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Multimodal neuromonitoring

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https://www.readbyqxmd.com/read/29875115/multimodal-neuromonitoring-in-neurocritical-care
#1
Sarah H Peacock, Amanda D Tomlinson
Neuromonitoring is important for patients with acute brain injury. The bedside neurologic examination is standard for neurologic monitoring; however, a clinical examination may not reliably detect subtle changes in intracranial physiology. Changes found during neurologic examinations are often late signs. The assessment of multiple physiological variables in real time can provide new clinical insights into treatment decisions. No single monitoring modality is ideal for all patients. Simultaneous assessment of cerebral hemodynamics, oxygenation, and metabolism, such as in multimodal monitoring, allows an innovative approach to individualized patient care...
2018: AACN Advanced Critical Care
https://www.readbyqxmd.com/read/29859358/how-i-do-it-technical-note-adjustable-and-rigid-fixation-of-brain-tissue-oxygenation-probe-licox-in-neurosurgery-from-bench-to-bedside
#2
Daniel Pinggera, Ondra Petr, Gabriel Putzer, Claudius Thomé
Multimodal neuromonitoring has become a fundamental part of management for many neurosurgical disorders such as subarachnoid hemorrhage and severe traumatic brain injury. Obviously, brain tissue oxygen tension monitoring requires insertion of a probe into the brain parenchyma through a single multiple lumen bolt, or in a subcutaneously tunneled fashion. As those patients often require early magnetic resonance imaging(MRI), typically used bolts are disadvantageous due to massive metal artifact. Similarly, subcutaneous tunneling is often problematic as suture fixation can loosen over time...
May 30, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29790979/petrosal-meningiomas-factors-affecting-outcome-and-the-role-of-intraoperative-multimodal-assistance-to-microsurgery
#3
Francesco Tomasello, Filippo Flavio Angileri, Alfredo Conti, Antonino Scibilia, Salvatore Cardali, Domenico La Torre, Antonino Germanò
BACKGROUND: Petrous meningiomas (PMs) represent a subset of posterior fossa tumors accounting for ∼8% of all intracranial meningiomas. Surgical treatment of PMs is challenging because of their relationships with vital neurovascular structures of the cerebellopontine angle. OBJECTIVE: To investigate independent pre- and intraoperative predictors of PM surgery outcome. METHODS: We reviewed the surgical and outcome data of patients who underwent microsurgical resection of PMs from 1997 to 2016...
May 22, 2018: Neurosurgery
https://www.readbyqxmd.com/read/29679696/effect-of-neuromonitor-guided-titrated-care-on-brain-tissue-hypoxia-after-opioid-overdose-cardiac-arrest
#4
Jonathan Elmer, Katharyn L Flickinger, Maighdlin W Anderson, Allison C Koller, Matthew L Sundermann, Cameron Dezfulian, David O Okonkwo, Lori A Shutter, David D Salcido, Clifton W Callaway, James J Menegazzi
INTRODUCTION: Brain tissue hypoxia may contribute to preventable secondary brain injury after cardiac arrest. We developed a porcine model of opioid overdose cardiac arrest and post-arrest care including invasive, multimodal neurological monitoring of regional brain physiology. We hypothesized brain tissue hypoxia is common with usual post-arrest care and can be prevented by modifying mean arterial pressure (MAP) and arterial oxygen concentration (PaO2 ). METHODS: We induced opioid overdose and cardiac arrest in sixteen swine, attempted resuscitation after 9 min of apnea, and randomized resuscitated animals to three alternating 6-h blocks of standard or titrated care...
April 18, 2018: Resuscitation
https://www.readbyqxmd.com/read/29579815/utility-of-transcranial-doppler-in-the-coordination-of-transplants-10-years-of-experience
#5
A Cacciatori, M Godino, R Mizraji
Transcranial Doppler (TCD) integrated to multimodal neuromonitoring of neurocritical patients is a useful tool in the clinical follow-up. A retrospective and descriptive study of 194 patients who were admitted into the intensive care unit (ICU) was carried out from December 2007 to February 2017. We analyzed the distribution of study frequencies with respect to the pathologies that motivated them, the characteristics of patients who evolved to brain death (BD), and most frequent patterns of cerebral circulatory arrest...
March 2018: Transplantation Proceedings
https://www.readbyqxmd.com/read/29541487/pbto-2-monitoring-in-normobaric-hyperoxia-targeted-therapy-in-acute-subarachnoidal-hemorrhage
#6
Vasilije Stambolija, Martina Miklić Bublić, Marin Lozić, Jakob Nemir, Miroslav Ščap
Background: Low brain tissue oxygen tension (PbtO2 ), or brain hypoxia, is an independent predictor of poor outcome. Increasing inspirational fraction of oxygen could have a significant influence on treating lower PbtO2 . Combined PbtO2 therapy, compared to the approach that focus only on regulation of cerebral perfusion pressure and intracranial pressure, shows better patient outcomes. Monitoring of PbtO2 could be helpful in individualizing treatment, preventing or limiting secondary brain injury, and maintaining better patient outcome...
2018: Surgical Neurology International
https://www.readbyqxmd.com/read/29536115/-technique-and-advantages-of-multimodal-intraoperative-neuromonitoring-for-complex-spinal-interventions-in-older-patients
#7
REVIEW
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...
April 2018: Der Orthopäde
https://www.readbyqxmd.com/read/29485961/cerebral-function-and-perfusion-during-cardiopulmonary-bypass-a-plea-for-a-multimodal-monitoring-approach
#8
Marcus Thudium, Ingo Heinze, Richard K Ellerkmann, Tobias Hilbert
BACKGROUND: Postoperative neurological injury still represents a major cause of morbidity after cardiac surgery. Our objective was to compare the limits as well as advantages of routine monitoring tools for the detection of cerebral function and perfusion deficits during cardiopulmonary bypass in a daily clinical setting. METHODS: Adult patients undergoing elective cardiac surgery with use of cardiopulmonary bypass were included. Patients received monitoring comprising Bispectral Index (BIS), Near Infrared Spectroscopy (NIRS) and assessment of middle cerebral artery flow velocity (MCAV) using transcranial Doppler (TCD) sonography...
January 31, 2018: Heart Surgery Forum
https://www.readbyqxmd.com/read/29463290/transcranial-doppler-combined-with-quantitative-eeg-brain-function-monitoring-and-outcome-prediction-in-patients-with-severe-acute-intracerebral-hemorrhage
#9
Ying Chen, Weihai Xu, Lijuan Wang, Xiaoming Yin, Jie Cao, Fang Deng, Yingqi Xing, Jiachun Feng
BACKGROUND: Neurological deterioration after intracerebral hemorrhage (ICH) is thought to be closely related to increased intracranial pressure (ICP), decreased cerebral blood flow (CBF), and brain metabolism. Transcranial Doppler (TCD) is increasingly used as an indirect measure of ICP, and quantitative EEG (QEEG) can reflect the coupling of CBF and metabolism. We aimed to combine TCD and QEEG to comprehensively assess brain function after ICH and provide prognostic diagnosis. METHODS: We prospectively enrolled patients with severe acute supratentorial (SAS)-ICH from June 2015 to December 2016...
February 20, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29456917/neuromonitoring-in-spinal-deformity-surgery-a-multimodality-approach
#10
REVIEW
Joseph L Laratta, Alex Ha, Jamal N Shillingford, Melvin C Makhni, Joseph M Lombardi, Earl Thuet, Ronald A Lehman, Lawrence G Lenke
Study Design: Literature review. Objective: The aim of this study was to provide an overview of the available intraoperative monitoring techniques and the evidence around their efficacy in vertebral column resection. Methods: The history of neuromonitoring and evolution of the modalities are reviewed and discussed. The authors' specific surgical techniques and preferred methods are outlined in detail. In addition, the authors' experience and the literature regarding vertebral column resection and surgical mitigation of neurologic alarms are discussed at length...
February 2018: Global Spine Journal
https://www.readbyqxmd.com/read/29455690/effect-of-cerebral-perfusion-pressure-on-acute-respiratory-distress-syndrome
#11
Sonny Thiara, Donald E Griesdale, William R Henderson, Mypinder S Sekhon
BACKGROUND: Increased cerebral perfusion pressure (CPP)>70 mmHg has been associated with acute respiratory distress syndrome (ARDS) after traumatic brain injury (TBI). Since this reported association, significant changes in ventilation strategies and fluid management have been accepted as routine critical care. Recently, individualized perfusion targets using autoregulation monitoring suggest CPP titration>70 mmHg. Given these clinical advances, the association between ARDS and increased CPP requires further delineation...
May 2018: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/29397959/neuromonitoring-in-the-neonatal-ecmo-patient
#12
REVIEW
Nan Lin, John Flibotte, Daniel J Licht
Utilization of extraocorporeal membrane oxygenation (ECMO) has become increasingly widespread as a bridging therapy for neonates with severe, reversible respiratory or cardiac diseases. While significant risks remain, due to advances in medical and surgical management, overall mortality has decreased. However, short and long-term neurological morbidity has remained high. Therefore, increasing attention has been focused on multimodal neuromonitoring to track and optimally, minimize or prevent intracranial injury...
March 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/29372857/early-experience-of-placing-image-guided-minimally-invasive-pedicle-screws-without-k-wires-or-bone-anchored-trackers
#13
Gregory M Malham, Rhiannon M Parker
OBJECTIVE Image guidance for spine surgery has been reported to improve the accuracy of pedicle screw placement and reduce revision rates and radiation exposure. Current navigation and robot-assisted techniques for percutaneous screws rely on bone-anchored trackers and Kirchner wires (K-wires). There is a paucity of published data regarding the placement of image-guided percutaneous screws without K-wires. A new skin-adhesive stereotactic patient tracker (SpineMask) eliminates both an invasive bone-anchored tracker and K-wires for pedicle screw placement...
April 2018: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/29236604/intraoperative-neuromonitoring-alarms-relationship-of-the-surgeon-s-decision-to-intervene-or-not-and-clinical-outcomes-in-a-subset-of-spinal-surgical-patients-with-a-new-postoperative-neurological-deficit
#14
Arvydas Tamkus, Kent S Rice, Howard L Kim
BACKGROUND: The goal of intraoperative neurophysiologic monitoring (IONM) is to minimize neurologic injury during surgery, yet patients still emerge with postoperative deficits. Few studies focus on outcomes relative to IONM alarms and interventions in this population. The authors sought to analyze the influence of IONM alarms with and without surgical intervention on patient outcome in spinal surgical patients who suffered immediate postoperative neurologic deficits. METHODS: Of 62,038 spinal surgeries with multimodality IONM, 90 patients with new or worsened postoperative neurologic deficits and whose outcomes were reported immediate to the surgery and at discharge were analyzed...
2017: Neurodiagnostic Journal
https://www.readbyqxmd.com/read/29088949/unraveling-the-complexities-of-invasive-multimodality-neuromonitoring
#15
Saurabh Sinha, Eric Hudgins, James Schuster, Ramani Balu
Acute brain injuries are a major cause of death and disability worldwide. Survivors of life-threatening brain injury often face a lifetime of dependent care, and novel approaches that improve outcome are sorely needed. A delayed cascade of brain damage, termed secondary injury, occurs hours to days and even weeks after the initial insult. This delayed phase of injury provides a crucial window for therapeutic interventions that could limit brain damage and improve outcome. A major barrier in the ability to prevent and treat secondary injury is that physicians are often unable to target therapies to patients' unique cerebral physiological disruptions...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28965444/intraoperative-neuromonitoring-alerts-in-a-pediatric-deformity-center
#16
Maria Zuccaro, James Zuccaro, Amer F Samdani, Joshua M Pahys, Steven W Hwang
OBJECTIVE Intraoperative neuromonitoring (IONM) involves the use of somatosensory evoked potentials (SSEPs) and transcranial electric motor evoked potentials (TceMEPs). In this retrospective study the authors examined the sensitivity and specificity of both SSEPs and TceMEPs during pediatric spinal deformity surgeries. METHODS The authors performed a retrospective quantitative analysis of data obtained in 806 patients (197 males and 609 females) treated from December 2011 until October 2015. All patients were diagnosed with scoliosis that was classified as one of the following: adolescent idiopathic scoliosis (AIS) (38%), congenital scoliosis (22%), or syndromic scoliosis (40%)...
October 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28958609/the-importance-of-bilateral-monitoring-of-cerebral-oxygenation-nirs-clinical-case-of-asymmetry-during-cardiopulmonary-bypass-secondary-to-previous-cerebral-infarction
#17
S Matcan, P Sanabria Carretero, M Gómez Rojo, L Castro Parga, F Reinoso-Barbero
Cerebral oximetry based on near infrared spectroscopy (NIRS) technology is used to determine cerebral tissue oxygenation. We hereby present the clinical case of a 12-month old child with right hemiparesis secondary to prior left middle cerebral artery stroke 8 months ago. The child underwent surgical enlargement of the right ventricular outflow tract (RVOT) with cardiopulmonary bypass. During cardiopulmonary bypass, asymmetric NIRS results were detected between both hemispheres. The utilization of multimodal neuromonitoring (NIRS-BIS) allowed acting on both perfusion pressure and anesthetic depth to balance out the supply and demand of cerebral oxygen consumption...
March 2018: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/28938340/paediatric-traumatic-brain-injury-prognostic-insights-and-outlooks
#18
REVIEW
Alicia K Au, Robert S B Clark
PURPOSE OF REVIEW: Traumatic brain injury (TBI) is a leading cause of death and disability in children. Prognostication of outcome following TBI is challenging in this population and likely requires complex, multimodal models to achieve clinically relevant accuracy. This review highlights injury characteristics, physiological indicators, biomarkers and neuromonitoring modalities predictive of outcome that may be integrated for future development of sensitive and specific prognostic models...
December 2017: Current Opinion in Neurology
https://www.readbyqxmd.com/read/28938277/multimodality-neuromonitoring-in-adult-traumatic-brain-injury-a-narrative-review
#19
Martin Smith
Neuromonitoring plays an important role in the management of traumatic brain injury. Simultaneous assessment of cerebral hemodynamics, oxygenation, and metabolism allows an individualized approach to patient management in which therapeutic interventions intended to prevent or minimize secondary brain injury are guided by monitored changes in physiologic variables rather than generic thresholds. This narrative review describes various neuromonitoring techniques that can be used to guide the management of patients with traumatic brain injury and examines the latest evidence and expert consensus guidelines for neuromonitoring...
February 2018: Anesthesiology
https://www.readbyqxmd.com/read/28805756/-an-experience-of-neurophysiological-monitoring-in-neurosurgery
#20
A G Vasyatkina, E A Levin, K Yu Orlov, V V Kobozev
AIM: To evaluate the efficacy of neuromonitoring methods in prevention of postoperative neurological complications and estimation of predictive power of intraoperative changes in monitored characteristics. MATERIAL AND METHODS: Retrospective study examined 240 patients, operated in the years 2014-2015 using intraoperative neurophysiological monitoring. One hundred and seventy-three patients suffered from hemispheric lesions and 67 had lesions located in or near the brainstem...
2017: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
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