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Takashi Kanemura, Hiroshi Miyata, Makoto Yamasaki, Tomoki Makino, Yasuhiro Miyazaki, Tsuyoshi Takahashi, Yukinori Kurokawa, Shuji Takiguchi, Masaki Mori, Yuichiro Doki
BACKGROUND: Recurrent laryngeal nerve (RLN) palsy is a critical postoperative complication in esophageal cancer surgery. However, intraoperative prediction of its occurrence and severity is difficult. In this prospective study, we evaluated the usefulness of intraoperative nerve monitoring (IONM) in predicting RLN palsy and its severity. METHODS: Twenty patients who underwent subtotal esophagectomy with 3-field lymph node dissection were enrolled. Intraoperative electromyography (EMG) amplitudes of the vocal cords were measured by IONM at RLN and vagus nerve (VN) stimulation...
March 15, 2019: General Thoracic and Cardiovascular Surgery
Wataru Ishida, Joshua Casaos, Arun Chandra, Adam D'Sa, Seba Ramhmdani, Alexander Perdomo-Pantoja, Nicholas Theodore, George Jallo, Ziya L Gokaslan, Jean-Paul Wolinsky, Daniel M Sciubba, Ali Bydon, Timothy F Witham, Sheng-Fu L Lo
OBJECTIVEWith the advent of intraoperative electrophysiological neuromonitoring (IONM), surgical outcomes of various neurosurgical pathologies, such as brain tumors and spinal deformities, have improved. However, its diagnostic and therapeutic value in resecting intradural extramedullary (ID-EM) spinal tumors has not been well documented in the literature. The objective of this study was to summarize the clinical results of IONM in patients with ID-EM spinal tumors.METHODSA retrospective patient database review identified 103 patients with ID-EM spinal tumors who underwent tumor resection with IONM (motor evoked potentials, somatosensory evoked potentials, and free-running electromyography) from January 2010 to December 2015...
March 1, 2019: Journal of Neurosurgery. Spine
Che-Wei Wu, Tzu-Yen Huang, Hui-Chun Chen, Hsiu-Ya Chen, Tsung-Yi Tsai, Pi-Ying Chang, Yi-Chu Lin, Hsin-Yi Tseng, Pao-Chu Hun, Xiaoli Liu, Hui Sun, Gregory W Randolph, Gianlorenzo Dionigi, Feng-Yu Chiang, I-Cheng Lu
Intraoperative injury to the recurrent laryngeal nerve (RLN) can cause vocal cord paralysis, which interferes with speech and can potentially interfere with breathing. In recent years, intraoperative neural monitoring (IONM) has been widely adapted as an adjunct technique to localize the RLN, detect RLN injury, and predict vocal cord function during the operations. Many studies have also used animal models to investigate new applications of IONM technology and to develop reliable strategies for preventing intraoperative RLN injury...
February 11, 2019: Journal of Visualized Experiments: JoVE
Nobuhito Morota
OBJECTIVEDespite the surge in the intraoperative use of the bulbocavernosus reflex (BCR) during lumbosacral surgeries, there are as yet no widely accepted BCR warning criteria for use with intraoperative neurophysiological monitoring (IONM). The author's aim was to find clinically acceptable warning criteria for use in IONM of the BCR.METHODSRecords of IONM of the BCR in 164 operations in 163 patients (median age 5 months) with a conus spinal lipoma who underwent surgery between August 2002 and May 2016 were retrospectively analyzed...
February 22, 2019: Journal of Neurosurgery. Pediatrics
Orhan Bican, Charles Cho, Areli Suarez-Roman, Viet Nguyen, Leslie Lee, Scheherazade Le, Jeremy Heit, Robert Dodd, Jaime López
Pharmacologic provocative testing (PT) and intraoperative neurophysiologic monitoring (IONM) both mitigate and predict risks associated with endovascular embolization procedures. We present a series of patients undergoing endovascular intracranial embolization predominantly for AVMs both under general anesthesia and awake with the use of IONM. We reviewed our database to identify all patients undergoing endovascular procedures between January 1, 2014 and January 1, 2016. Awake patients were tested with SSEP, EEG and real time neurologic examination while TcMEPs were performed in all anesthetized patients...
February 13, 2019: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Mai Naytah, Iman Ibrahim, Sabrina da Silva
BACKGROUND: Voice changes are frequently reported after thyroidectomy due to injury to the external branch of the superior laryngeal nerve (EBSLN) and paralysis of the cricothyroid muscle, The objective is to evaluate the advantage of intraoperative neuromonitoring (IONM) in identifying EBSLN during thyroid surgery. METHODS: Data sources were MEDLINE, PubMed, Web of Science, and Cochrane Library from January 1, 1995, through July 1, 2018. Published studies of adult patients who had thyroid surgery and an attempt to identify EBSLN done by conventional methods and/or IONM were selected...
February 1, 2019: Head & Neck
Serdar Kahraman, Selcuk Gocmen, Meltem Hale Alpsan Gokmen, Gokhan Acka, Serhat Pusat
OBJECTIVE: Intraoperative multimodal neuromonitoring (IONM) is considered valuable for the early detection and prevention of any neurological compromise during spine surgery. It has also become the standard of care at many institutions, both to improve the surgical outcome and as a safety net for both clinical and medico-legal concerns. METHODS: Our experience and outcomes in 46 consecutive cases of lumbar intradural schwannoma resection were reviewed with respect to clinical outcomes and patient safety, before and after the integration of IONM into our clinical practice...
January 23, 2019: World Neurosurgery
Hui Sun, Che-Wei Wu, Daqi Zhang, Özer Makay, Yishen Zhao, Paolo Carcofaro, Hoon Yub Kim, Gianlorenzo Dionigi, Antonella Pino, Ettore Caruso, Alessandro Pontin, Vincenzo Pappalardo
Intraoperative neuromonitoring (IONM) in thyroid gland surgery provides real-time feedback to the endocrine surgeon regarding the electrophysiological consequences of surgical manipulation of the laryngeal nerves. The goal of monitoring modalities is to detect surgical or physiological insults to the recurrent laryngeal nerve (RLN) while they are still reversible or, in cases where prevention is not an option, to minimize the damage done to these structures during thyroidectomy. In recent decades, monitoring of the RLN has become a fundamental part of endocrine surgery...
January 18, 2019: Surgical Technology International
Sandro M Krieg, Lukas Bobinski, Lucia Albers, Bernhard Meyer
OBJECTIVELateral lumbar interbody fusion (LLIF) is frequently used for anterior column stabilization. Many authors have reported that intraoperative neuromonitoring (IONM) of the lumbar plexus nerves is mandatory for this approach. However, even with IONM, the reported motor and sensory deficits are still considerably high. Thus, the authors' approach was to focus on the indication, trajectory, and technique instead of relying on IONM findings per se. The objective of this study therefore was to analyze the outcome of our large cohort of patients who underwent LLIF without IONM...
January 18, 2019: Journal of Neurosurgery. Spine
Koen Rijs, Markus Klimek, Marjan Scheltens-de Boer, Karla Biesheuvel, Biswadjiet S Harhangi
BACKGROUND: Intramedullary spinal cord tumors (IMSCT) comprise the least common types of spinal neoplasms; surgery is mostly conducted with intraoperative neuromonitoring (IONM). However, although IONM is widely used to prevent neurological damage and many single-center studies have been published, the added value, in terms of overall sensitivity and specificity, of different monitoring techniques used in IMSCT surgery, remains to be clearly defined. OBJECT: Summarize and review the published evidence on the use of IONM in IMSCT surgery, including our own case series (n=75 patients)...
January 16, 2019: World Neurosurgery
Roberto Cirocchi, Alberto Arezzo, Vito D'Andrea, Iosief Abraha, Georgi I Popivanov, Nicola Avenia, Chiara Gerardi, Brandon Michael Henry, Justus Randolph, Marcin Barczyñski
BACKGROUND: Injuries to the recurrent inferior laryngeal nerve (RILN) remain one of the major post-operative complications after thyroid and parathyroid surgery. Damage to this nerve can result in a temporary or permanent palsy, which is associated with vocal cord paresis or paralysis. Visual identification of the RILN is a common procedure to prevent nerve injury during thyroid and parathyroid surgery. Recently, intraoperative neuromonitoring (IONM) has been introduced in order to facilitate the localisation of the nerves and to prevent their injury during surgery...
January 19, 2019: Cochrane Database of Systematic Reviews
Si-Yuan Wu, Hung-Yuan Shen, Quan-Yang Duh, Chung-Bao Hsieh, Jyh-Cherng Yu, Ming-Lang Shih
Routine use of intraoperative neuromonitoring (IONM) in thyroid cancer surgery is controversial. We aimed to investigate whether it improves the completeness of thyroidectomy and ensures safety. This retrospective study included 380 thyroid cancer patients who underwent thyroidectomy, by one surgeon, between July 2006 and November 2015. Patients were grouped according to the surgeon's adaptation of IONM, as follows: none (period 1; n = 92), early (period 2; n = 141), and late (period 3; n = 147). The operative time and rates of vocal cord palsy were determined...
December 1, 2018: American Surgeon
Jaiben George, Soumabha Das, Anthony C Egger, Reid C Chambers, Thomas E Kuivila, Ryan C Goodwin
BACKGROUND: Intraoperative neuromonitoring (IONM) is used to detect impending neurologic damage during complex spinal surgeries. Although IONM is increasingly used during pediatric scoliosis surgeries in the United States, the effect of IONM on the outcomes of such surgeries at a national level is unclear. METHODS: Using National Inpatient Sample (NIS) from 2009 to 2012, 32,305 spinal fusions performed in children 18 years old or younger of age with scoliosis were identified using ICD-9 procedure and diagnosis codes...
January 2019: Spine Deformity
Go Yoshida, Hiroki Ushirozako, Sho Kobayashi, Tomohiko Hasegawa, Yu Yamato, Tomohiro Banno, Shin Oe, Hideyuki Arima, Yuki Mihara, Tatsuya Yasuda, Daisuke Togawa, Yukihiro Matsuyama
STUDY DESIGN: Retrospective study. OBJECTIVES: To analyze intraoperative neuromonitoring (IONM) alerts in various surgical procedures and clarify incidences and causes of IONM alarms in consecutive adult spinal deformity (ASD) surgeries. SUMMARY OF BACKGROUND DATA: ASD surgery has a high neurologic complication rate. IONM may play a role in identifying and preventing neurologic complications. METHODS: This study included 275 consecutive ASD patients treated by posterior corrective fusion who had been followed up for more than two years...
January 2019: Spine Deformity
Myung Jin Ban, Eun Hae Estelle Chang, Dong Yun Lee, Jae Hong Park, Chan Lee, Da Hee Kim, Joo Hyun Kim, Yoon Woo Koh
OBJECTIVE: Loss of signal (LOS) during intraoperative neuromonitoring (IONM) of robotic or endoscopic thyroidectomy via a retroauricular approach (RAT) and during conventional open thyroidectomy (COT) was investigated to compare the risk of recurrent laryngeal nerve (RLN) injury between the two groups. STUDY DESIGN: Original article. METHODS: This is a retrospective case series study performed between May 2014 and September 2016. IONM using the NIM 3...
December 25, 2018: Laryngoscope
Kayoko Mizuno, Masato Takeuchi, Yuji Kanazawa, Morimasa Kitamura, Kazuki Ide, Koichi Omori, Koji Kawakami
OBJECTIVES/HYPOTHESIS: This study aimed to investigate the risk of postoperative recurrent laryngeal nerve paralysis (RLNP) with and without the use of intraoperative nerve monitoring (IONM) during thyroid cancer surgery. STUDY DESIGN: Retrospective cohort study. METHODS: This study utilized a nationwide claims database in Japan. Patients who underwent thyroid cancer surgery with and without IONM were included, and postoperative RLNP incidence was compared...
December 24, 2018: Laryngoscope
Martin Sutter, Andreas Eggspuehler, Dezsoe Jeszenszky, Frank Kleinstueck, Tamàs F Fekete, Daniel Haschtmann, François Porchet, Jiri Dvorak
PURPOSE: We compared the value of different uni- and multimodal intraoperative neurophysiological monitoring (IONM) methods on the detection of neurological complications during spine surgery. METHODS: IONM data derived from sensory spinal and cortical evoked potentials combined with continuous electromyography monitoring, motor evoked potentials and spinal recording were evaluated in relation to subsequent post-operative neurological changes. Patients were categorised based on their true-positive or true-negative post-operative neurological status...
December 17, 2018: European Spine Journal
Eui-Suk Sung, Jin-Choon Lee, Sung-Chan Shin, Hyun-Geun Kwon, Min-Sik Kim, Dong-Jo Kim, Jung-Hoon Ro, Byung-Joo Lee
Objectives: False-negative or false-positive responses in intraoperative neuromonitoring (IONM) using electromyography (EMG) in thyroid surgery pose a challenge. Therefore, we developed a novel IONM system that uses a surface pressure sensor instead of EMG to detect muscle twitching. This study aimed to investigate the feasibility and safety of a new IONM system using a piezo-electric surface pressure sensor in an experimental animal model. Methods: We developed the surface pressure sensor by modifying a commercial piezo-electric sensor...
December 11, 2018: Clinical and Experimental Otorhinolaryngology
Rob J M Groen, Jertske N M Lukassen, Gert Jan Boer, Rob A Vergeer, Maarten H Coppes, Gea Drost, Berrie Middel
BACKGROUND: Anterior thoracic spinal cord herniation (ATSCH) is a rare cause of progressive myelopathy. Early surgery is essential, but there is no agreement about the best surgical approach. OBJECTIVE: To identify factors that determine surgical results, and to find evidence for the most favorable technique to correct ATSCH. METHODS: To find relevant literature, computerized databases of PubMed, EMBASE, and ISI Web of Science were searched...
December 7, 2018: World Neurosurgery
Le Zhou, Gianlorenzo Dionigi, Alessandro Pontin, Antonella Pino, Ettore Caruso, Che-Wei Wu, Hui Sun, Ralph P Tufano, Hoon Yub Kim
We evaluate the role of intraoperative neuromonitoring (IONM) in thyroidectomy performed for Graves' disease (GD) with an emphasis on recurrent laryngeal nerve (RLN) management and completeness of resection. The study is a retrospective series comprising 55 thyroidectomy (control group) versus 82 procedures with intermittent IONM (I-IONM) and 72 by means of continuous IONM (C-IONM). In the control group the laryngeal nerves have been identified by visualization solely. In the I-IONM group both vagal nerve (VN) and RLN have been localized and monitored during thyroid resection...
March 2019: Journal of Clinical & Translational Endocrinology
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