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Intraoperative Neurophysiologic Monitoring

Ephraim W Church, Pratik Rohatgi, Amy E Feidt, Paul Kalapos, Kevin M Cockroft
BACKGROUND: Neurophysiological monitoring (NPM) is frequently performed during arteriovenous malformation (AVM) embolization. However, the ability of NPM to predict neurological deficits or improve surgical decision making in this setting has not been studied. OBJECTIVE: To review our use of NPM during AVM embolization to better define its utility. METHODS: We retrospectively examined AVM embolization cases from 2004 to 2017. We recorded patient and AVM characteristics as well as outcomes...
March 19, 2019: Operative Neurosurgery (Hagerstown, Md.)
D Adler, H Almansour, M Akbar
PURPOSE: Pediatric cervical spine injuries constitute approximately 1-2% of all pediatric trauma cases. Usually pediatric vertebral injuries appear as stable A type fractures, whereas B and C type injuries are relatively uncommon. In contrast to adults, the appropriate treatment strategy in children is still controversial and places spine surgeons in complex situations. This article reports the case of a 4-year-old girl with an unstable B type injury at the C6/7 level (AOSpine C6-7: B2 [F4 BL, C7:A1]) with bilateral locked fractures of the facet joints after falling down a flight of stairs...
March 18, 2019: Der Orthopäde
Krishnapundha Bunyaratavej, Piyanat Wangsawatwong
PURPOSE: A challenging aspect of glioma surgery is to distinguish tumour tissue from surrounding eloquent structures and perform resection with accuracy. Various technologies have been used to address this issue including neuronavigator, intraoperative magnetic resonant imaging, intraoperative ultrasound, and fluorescence, each of which has certain drawbacks and limitations. In this study, authors demonstrate the technique of using stereotactically placed catheters as guidance during cerebral glioma resection and report the surgical outcomes...
March 12, 2019: British Journal of Neurosurgery
Zulfiqar Ali
No abstract text is available yet for this article.
February 2019: Indian Journal of Anaesthesia
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
Ahmed R Rizk, Marcus Mehlitz, Martin Bettag
Background and Study Aim  Facial nerve (FN) weakness as a presenting feature in vestibular schwannoma (VS) is extremely rare. We are presenting two different cases of VS with significant facial weakness and reviewed the literature for similar cases. Methods and Results  We are presenting two cases of VS with significant facial weakness. The first case was a 63-year-old male patient presented with 3 weeks' history of severe left-sided facial weakness (House-Brackmann [HB] grade V) and hearing loss. Magnetic resonance imaging (MRI) of the brain showed a tumor in the left internal auditory canal...
February 2019: Journal of Neurological Surgery. Part B, Skull Base
Ahmed Jorge, James Zhou, Edward C Dixon, Kojo D Hamilton, Jeffrey Balzer, Parthasarathy Thirumala
PURPOSE: Intraoperative neurophysiological monitoring using somatosensory evoked potentials has been linked to a reduction in the incidence of neurological deficits during corrective surgery. Nonetheless, quantitative assessments of somatosensory evoked potential waveforms are often difficult to evaluate, because they are affected by anesthesia, injury, and noise. Here, we discuss a novel method that integrates somatosensory evoked potential signals into a single metric by calculating the area under the curve (AUC)...
January 28, 2019: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Benjamin B Whiting, Bryan S Lee, Vaidehi Mahadev, Hamid Borghei-Razavi, Sanchit Ahuja, Xuefei Jia, Alireza M Mohammadi, Gene H Barnett, Lilyana Angelov, Shobana Rajan, Rafi Avitsian, Michael A Vogelbaum
OBJECTIVECurrent management of gliomas involves a multidisciplinary approach, including a combination of maximal safe resection, radiotherapy, and chemotherapy. The use of intraoperative MRI (iMRI) helps to maximize extent of resection (EOR), and use of awake functional mapping supports preservation of eloquent areas of the brain. This study reports on the combined use of these surgical adjuncts.METHODSThe authors performed a retrospective review of patients with gliomas who underwent minimal access craniotomy in their iMRI suite (IMRIS) with awake functional mapping between 2010 and 2017...
January 25, 2019: Journal of Neurosurgery
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
Isabel Graul, Timo Zippelius, Alexander Hölzl, Patrick Strube
BACKGROUND: Both progression of scoliosis following completion of growth, and the combination of low mental retardationand the conspicuous sagittal clinical and radiographic abnormalities suggest a secondary genesis of the scoliosis according to a genetic aberration. CASE DISCRIPTION: In the outpatient department, an 18-year-old girl presents with scoliosis and mild mental retardation. Radiography findings demonstrate a sacral agenesis and the consecutively performed MRI a conus depression...
January 11, 2019: World Neurosurgery
Kyung Hyun Kim, Sangjoon Chong, Ji Yeoun Lee, Keewon Kim, Seung-Ki Kim, Kyu-Chang Wang
PURPOSE: It is well known that the preoperative enlarged sac in occult spinal dysraphism, in which the spinal cord is attached to its dome, can be associated with neurological deficits by aggravation of spinal cord traction. We experienced a similar phenomenon during the early stage of untethering surgery for "lipomyelomeningocele in a strict sense (LMMC)." CLINICAL PRESENTATION: We report a case of a 3-month-old girl with LMMC, which showed decreased motor evoked potentials (MEPs) in the lower extremities during the early stage of untethering surgery...
January 8, 2019: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Satoshi Sumiya, Shigenori Kawabata, Shuta Ushio, Shoji Tomizawa, Kyohei Sakaki, Takashi Hirai, Masato Yuasa, Hiroyuki Inose, Toshitaka Yoshii, Atsushi Okawa
STUDY DESIGN: A retrospective analysis of prospectively collected data of 179 consecutive patients who underwent intraoperative neurophysiological monitoring during posterior cervical spine surgery for compression myelopathy. OBJECTIVE: To evaluate preoperative factors in patients with deteriorating spinal cord function due to flexion of the neck during posterior cervical spine surgery by observing changes in waveforms on intraoperative monitoring. SUMMARY OF BACKGROUND DATA: We encountered several cases of intraoperative monitoring warning alerts because of neck flexion during posterior cervical spine surgery...
January 2, 2019: Clinical Spine Surgery
Alberto Grande-Martín, Agustina Martínez-Moreno, Rosa María Sánchez-Honrubia, José Manuel Pardal-Fernández
In surgical procedures of the supraclavicular and lateral cervical regions, as well as in cardiac and mediastinal surgeries, diaphragm function can be compromised by the risk of injury to the phrenic nerve and/or the C4 root. There are few publications that treat the intraoperative stimulation of these nerve structures to evaluate their functionality and, to our knowledge, until now it has not been hypothesized about whether it is possible to reduce the injury rates, which reach 26% in some cardiac surgery studies...
December 20, 2018: Cirugía Española
Myoung Jin Ko, Beomjin Oh, Jae-Wook Jung, Dae Seok Oh, Sung Chul Jin, Eunsu Kang, Yong Han Kim, Se Hun Kim, Hyojoong Kim
BACKGROUND: Medical researchers have been reluctant to use neuromuscular blocking drugs (NMBD) during the use of intraoperative motor evoked potential (MEP) monitoring despite the possibility of patient movement. In this study, we compared the effects of no NMBD and continuous rocuronium infusion on the incidence of patient involuntary movement and MEP monitoring. METHODS: In this study, 80 patients who underwent neuro intervention with MEP monitoring were randomly assigned into 2 groups...
December 2018: Medicine (Baltimore)
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
Tuija Teerijoki-Oksa, Heli Forssell, Satu K Jääskeläinen
INTRODUCTION: We evaluated diagnostic value of sensory tests during recovery from iatrogenic sensory neuropathy using intraoperatively verified nerve injury with subjective symptoms as gold standard. METHODS: Inferior alveolar nerves were monitored neurophysiologically throughout mandibular osteotomy in 19 patients. Sensory disturbance was registered and sensation tested using clinical and quantitative sensory (QST) and neurophysiologic tests postoperatively at 1, 3, 6, 12 months...
December 14, 2018: Muscle & Nerve
(no author information available yet)
OBJECTIVEThe purpose of this study was to evaluate the technical feasibility, accuracy, and relevance on surgical outcome of D-wave monitoring combined with somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) during resection of intradural extramedullary (IDEM) spinal tumors.METHODSClinical and intraoperative neurophysiological monitoring (IONM) data obtained in 108 consecutive patients who underwent surgery for IDEM tumors at the Institute for Scientific and Care Research "ASMN" of Reggio Emilia, Italy, were prospectively entered into a database and retrospectively analyzed...
November 1, 2018: Journal of Neurosurgery. Spine
Woo Hyung Lee, Chul-Kee Park, Hee-Pyoung Park, Sung-Min Kim, Byung-Mo Oh, Keewon Kim, Young-Doo Choi, Han Gil Seo
BACKGROUND: Dexmedetomidine (DEX) is used as an adjunct to total intravenous anesthesia. However, its effect on intraoperative neurophysiological monitoring (IOM) during brain tumor surgery remains controversial. The aim of this study was to explore the effect of DEX on IOM during brain tumor surgery. METHODS: Seventy eight consecutive patients (DEX group, n=40; control group, n=38), who underwent brain tumor surgery with IOM, were retrospectively reviewed. The outcomes included the predictability, laterality of alterations, and stimulation parameters of transcranial motor-evoked potentials (tcMEPs) and somatosensory-evoked potentials (SSEPs)...
November 26, 2018: World Neurosurgery
Luciano Mastronardi, Ettore Di Scipio, Guglielmo Cacciotti, Raffaelino Roperto, Carlo Giacobbo Scavo
BACKGROUND AND OBJECTIVE: Goals of small vestibular schwannoma (VS) microneurosurgery are as follows: radical resection, facial nerve (FN) preservation, and hearing preservation (HP). Microsurgical advances make HP possible in many patients with preoperative socially useful hearing (SUH). We evaluated postoperative HP in VS with maximum diameter < 2 cm monitored with two different auditory brainstem response (ABR) techniques. MATERIALS AND METHODS: Twenty-eight consecutive non-randomized patients with SUH suffering from small VS underwent keyhole microneurosurgery by retrosigmoid (RS) approach...
January 2019: Acta Neurochirurgica
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