischemic changes, while still potentially reversible. However, the value, safety, and efficacy of temporary clipping and multimodal intraoperative neuromonitoring (IONM) to minimize risks are debated. Our retrospective series examined the sensitivity and specificity of IONM using transcranial motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs), and quantified the safety of temporary clipping by duration and vascular territory...
January 12, 2017: World Neurosurgery
Yuguang Chen, Baoqing P Wang, Junlin Yang, Yaolong Deng
INTRODUCTION: Intraoperative neurophysiological monitoring (IONM) has proven to help reduce the probability of postoperative neurological deficit for spinal deformity correctional surgeries. However, in rare cases new deficits may still happen. We report a surgical case in which the patient had postoperative paralysis. We would like to call for more case reports with postoperative neurological deficits as they present difficult clinical cases. PRESENTATION OF CASE: A 61-year-old male patient with severe thoracolumbar kyphoscoliosis underwent posterior spinal correction and fusion with segmental T10-L5 pedicle screws and rods instrumentation with IONM...
November 19, 2016: International Journal of Surgery Case Reports
Eduardo N Novais, Travis Heare, Lauryn Kestel, Patricia Oliver, Willy Boucharel, Jason Koerner, Kim Strupp
PURPOSE: Sciatic nerve palsy after periacetabular osteotomy (PAO) is a serious complication. The purpose of this study was to determine whether a multimodal sciatic monitoring technique allows for identification of surgical steps that place the sciatic nerve at risk. METHODS: Transcranial electrical motor evoked potentials (TcMEPs), somatosensory evoked potentials (SSEPs), and spontaneous electromyography (EMG) were monitored in a consecutive series of 34 patients (40 hips) who underwent PAO for the treatment of symptomatic hip dysplasia between January 2012 and November 2014...
January 11, 2017: International Orthopaedics
Luisa Vinciguerra, Julian Bösel
Noninvasive neuromonitoring is increasingly being used to monitor the course of primary brain injury and limit secondary brain damage of patients in the neurocritical care unit. Proposed advantages over invasive neuromonitoring methods include a lower risk of infection and bleeding, no need for surgical installation, mobility and portability of some devices, and safety. The question, however, is whether noninvasive neuromonitoring is practical and trustworthy enough already. We searched the recent literature and reviewed English-language studies on noninvasive neuromonitoring in subarachnoid hemorrhage, traumatic brain injury, and ischemic and hemorrhagic stroke between the years 2010 and 2015...
December 21, 2016: Neurocritical Care
Arnab Ghosh, David Highton, Christina Kolyva, Ilias Tachtsidis, Clare E Elwell, Martin Smith
Acute brain injury is associated with depressed aerobic metabolism. Below a critical mitochondrial pO2 cytochrome c oxidase, the terminal electron acceptor in the mitochondrial respiratory chain, fails to sustain oxidative phosphorylation. After acute brain injury, this ischaemic threshold might be shifted into apparently normal levels of tissue oxygenation. We investigated the oxygen dependency of aerobic metabolism in 16 acutely brain-injured patients using a 120-min normobaric hyperoxia challenge in the acute phase (24-72 h) post-injury and multimodal neuromonitoring, including transcranial Doppler ultrasound-measured cerebral blood flow velocity, cerebral microdialysis-derived lactate-pyruvate ratio (LPR), brain tissue pO2 (pbrO2), and tissue oxygenation index and cytochrome c oxidase oxidation state (oxCCO) measured using broadband spectroscopy...
November 11, 2016: Journal of Cerebral Blood Flow and Metabolism
Kanokwan Limnuson, Raj K Narayan, Amrit Chiluwal, Eugene V Golanov, Chad E Bouton, Chunyan Li
Multimodal monitoring of brain activity, physiology, and neurochemistry is an important approach to gain insight into brain function, modulation, and pathology. With recent progress in micro- and nanotechnology, micro-nano-implants have become important catalysts in advancing brain research. However, to date, only a limited number of brain parameters have been measured simultaneously in awake animals in spite of significant recent progress in sensor technology. Here we have provided a cost and time effective approach to designing a headstage to conduct a multimodality brain monitoring in freely moving animals...
2016: Frontiers in Neuroscience
Fernando Mendes Paschoal, Ricardo Carvalho Nogueira, Karla De Almeida Lins Ronconi, Marcelo de Lima Oliveira, Manoel Jacobsen Teixeira, Edson Bor-Seng-Shu
Acute liver failure, also known as fulminant hepatic failure (FHF), embraces a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction, and hepatic encephalopathy. Cerebral edema and intracranial hypertension are common causes of mortality in patients with FHF. The management of patients who present acute liver failure starts with determining the cause and an initial evaluation of prognosis. Regardless of whether or not patients are listed for liver transplantation, they should still be monitored for recovery, death, or transplantation...
August 8, 2016: World Journal of Hepatology
Matthew A Kirkman, Martin Smith
A mismatch between cerebral oxygen supply and demand can lead to cerebral hypoxia/ischemia and deleterious outcomes. Cerebral oxygenation monitoring is an important aspect of multimodality neuromonitoring. It is increasingly deployed whenever intracranial pressure monitoring is indicated. Although there is a large body of evidence demonstrating an association between cerebral hypoxia/ischemia and poor outcomes, it remains to be determined whether restoring cerebral oxygenation leads to improved outcomes. Randomized prospective studies are required to address uncertainties about cerebral oxygenation monitoring and management...
September 2016: Anesthesiology Clinics
Matthew A Kirkman, Martin Smith
The monitoring of systemic and central nervous system physiology is central to the management of patients with neurologic disease in the perioperative and critical care settings. There exists a range of invasive and noninvasive and global and regional monitors of cerebral hemodynamics, oxygenation, metabolism, and electrophysiology that can be used to guide treatment decisions after acute brain injury. With mounting evidence that a single neuromonitor cannot comprehensively detect all instances of cerebral compromise, multimodal neuromonitoring allows an individualized approach to patient management based on monitored physiologic variables rather than a generic one-size-fits-all approach targeting predetermined and often empirical thresholds...
September 2016: Anesthesiology Clinics
S A Abudeev, K A Popugaev, N M Kruglyakov, K A Belousova, D A Terekhov, K Yu Leushin, M S Aronov, O V Karpova, A V Zelenkov, K V Kiselev, A B Fedin, M V Zabelin, A S Samoylov
Aneurysmal subarachnoid hemorrhage is a serious medical and social problem. The main physiological mechanisms that determine secondary brain damage in this patients are intracranial hypertension, cerebral vasospasm, dysfunction of autoregulation mechanisms, violation of liquorodynamics and delayed cerebral ischemia. The multimodal neuromonitoring for prevention and timely correction ofsecondary brain injury factors has become routine practice in neuroICU. Measurement of oxygen tension in the brain parenchyma is one of neuromonitoring options...
March 2016: Anesteziologiia i Reanimatologiia
Laura B Ngwenya, John F Burke, Geoffrey T Manley
Traumatic brain injury is a problem that affects millions of Americans yearly and for which there is no definitive treatment that improves outcome. Continuous brain tissue oxygen (PbtO2 ) monitoring is a complement to traditional brain monitoring techniques, such as intracranial pressure and cerebral perfusion pressure. PbtO2 monitoring has not yet become a clinical standard of care, due to several unresolved questions. In this review, we discuss the rationale and technology of PbtO2 monitoring. We review the literature, both historic and current, and show that continuous PbtO2 monitoring is feasible and useful in patient management...
September 2016: Respiratory Care
Matthew Pease, Gurpreet Surinder Gandhoke, Jaspreet Kaur, Parthasarthy Thirumala, Jeffrey Balzer, Donald Crammond, David O Okonkwo, Adam S Kanter
INTRODUCTION: A single-center study to define the sensitivity and specificity of intraoperative neurophysiological monitoring in detecting new neurological deficits. METHODS: A cohort of 4989 consecutive (2962 male and 2027 female) patients operated on over 3 years was evaluated. Subgroup analysis was performed for patients undergoing posterior cervical intervention (n = 1373) and posterior lumbar fusion surgery (n = 2420). Sensitivity and specificity were determined using Bayesian techniques...
August 2016: Neurosurgery
John Frederick Burke, Junichi Ohya, Todd Douglas Vogel, Michael Virk, Dean Chou, Praveen V Mummaneni
INTRODUCTION: The utility multimodality intraoperative neuromonitoring (IONM) to predict postoperative neural deficits following cervical laminoplasty remains unclear. The purpose of this study is to determine whether multimodality IONM can predict postoperative C5 palsy. METHODS: We retrospectively reviewed 131 consecutive patients with cervical myelopathy who underwent open door laminoplasty utilizing motor evoked potential (MEP) monitoring combined with somatosensory-evoked potentials (SSEP) and free-running electromyography (EMG)...
August 2016: Neurosurgery
Remi M Ajiboye, Stephen D Zoller, Akshay Sharma, Gina M Mosich, Austin Drysch, Jesse Li, Tara Reza, Sina Pourtaheri
STUDY DESIGN: Systematic review and meta-analysis OBJECTIVE.: The goal of this study was to 1). Assess the risk of neurological injury following anterior cervical spine surgery (ACSS) with and without intraoperative neuromonitoring (ION) and 2). Evaluate differences in the sensitivity and specificity of ION for ACSS. SUMMARY OF BACKGROUND DATA: Although ION is used to detect impending neurological injuries in deformity surgery, its utility in ACSS remains controversial...
July 7, 2016: Spine
Jens P Dreier, Martin Fabricius, Cenk Ayata, Oliver W Sakowitz, C William Shuttleworth, Christian Dohmen, Rudolf Graf, Peter Vajkoczy, Raimund Helbok, Michiyasu Suzuki, Alois J Schiefecker, Sebastian Major, Maren Kl Winkler, Eun-Jeung Kang, Denny Milakara, Ana I Oliveira-Ferreira, Clemens Reiffurth, Gajanan S Revankar, Kazutaka Sugimoto, Nora F Dengler, Nils Hecht, Brandon Foreman, Bart Feyen, Daniel Kondziella, Christian K Friberg, Henning Piilgaard, Eric S Rosenthal, M Brandon Westover, Anna Maslarova, Edgar Santos, Daniel Hertle, Renán Sánchez-Porras, Sharon L Jewell, Baptiste Balança, Johannes Platz, Jason M Hinzman, Janos Lückl, Karl Schoknecht, Michael Schöll, Christoph Drenckhahn, Delphine Feuerstein, Nina Eriksen, Viktor Horst, Julia S Bretz, Paul Jahnke, Michael Scheel, Georg Bohner, Egill Rostrup, Bente Pakkenberg, Uwe Heinemann, Jan Claassen, Andrew P Carlson, Christina M Kowoll, Svetlana Lublinsky, Yoash Chassidim, Ilan Shelef, Alon Friedman, Gerrit Brinker, Michael Reiner, Sergei A Kirov, R David Andrew, Eszter Farkas, Erdem Güresir, Hartmut Vatter, Lee S Chung, K C Brennan, Thomas Lieutaud, Stephane Marinesco, Andrew Ir Maas, Juan Sahuquillo, Markus A Dahlem, Frank Richter, Oscar Herreras, Martyn G Boutelle, David O Okonkwo, M Ross Bullock, Otto W Witte, Peter Martus, Arn Mjm van den Maagdenberg, Michel D Ferrari, Rick M Dijkhuizen, Lori A Shutter, Norberto Andaluz, André P Schulte, Brian MacVicar, Tomas Watanabe, Johannes Woitzik, Martin Lauritzen, Anthony J Strong, Jed A Hartings
Spreading depolarizations (SD) are waves of abrupt, near-complete breakdown of neuronal transmembrane ion gradients, are the largest possible pathophysiologic disruption of viable cerebral gray matter, and are a crucial mechanism of lesion development. Spreading depolarizations are increasingly recorded during multimodal neuromonitoring in neurocritical care as a causal biomarker providing a diagnostic summary measure of metabolic failure and excitotoxic injury. Focal ischemia causes spreading depolarization within minutes...
June 17, 2016: Journal of Cerebral Blood Flow and Metabolism
Harminder Singh, Richard W Vogel, Robert M Lober, Adam T Doan, Craig I Matsumoto, Tyler J Kenning, James J Evans
Intraoperative neurophysiological monitoring during endoscopic, endonasal approaches to the skull base is both feasible and safe. Numerous reports have recently emerged from the literature evaluating the efficacy of different neuromonitoring tests during endonasal procedures, making them relatively well-studied. The authors report on a comprehensive, multimodality approach to monitoring the functional integrity of at risk nervous system structures, including the cerebral cortex, brainstem, cranial nerves, corticospinal tract, corticobulbar tract, and the thalamocortical somatosensory system during endonasal surgery of the skull base...
2016: Scientifica
J B Kuramatsu, H B Huttner, S Schwab
In Germany dedicated neurological-neurosurgical critical care (NCC) is the fastest growing specialty and one of the five big disciplines integrated within the German critical care society (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin; DIVI). High-quality investigations based on resilient evidence have underlined the need for technical advances, timely optimization of therapeutic procedures, and multidisciplinary team-work to treat those critically ill patients. This evolution has repeatedly raised questions, whether NCC-units should be run independently or better be incorporated within multidisciplinary critical care units, whether treatment variations exist that impact clinical outcome, and whether nowadays NCC-units can operate cost-efficiently? Stroke is the most frequent disease entity treated on NCC-units, one of the most common causes of death in Germany leading to a great socio-economic burden due to long-term disabled patients...
June 2016: Der Nervenarzt
Primoz Gradisek, Simon Dolenc
PRIMARY OBJECTIVE: To assess the unusual use of a volatile anaesthetic for treatment of life-threatening bronchospasm in a patient with traumatic brain injury (TBI). RESEARCH DESIGN: Case report. METHODS AND PROCEDURES: This study presents a previously healthy 30-year-old man with severe TBI and bronchospasm-induced acute hypercapnia. He was treated with inhaled isoflurane in combination with monitoring of intracranial pressure (ICP) and regional cerebral blood flow (rCBF)...
2016: Brain Injury: [BI]
Mario Kofler, Alois Schiefecker, Ronny Beer, Florian Sohm, Gregor Broessner, Paul Rhomberg, Peter Lackner, Bettina Pfausler, Claudius Thomé, Erich Schmutzhard, Raimund Helbok
INTRODUCTION: Viral encephalitis is an emerging disease requiring intensive care management in severe cases. Underlying pathophysiologic mechanisms are incompletely understood and may be elucidated using invasive multimodal neuromonitoring techniques in humans. METHODS: Two otherwise healthy patients were admitted to our neurological intensive care unit with altered level of consciousness necessitating mechanical ventilation. Brain imaging and laboratory workup suggested viral encephalitis in both patients...
October 2016: Neurocritical Care
Maren Kl Winkler, Nora Dengler, Nils Hecht, Jed A Hartings, Eun J Kang, Sebastian Major, Peter Martus, Peter Vajkoczy, Johannes Woitzik, Jens P Dreier
Multimodal neuromonitoring in neurocritical care increasingly includes electrocorticography to measure epileptic events and spreading depolarizations. Spreading depolarization causes spreading depression of activity (=isoelectricity) in electrically active tissue. If the depression is long-lasting, further spreading depolarizations occur in still isoelectric tissue where no activity can be suppressed. Such spreading depolarizations are termed isoelectric and are assumed to indicate energy compromise. However, experimental and clinical recordings suggest that long-lasting spreading depolarization-induced depression and isoelectric spreading depolarizations are often recorded outside of the actual ischemic zones, allowing the remote diagnosis of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage...
March 29, 2016: Journal of Cerebral Blood Flow and Metabolism
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