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Spinal cord stimulators in the operating room

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https://www.readbyqxmd.com/read/26083137/designing-an-operating-theatre-for-awake-procedures-a-solution-to-improve-multimodality-information-input
#1
Michel Wager, Philippe Rigoard, Benoit Bataille, Claude Guenot, Aurélie Supiot, Jean-Luc Blanc, Veronique Stal, Claudette Pluchon, Coline Bouyer, Roger Gil, Foucaud Du Boisgueheneuc
OBJECTIVE: Many neurosurgical procedures are now performed with the patient aware in order to allow interactions between the patient and healthcare professionals. These procedures include awake brain surgery and spinal cord stimulation (SCS), lead placement for treatment of refractory chronic back and leg pain. Neurosurgical procedures under local anaesthesia require optimal intraoperative cooperation of the patient and all personnel involved in surgery. In addition to accommodating this extra source of intraoperative information all other necessary sources of data relevant to the procedure must be presented...
December 2015: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/24015028/intraoperative-neurophysiologic-monitoring-basic-principles-and-recent-update
#2
REVIEW
Sung-Min Kim, Seung Hyun Kim, Dae-Won Seo, Kwang-Woo Lee
The recent developments of new devices and advances in anesthesiology have greatly improved the utility and accuracy of intraoperative neurophysiological monitoring (IOM). Herein, we review the basic principles of the electrophysiological methods employed under IOM in the operating room. These include motor evoked potentials, somatosensory evoked potentials, electroencephalography, electromyography, brainstem auditory evoked potentials, and visual evoked potentials. Most of these techniques have certain limitations and their utility is still being debated...
September 2013: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/23703411/infectious-complications-related-to-intrathecal-drug-delivery-system-and-spinal-cord-stimulator-system-implantations-at-a-comprehensive-cancer-pain-center
#3
Mitchell P Engle, Baominh P Vinh, Nusrat Harun, Dhanalakshmi Koyyalagunta
BACKGROUND: Intrathecal drug delivery (IDD) and spinal cord stimulator (SCS) systems are implantable devices for the management of both chronic and cancer pain. Although these therapies have favorable long-term outcomes, they are associated with occasional complications including infection. The incidence of infectious complications varies from 2 - 8% and frequently requires prolonged antibiotics and device revision or removal. Cancer patients are particularly susceptible to infectious complications because they are immunocompromised, malnourished, and receiving cytotoxic cancer-related therapies...
May 2013: Pain Physician
https://www.readbyqxmd.com/read/23242711/live-surgery-in-neurosurgical-training-courses-essential-infrastructure-and-technical-set-up
#4
Florian Roser, Gerd Pfister, Marcos Tatagiba, Florian H Ebner
BACKGROUND: Training courses in neurosurgery are essential educational elements of residency. Teaching methods vary due to cultural differences, monetary restrictions and infrastructure conditions. Anatomical dissection courses combined with annotated live surgeries performed by senior surgeons have proved to be best accepted by students. OBJECTIVE: In this technical note, we provide detailed information about the necessary requirements, resources and optimal performance of live surgeries in neurosurgical training courses...
March 2013: Acta Neurochirurgica
https://www.readbyqxmd.com/read/22989191/effect-of-a-novel-fixation-method-for-spinal-cord-stimulators
#5
William Porter McRoberts, Paul Wu, Ishmael Bentley
INTRODUCTION: Spinal cord stimulation is a well-established treatment for recalcitrant pain syndromes such as failed back surgery syndrome. Techniques minimizing surgical time and incision size and increasing lead stability are of great value to both the patient and implanting physician. We present a consecutive case series review of ten permanent percutaneous spinal cord implants utilizing a novel lead fixation device. The purpose of this case series review is to present initial findings of the minimized incision size and thoughts surrounding the new device and technique...
September 2013: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/21927048/spinal-cord-stimulation-for-treatment-of-pain-in-a-patient-with-post-thoracotomy-pain-syndrome
#6
Jordan Graybill, Till Conermann, Abraham J Kabazie, Sunil Chandy
Post Thoracotomy Pain Syndrome (PTPS) is defined as pain that occurs or persists in the area of the thoracotomy incision for at least 2 months following the initial procedure.  The true incidence of PTPS is hard to define as literature reports a wide range of occurrence from 5% to 90%.  Thoracotomy is associated with a high risk of severe chronic postoperative pain.  Presenting symptoms include both neuropathic pain in the area of the incision, as well as myofascial pain commonly in the ipsilateral scapula and shoulder...
September 2011: Pain Physician
https://www.readbyqxmd.com/read/20412727/interventional-neurophysiology-and-an-implantable-system-for-neurostimulation-of-the-sacral-area
#7
Silvia Malaguti
Surgical or interventional neurophysiology is a term commonly used to refer to a large number of neurosurgical procedures involving the brain, cranial nerves, spinal cord and peripheral nervous system which, to be efficient and safe, demand specific neurophysiological know-how. As a result of the development of these procedures and their increasing use in the operating room, the role of clinical neurophysiology, traditionally diagnostic, has been extended. With the advent of 'neurostimulation' and 'neuromodulation', some neurophysiological techniques have, in themselves, progressively become more therapeutic, the therapeutic alteration of nervous system activity being achieved not only by surgical ablation or medication but also through electrophysiological means via implanted or non-implanted devices, whose development was made possible by extensive studies in the field of neurophysiology...
October 2009: Functional Neurology
https://www.readbyqxmd.com/read/18831509/awake-operative-videothoracoscopic-pulmonary-resections
#8
REVIEW
Eugenio Pompeo, Tommaso C Mineo
The authors' initial experience with awake videothoracoscopic lung resection suggests that these procedures can be easily and safely performed under sole thoracic epidural anesthesia with no mortality and negligible morbidity. One major concern was that operating on a ventilating lung would render surgical maneuvers more difficult because of the lung movements and lack of a sufficient operating space. Instead, the open pneumothorax created after trocar insertion produces a satisfactory lung collapse that does not hamper surgical maneuvers...
August 2008: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/18083496/intraoperative-neurophysiologic-monitoring-for-intramedullary-spinal-cord-tumor-surgery
#9
REVIEW
K F Kothbauer
During resection of intramedullary spinal-cord tumors intraoperative neurophysiological monitoring has become a true surgical technology. Motor evoked potentials are the most important modality for this purpose. Its use requires neurophysiological expertise from the surgeon, and a monitoring team in place able to handle the necessary equipment. Motor potentials are evoked by transcranial electrical motor cortex stimulation. A "single stimulus technique" evokes D-waves recorded from the spinal cord. The "multipulse (or train) stimulation technique" evokes electromyographic responses in peripheral muscles...
December 2007: Neurophysiologie Clinique, Clinical Neurophysiology
https://www.readbyqxmd.com/read/16167223/cerebral-monitoring-in-the-operating-room-and-the-intensive-care-unit-an-introductory-for-the-clinician-and-a-guide-for-the-novice-wanting-to-open-a-window-to-the-brain-part-ii-sensory-evoked-potentials-ssep-aep-vep
#10
Enno Freye
An evoked potential differs from the EEG mainly in two ways: 1. The EEG is a random, continuous signal, which arises from the ongoing activity of the outer layers of the cortex. An evoked potential is the brain's response to a repetitive stimulus along a specific nerve pathway. 2.EEG signals range from 10-200 milliVolt (mV). Evoked potentials are smaller in amplitude (1-5-20 microVolt requiring precise electrode positioning and special techniques (signal averaging) to extract the specific response from the underlying EEG "noise"...
April 2005: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/15769303/electrophysiological-monitoring-and-identification-of-neural-roots-during-somatic-autonomic-reflex-pathway-procedure-for-neurogenic-bladder
#11
Cheng-fu Dai, Chuan-guo Xiao
OBJECTIVE: To identify and separate the ventral root from dorsal root, which is the key for success of the artificial somatic-autonomic reflex pathway procedure for neurogenic bladder after spinal cord injury (SCI). Here we report the results of intra-operating room monitoring with 10 paralyzed patients. METHODS: Ten male volunteers with complete suprasacral SCI underwent the artificial somatic-autonomic procedure under general anesthesia. Vastus medialis, tibialis anticus and gastrocnemius medialis of the left lower limb were monitored for electromyogram (EMG) activities resulted from L4, L5, and S1 stimulation respectively to differentiate the ventral root from dorsal root...
April 2005: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/10828931/femoral-artery-ischemia-during-spinal-scoliosis-surgery-detected-by-posterior-tibial-nerve-somatosensory-evoked-potential-monitoring
#12
D G Vossler, T Stonecipher, M D Millen
STUDY DESIGN: A case report of unilateral leg ischemia caused by femoral artery compression detected using posterior tibial nerve somatosensory-evoked potentials during spinal scoliosis instrumentation surgery. OBJECTIVES: To report a rare cause of intraoperative unilateral loss of all posterior tibial nerve somatosensory-evoked potential waveforms. SUMMARY OF BACKGROUND DATA: Failure to obtain adequate popliteal fossa, spinal, subcortical, and cortical potentials during posterior tibial nerve somatosensory-evoked potential spinal cord monitoring usually results from technical factors or chronic conditions affecting the peripheral nerve...
June 1, 2000: Spine
https://www.readbyqxmd.com/read/10357336/the-state-of-implantable-pain-therapies-in-the-united-states-a-nationwide-survey-of-academic-teaching-programs
#13
G J Fanciullo, R J Rose, P G Lunt, P K Whalen, E Ross
UNLABELLED: The purpose of this questionnaire survey was to provide an overview of anesthesiology pain fellowship programs in the United States with regard to implantation of spinal cord stimulators (SCS) and opioid infusion devices. Of the 95 programs solicited, 80% responded to questions pertaining to the prevalence of use and technical considerations of implantation. Of the responding programs, 87% report implanting SCS, and 84% report implanting neuraxial infusion pumps. All programs perform a stimulation or infusion trial before implantation, although the duration varied from a trial in the operating room at the time of implantation to 25 days...
June 1999: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/8852314/intraoperative-improvements-of-somatosensory-evoked-potentials-correlation-to-clinical-outcome-in-surgery-for-cervical-spondylitic-myelopathy
#14
J A Bouchard, H H Bohlman, C Biro
STUDY DESIGN: Retrospective review of all patients who underwent surgical treatment of cervical spondylitic myelopathy and were monitored by somatosensory evoked potentials. OBJECTIVES: To identify the patients who had recognizable improvements in somatosensory evoked potential signals intraoperatively and to correlate the changes in somatosensory evoked potential signals to the post-operative clinical status of the patients and compare this group of patients with those that had stable intraoperative somatosensory evoked potential recordings...
March 1, 1996: Spine
https://www.readbyqxmd.com/read/6611163/-our-experiences-of-pisces-percutaneously-inserted-spinal-cord-electrical-stimulation-in-smon-and-other-neurologic-disorders
#15
S Tani, H Shimizu, B Ishijima, R Hanakago
Percutaneously inserted spinal cord electrical stimulation (PISCES) was carried out in eleven intractable pain cases and in one spastic paraplegic case. The causes of intractable pain constitute subacute myelo-optic neuropathy (SMON) 6 cases, cerebrovascular disease 2 cases, multiple sclerosis (MS) 1 case, Charcot-Marie-Tooth (CMT) 1 case and transverse myelitis (TM) 1 case. The cause of spastic paraplegia was due to the ossification of posterior longitudinal ligament (OPLL). A trial stimulation was performed about two weeks before planning a permanent implantation of PISCES system...
April 1984: Nō to Shinkei, Brain and Nerve
https://www.readbyqxmd.com/read/6358936/use-of-an-anal-sphincter-pressure-monitor-during-operations-on-the-sacral-spinal-cord-and-nerve-roots
#16
D Pang, K Casey
The distinction of sacral roots and conus medullaris from lipoma, fibrous adhesions, and an abnormally thickened filum terminale can be difficult during operations on certain complicated dysraphic lesions. We describe a simple, noninvasive method of monitoring external anal sphincter "squeeze pressure" by means of an elongated, fluid-filled, polyethylene anal balloon connected to a pressure transducer. Cutaneous electrocardiographic (ECG) leads on both hips register the stimulus artifact from a monopolar nerve stimulator...
November 1983: Neurosurgery
https://www.readbyqxmd.com/read/4049106/spinal-cord-monitoring-electrophysiological-measures-of-sensory-and-motor-function-during-spinal-surgery
#17
M Machida, S L Weinstein, T Yamada, J Kimura
Various recording methods were tested in 60 patients who underwent scoliosis surgery to find the most suitable technique for the spinal cord monitoring and to elucidate the neuroanatomic relationship of the evoked potentials recorded by these methods. Responses were recorded from the scalp and spine after stimulation of the tibial nerve or the spinal cord. The potentials from electrodes placed over the muscles and the tibial nerve after stimulation of the spinal cord were also recorded. Epidurally recorded spinal evoked potentials after stimulation of the tibial nerve generally consisted of two major negative peaks, NI and NII, and subsequent multiple waves...
June 1985: Spine
https://www.readbyqxmd.com/read/3819795/intraoperative-monitoring-of-sensory-evoked-potentials-may-be-neither-a-proven-nor-an-indicated-technique
#18
COMPARATIVE STUDY
J D Michenfelder
Excluding specific neurosurgical indications for cortical localization or peripheral nerve surgery, the use of sensory evoked potentials as a monitor in the operating room should be controversial at this time. Whether appropriate or not, legal and medical forces have largely established the use of somatosensory evoked potential monitoring as a standard during procedures that threaten the integrity of the spinal cord. The author believes that such monitoring should not replace the use of a "wake-up" test during these procedures because of the recognized possible occurrence of false negative results (i...
January 1987: Journal of Clinical Monitoring
https://www.readbyqxmd.com/read/3808259/clinical-experience-with-motor-and-cerebellar-evoked-potential-monitoring
#19
W J Levy
We are reporting 98 cases of motor evoked potential (MEP) monitoring performed between 1982 and 1986. These were divided into supratentorial, posterior fossa, and spinal cord categories. We observed in this sample that the peripheral nerve or electromyographic response was substantially more sensitive than the spinal cord response to injury and hypotension during operation and was often present bilaterally. Reversible weakening or loss of the peripheral nerve response was not associated with a deficit. However, weakening of the peripheral nerve response without recovery could warn of a motor defect after operation...
January 1987: Neurosurgery
https://www.readbyqxmd.com/read/3683251/transcranial-stimulation-of-the-motor-cortex-to-produce-motor-evoked-potentials
#20
W J Levy
Monitoring of the nervous system using evoked potentials is a developing tool. A new evoked potential, the motor-evoked potential (MEP), based on a traditional test, uses brain stimulation to monitor the motor system. The MEP complements the existing modalities, which are wholly sensory. The MEP can be prompted by direct stimulation of the motor cortex, but, in a more general way, by transcranial stimulation. Electric or magnetic means can be used. One electric system involves placement of an electrode on the scalp over the motor cortex, paired with a cathodal plate on the roof of the hard palate...
October 1987: Medical Instrumentation
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