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Intraoperative neurophysiological monitoring

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https://www.readbyqxmd.com/read/28089323/neurophysiological-monitoring-of-lumbar-spinal-nerve-roots-a-case-report-of-postoperative-deficit-and-literature-review
#1
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
https://www.readbyqxmd.com/read/28045855/the-interpretation-of-muscle-motor-evoked-potentials-for-spinal-cord-monitoring
#2
Karl F Kothbauer
OBJECTIVE: To provide a summary of the intraoperative monitoring of muscle motor evoked potentials (MEPs) based on the presence-absence concept during neurosurgical operations along the spinal cord. METHOD: Expert review. DISCUSSION: The measurable parameters of MEPs, such as signal amplitudes and thresholds vary considerably both during a single surgery in a single individual patient as well as between individuals and operations. The presence or absence of responses irrespective of stimulus intensity and response amplitude is much more clearly defined...
January 2017: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
https://www.readbyqxmd.com/read/28019107/gross-total-resection-rates-of-grade-ii-iii-intramedullary-ependymomas-using-the-surgical-strategy-of-en-bloc-resection-without-intra-operative-neurophysiological-monitoring
#3
Kieron J Sweeney, Matt Reynolds, Michael Farrell, Ciaran Bolger
INTRODUCTION: Grade II and III intramedullary ependymomas [IME] are circumscribed with a plane of cleavage that should facilitate high gross total resection rates (GTR). Gross total resection of grade II/III IME is superior to subtotal resection (STR) and radiotherapy (RTx) for progression-free and overall survival. We sought to compare our GTR with other series that have utilised standard intraoperative monitoring techniques and we explored factors that may influence rates of resection...
December 25, 2016: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/28017534/direct-motor-evoked-potentials-and-cortical-mapping-using-the-nim%C3%A2-nerve-monitoring-system-a-technical-note
#4
Suparna Bharadwaj, Faizal Haji, Matthew Hebb, Jason Chui
Motor evoked potentials (MEPs) are commonly used to prevent neurological injury when operating in close proximity to the motor cortex or corticospinal pathway. We report a novel application of the NIM® nerve monitoring system (Medtronic@ NIM response 3.0) for intraoperative direct cortical (dc)-MEPs monitoring. A 69-year-old female patient presented with a 4month history of progressive left hemiparesis resulting from a large right sided posterior frontal meningioma that abutted and compressed the motor cortex...
December 22, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28010998/comparison-of-multimodal-intraoperative-neurophysiological-monitoring-efficacy-in-early-childhood-and-school-aged-children-undergoing-spinal-surgery
#5
Alpaslan Şenköylü, Murat Zinnuroğlu, Alp Börçek, Erdem Aktaş, İrfan Güngör, Mehmet Beyazova
OBJECTIVE: The aim of this study was to compare the performance of multimodal intraoperative neurophysiological monitoring (MIONM) in children below and over 6 years of age. METHODS: 43 children, diagnosed with spinal pathologies were divided into two cohorts according to their age and enrolled in the study. Those under the age of 6 consisted group A, whereas those between the age of 6 and 11 consisted group B. All patients underwent spinal surgical procedures according to their diagnosis...
December 20, 2016: Acta Orthopaedica et Traumatologica Turcica
https://www.readbyqxmd.com/read/28001090/recent-technological-advances-in-pediatric-brain-tumor-surgery
#6
Bassel Zebian, Francesco Vergani, José Pedro Lavrador, Soumya Mukherjee, William John Kitchen, Vita Stagno, Christos Chamilos, Benedetta Pettorini, Conor Mallucci
X-rays and ventriculograms were the first imaging modalities used to localize intracranial lesions including brain tumors as far back as the 1880s. Subsequent advances in preoperative radiological localization included computed tomography (CT; 1971) and MRI (1977). Since then, other imaging modalities have been developed for clinical application although none as pivotal as CT and MRI. Intraoperative technological advances include the microscope, which has allowed precise surgery under magnification and improved lighting, and the endoscope, which has improved the treatment of hydrocephalus and allowed biopsy and complete resection of intraventricular, pituitary and pineal region tumors through a minimally invasive approach...
December 21, 2016: CNS Oncology
https://www.readbyqxmd.com/read/27994536/a-novel-technique-for-region-and-linguistic-specific-ntms-based-dti-fiber-tracking-of-language-pathways-in-brain-tumor-patients
#7
Giovanni Raffa, Ina Bährend, Heike Schneider, Katharina Faust, Antonino Germanò, Peter Vajkoczy, Thomas Picht
Navigated transcranial magnetic stimulation (nTMS) has recently been introduced as a non-invasive tool for functional mapping of cortical language areas prior to surgery. It correlates well with intraoperative neurophysiological monitoring (IONM) findings, allowing defining the best surgical strategy to preserve cortical language areas during surgery for language-eloquent tumors. Nevertheless, nTMS allows only for cortical mapping and postoperative language deficits are often caused by injury to subcortical language pathways...
2016: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/27982764/spinal-cord-hemangioblastomas-significance-of-intraoperative-neurophysiological-monitoring-for-resection-and-long-term-outcome
#8
Sebastian Siller, Andrea Szelényi, Lisa Herlitz, Joerg Christian Tonn, Stefan Zausinger
OBJECTIVE Spinal cord hemangioblastomas are rare benign tumors developing either sporadically or as part of von Hippel-Lindau (VHL) disease. Generally, resection is the treatment of choice. However, the significance of intraoperative neurophysiological monitoring (IONM) for resection and postoperative outcome is still controversial. The authors analyzed the surgical and clinical courses of patients who had undergone resection of spinal cord hemangioblastoma, with special attention to preoperative imaging, the use of IONM, and short- and long-term outcomes...
December 16, 2016: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/27923761/intraoperative-neurophysiological-monitoring-for-adult-patients-undergoing-posterior-spinal-fusion
#9
Nitin Agarwal, D Kojo Hamilton, Alp Ozpinar, Phillip Choi, Robert Hart, Ilker Yaylali
INTRODUCTION: Somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP) are frequently used to monitor neurological function during spinal deformity surgery. The sensitivity and specificity of intraoperative neurophysiological monitoring (IONM) in patients undergoing posterior spinal fusion (PSF) in debatable. METHODS: A retrospective review of all patients undergoing PSF with IONM from October 2008 to December 2012 was performed. Factors including gender, operative time and spinal levels of posterior fusion were analyzed as risk factors for intraoperative alerts...
December 3, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27853667/resection-of-beak-type-thoracic-ossification-of-the-posterior-longitudinal-ligament-from-a-posterior-approach-under-intraoperative-neurophysiological-monitoring-for-paralysis-after-posterior-decompression-and-fusion-surgery
#10
Shiro Imagama, Kei Ando, Zenya Ito, Kazuyoshi Kobayashi, Tetsuro Hida, Kenyu Ito, Yoshimoto Ishikawa, Mikito Tsushima, Akiyuki Matsumoto, Satoshi Tanaka, Masayoshi Morozumi, Masaaki Machino, Kyotaro Ota, Hiroaki Nakashima, Norimitsu Wakao, Yoshihiro Nishida, Yukihiro Matsuyama, Naoki Ishiguro
Study Design Prospective clinical study. Objective Posterior decompression and fusion surgery for beak-type thoracic ossification of the posterior longitudinal ligament (T-OPLL) generally has a favorable outcome. However, some patients require additional surgery for postoperative severe paralysis, a condition that is inadequately discussed in the literature. The objective of this study was to describe the efficacy of a procedure we refer to as "resection at an anterior site of the spinal cord from a posterior approach" (RASPA) for severely paralyzed patients after posterior decompression and fusion surgery for beak-type T-OPLL...
December 2016: Global Spine Journal
https://www.readbyqxmd.com/read/27803238/intraoperative-neurophysiological-monitoring-of-the-laryngeal-nerves-during-anterior-neck-surgery-a-review
#11
Anurag Tewari, Ravi N Samy, Joshua Castle, Tiffany M Frye, Miguel E Habeych, Mahmoud Mohamed
Contributions to the literature on intraoperative neuro monitoring (IONM) during endocrine and head and neck surgery have increased over recent years. Organizational support for neural monitoring during surgery is becoming evident and is increasingly recognized as an adjunct to visual nerve identification. A comprehensive understanding of the role of IONM for prevention of nerve injuries is critical to maximize safety during surgery of the anterior compartment of the neck. This review will explore the potential advantages of IONM to improve the outcomes among patients undergoing anterior neck surgery...
January 2017: Annals of Otology, Rhinology, and Laryngology
https://www.readbyqxmd.com/read/27792108/efficacy-of-intraoperative-neurophysiologic-monitoring-for-pediatric-cervical-spine-surgery
#12
Daniel G Tobert, Michael P Glotzbecker, M Timothy Hresko, Lawrence I Karlin, Mark R Proctor, John B Emans, Patricia E Miller, Daniel J Hedequist
STUDY DESIGN: Clinical case series OBJECTIVE.: To investigate the efficacy of intraoperative neuromonitoring in pediatric cervical spine surgery SUMMARY OF BACKGROUND DATA.: Intraoperative neuromonitoring (IONM) consisting of somatosensory evoked potentials (SSEP) and transcranial motor evoked potentials (tcMEP) has been shown to effectively prevent permaneny neurologic injury in deformity surgery. The role of IONM during pediatric cervical spine surgery is not well documented. Advances in cervical spine instrumentation have expanded the surgical options in pediatric populations...
October 25, 2016: Spine
https://www.readbyqxmd.com/read/27767401/-awake-clipping-of-cerebral-aneurysms-report-of-initial-series
#13
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
https://www.readbyqxmd.com/read/27766191/vertebral-column-resection-for-kyphoscoliosis-in-a-patient-with-ehlers-danlos-syndrome-an-intraoperative-neurophysiological-monitoring-alert
#14
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
https://www.readbyqxmd.com/read/27757429/surgeon-driven-neurophysiologic-monitoring-in-a-spinal-surgery-population
#15
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: Journal of Spine Surgery (Hong Kong)
https://www.readbyqxmd.com/read/27757428/can-intraoperative-neurophysiologic-monitoring-during-cervical-spine-decompression-predict-post-operative-segmental-c5-palsy
#16
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: Journal of Spine Surgery (Hong Kong)
https://www.readbyqxmd.com/read/27749617/pygopagus-conjoined-twins-a-neurophysiologic-intraoperative-monitoring-schema
#17
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
https://www.readbyqxmd.com/read/27716571/pedicle-screw-position-changing-policy-for-nerve-injury-problems-during-screw-insertion-on-thoracolumbar-compression-fractures
#18
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
https://www.readbyqxmd.com/read/27708177/neurophysiological-intraoperative-monitoring-during-aortic-arch-surgery
#19
REVIEW
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...
December 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27696001/perioperative-stroke-after-carotid-endarterectomy-etiology-and-implications
#20
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
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