Neurophysiologic Intraoperative Monitoring for Spine Surgery: A Practical Guide From Past to Present

2020 ◽  
pp. 088506662096245
Author(s):  
Lauren K. Buhl ◽  
Andres Brenes Bastos ◽  
Richard J. Pollard ◽  
Jeffrey E. Arle ◽  
George P. Thomas ◽  
...  
Keyword(s):  
Nervous System ◽  
Peripheral Nervous System ◽  
Spine Surgery ◽  
Intraoperative Monitoring ◽  
Effective Means ◽  
Tumor Resection ◽  
Spinal Tumor ◽  
Adverse Outcomes ◽  
Scoliosis Surgery ◽  
Increased Risk

Intraoperative neuromonitoring was introduced in the second half of the 20th century with the goal of preventing patient morbidity for patients undergoing complex operations of the central and peripheral nervous system. Since its early use for scoliosis surgery, the growth and utilization of IOM techniques expanded dramatically over the past 50 years to include spinal tumor resection and evaluation of cerebral ischemia. The importance of IOM has been broadly acknowledged, and in 1989, the American Academy of Neurology (AAN) released a statement that the use of SSEPs should be standard-of-care during spine surgery. In 2012, both the AAN and the American Clinical Neurophysiology Society (ACNS) recommended that: “Intraoperative monitoring (IOM) using SSEPs and transcranial MEPs be established as an effective means of predicting an increased risk of adverse outcomes, such as paraparesis, paraplegia, and quadriplegia, in spinal surgery.” With a multimodal approach that combines SSEPs, MEPs, and sEMG with tEMG and D waves, as appropriate, sensitivity and specificity can be maximized for the diagnosis of reversible insults to the spinal cord, nerve roots, and peripheral nerves. As with most patient safety efforts in the operating room, IOM requires contributions from and communication between a number of different teams. This comprehensive review of neuromonitoring techniques for surgery on the central and peripheral nervous system will highlight the technical, surgical and anesthesia factors required to optimize outcomes. In addition, this review will discuss important trouble shooting measures to be considered when managing ION changes concerning for potential injury.

Electrodiagnostics

2019 ◽  
pp. 827-838
Author(s):  
Alan Forster ◽  
Robert Morris
Keyword(s):  
Nervous System ◽  
Intraoperative Monitoring ◽  
Neurophysiological Monitoring ◽  
Scoliosis Surgery ◽  
Motor Pathways ◽  
Dorsal Rhizotomy ◽  
System A ◽  
Human Thalamus ◽  
The 1960S ◽  
Neurophysiological Mapping

Clinical neurophysiology provides valuable information in neurosurgery, serving as: a diagnostic tool that can quantify type and severity of damage to the central and peripheral nervous system, a means of monitoring the safety of structures within and around the surgical site, and a method to map structures. As such it aides in identifying structures (e.g. finding sacral nerve roots within a spinal lipoma or nuclei within the thalamus), assessing functional integrity (e.g. motor pathways from cortex to any relevant accessible muscle), and monitoring their function while surgery occurs near to structures (e.g. VII while retraction during trigeminal microvascular decompression, and in scoliosis surgery) and provide guidance to technical operative steps (e.g. for selective dorsal rhizotomy). Intraoperative monitoring is not new, though the advances in equipment and technique of recent years have seen an explosion in the useful ways that neurophysiology can aid the neurosurgeon and protect the patient. The development of techniques to localize epileptic foci and map eloquent cerebral cortex in the 1950s produced major scientific advances as well as revolutionizing epilepsy surgery. Since the 1960s Tasker in Toronto, and Gillingham in Edinburgh, were recording from microelectrodes in the human thalamus to guide movement disorder surgery. Pioneers such as Møller have extended the applications of neurophysiological monitoring in skull base surgery. This chapter describes neurophysiological mapping and monitoring, and the different tools that are useful in different situations.

Impact of preoperative anemia on outcomes in patients undergoing elective cranial surgery

2014 ◽  
Vol 120 (3) ◽  
pp. 764-772 ◽  
Author(s):  
Nima Alan ◽  
Andreea Seicean ◽  
Sinziana Seicean ◽  
Duncan Neuhauser ◽  
Robert J. Weil
Keyword(s):  
Odds Ratio ◽  
Tumor Resection ◽  
Adverse Outcomes ◽  
Sensitivity Analyses ◽  
Severe Anemia ◽  
Improvement Program ◽  
Preoperative Anemia ◽  
Cranial Surgery ◽  
Mild Anemia ◽  
Increased Risk

Object The objective of this study was to assess whether preoperative anemia in patients undergoing elective cranial surgery influences outcomes in the immediate perioperative period (≤ 30 days). Methods The National Surgical Quality Improvement Program (NSQIP) was used to identify 6576 patients undergoing elective cranial surgery between 2006 and 2011. Propensity scores were used to match patients with moderate to severe anemia (moderate-severe) or mild anemia with patients without anemia. Logistic regression analysis was used to predict the outcomes of interest. Sensitivity analyses were used to limit the sample to patients without perioperative transfusion as well as those who underwent craniotomy for definitive resection of a malignant brain tumor. Results A total of 6576 patients underwent elective cranial surgery, of whom 175 had moderate-severe anemia and 1868 had mild anemia. Patients with moderate-severe (odds ratio 1.8, 95% CI 1.1–2.8) and mild (odds ratio 1.5, 95% CI 1.3–1.7) anemia were more likely to have prolonged length of stay (LOS) in the hospital compared to those with no anemia. Similarly, in patients who underwent craniotomy for a malignant tumor resection (n = 2537), anemia of any severity was associated with prolonged LOS, but not postoperative complications nor death. Conclusions Anemia is not associated with an overall increased risk for adverse outcomes in patients undergoing elective cranial surgery. However, patients with anemia are more likely to experience prolonged hospitalization postoperatively, resulting in increased resource utilization.

scholarly journals Cardiac Vagal Control in Depression and Attention Deficit/Hyperactivity Disorder

2011 ◽  
Vol 11 (Supplement-1) ◽  
pp. 46-51 ◽  
Author(s):  
I. Tonhajzerova ◽  
I. Ondrejka ◽  
K. Javorka ◽  
A. Calkovska ◽  
M. Javorka
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Nervous System ◽  
Attention Deficit ◽  
Adverse Outcomes ◽  
Polyvagal Theory ◽  
Sinus Arrhythmia ◽  
Hyperactivity Disorder ◽  
Vagal Control ◽  
Cardiac Vagal Control ◽  
Increased Risk

Cardiac Vagal Control in Depression and Attention Deficit/Hyperactivity DisorderThe importance of the vagus nerve in the two way communication between the brain and the heart has been known for over 100 years. Recently, integrative theories that link central nervous system structures to cardiac vagal regulation, such as the polyvagal theory, have of late emerged. Based on the polyvagal theory, the respiratory sinus arrhythmia (as an index of cardiac vagal control) is considered as a psychophysiological marker of many aspects of behavioural functioning and emotion regulation in both children and adults. Although a lack of sensitive heart rate autonomic control likely reflects impaired cardiac nervous system regulation, the sophisticated brain-heart interactions are incompletely understood. Importantly, cardiac vagal dysregulation is associated with the increased risk of cardiovascular morbidity reflecting various pathophysiological states. Thus, we believe that the identifying of cardiac vagal control changes in mental disorders should represent an initial step towards the understanding of a potential pathomechanisms leading to later cardiac adverse outcomes; especially in children and adolescents.

The LACE+ Index as a Predictor of 90-Day Supratentorial Tumor Surgery Outcomes

Neurosurgery ◽  
2020 ◽  
Author(s):  
Eric Winter ◽  
Debanjan Haldar ◽  
Gregory Glauser ◽  
Ian F Caplan ◽  
Kaitlyn Shultz ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Tumor Resection ◽  
Adverse Outcomes ◽  
University Of Pennsylvania ◽  
Tumor Surgery ◽  
Exact Matching ◽  
Increased Risk ◽  
Comorbidity Index ◽  
Ed Visits ◽  
The University

Abstract BACKGROUND The LACE+ (Length of stay, Acuity of admission, Charlson Comorbidity Index [CCI] score, and Emergency department [ED] visits in the past 6 mo) index risk-prediction tool has never been successfully tested in a neurosurgery population. OBJECTIVE To assess the ability of LACE+ to predict adverse outcomes after supratentorial brain tumor surgery. METHODS LACE+ scores were retrospectively calculated for all patients (n = 624) who underwent surgery for supratentorial tumors at the University of Pennsylvania Health System (2017-2019). Confounding variables were controlled with coarsened exact matching. The frequency of unplanned hospital readmission, ED visits, and death was compared for patients with different LACE+ score quartiles (Q1, Q2, Q3, and Q4). RESULTS A total of 134 patients were matched between Q1 and Q4; 152 patients were matched between Q2 and Q4; and 192 patients were matched between Q3 and Q4. Patients with higher LACE+ scores were significantly more likely to be readmitted within 90 d (90D) of discharge for Q1 vs Q4 (21.88% vs 46.88%, P = .005) and Q2 vs Q4 (27.03% vs 55.41%, P = .001). Patients with larger LACE+ scores also had significantly increased risk of 90D ED visits for Q1 vs Q4 (13.33% vs 30.00%, P = .027) and Q2 vs Q4 (22.54% vs 39.44%, P = .039). LACE+ score also correlated with death within 90D of surgery for Q2 vs Q4 (2.63% vs 15.79%, P = .003) and with death at any point after surgery/during follow-up for Q1 vs Q4 (7.46% vs 28.36%, P = .002), Q2 vs Q4 (15.79% vs 31.58%, P = .011), and Q3 vs Q4 (18.75% vs 31.25%, P = .047). CONCLUSION LACE+ may be suitable for characterizing risk of certain perioperative events in a patient population undergoing supratentorial brain tumor resection.

Glucuronyl 3-sulfate occurs exclusively on distal unmyelinated terminals of selected sensory neurons in the peripheral nervous system

1995 ◽  
Vol 53 ◽  
pp. 958-959
Author(s):  
S.S. Spicer ◽  
B.A. Schulte
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cerebral Cortex ◽  
Peripheral Nervous System ◽  
Sensory Neurons ◽  
Sensory Nerves ◽  
Tissue Antigens ◽  
The Central Nervous System ◽  
The Brain ◽  
Leu 7

Generation of monoclonal antibodies (MAbs) against tissue antigens has yielded several (VC1.1, HNK- 1, L2, 4F4 and anti-leu 7) which recognize the unique sugar epitope, glucuronyl 3-sulfate (Glc A3- SO4). In the central nervous system, these MAbs have demonstrated Glc A3-SO4 at the surface of neurons in the cerebral cortex, the cerebellum, the retina and other widespread regions of the brain.Here we describe the distribution of Glc A3-SO4 in the peripheral nervous system as determined by immunostaining with a MAb (VC 1.1) developed against antigen in the cat visual cortex. Outside the central nervous system, immunoreactivity was observed only in peripheral terminals of selected sensory nerves conducting transduction signals for touch, hearing, balance and taste. On the glassy membrane of the sinus hair in murine nasal skin, just deep to the ringwurt, VC 1.1 delineated an intensely stained, plaque-like area (Fig. 1). This previously unrecognized structure of the nasal vibrissae presumably serves as a tactile end organ and to our knowledge is not demonstrable by means other than its selective immunopositivity with VC1.1 and its appearance as a densely fibrillar area in H&E stained sections.

Questions and Answers

2000 ◽  
Vol 5 (2) ◽  
pp. 3-3
Author(s):  
Christopher R. Brigham ◽  
James B. Talmage
Keyword(s):  
Nervous System ◽  
Peripheral Nervous System ◽  
Spinal Nerve ◽  
Sensory Loss ◽  
Residual Symptoms ◽  
Additional Information ◽  
Questions And Answers ◽  
Motor Nerves ◽  
Symptoms And Signs ◽  
Limited Motion

Abstract Lesions of the peripheral nervous system (PNS), whether due to injury or illness, commonly result in residual symptoms and signs and, hence, permanent impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) describes procedures for rating upper extremity neural deficits in Chapter 3, The Musculoskeletal System, section 3.1k; Chapter 4, The Nervous System, section 4.4 provides additional information and an example. The AMA Guides also divides PNS deficits into sensory and motor and includes pain within the former. The impairment estimates take into account typical manifestations such as limited motion, atrophy, and reflex, trophic, and vasomotor deficits. Lesions of the peripheral nervous system may result in diminished sensation (anesthesia or hypesthesia), abnormal sensation (dysesthesia or paresthesia), or increased sensation (hyperesthesia). Lesions of motor nerves can result in weakness or paralysis of the muscles innervated. Spinal nerve deficits are identified by sensory loss or pain in the dermatome or weakness in the myotome supplied. The steps in estimating brachial plexus impairment are similar to those for spinal and peripheral nerves. Evaluators should take care not to rate the same impairment twice, eg, rating weakness resulting from a peripheral nerve injury and the joss of joint motion due to that weakness.

Chronic neonatal mild stress induces long lasting alterations on peripheral nervous system programming in mice

2004 ◽  
Author(s):  
G. Galietta ◽  
A. Capasso ◽  
A. Fortuna ◽  
F. Fabi ◽  
P. Del Basso ◽  
...  
Keyword(s):  
Nervous System ◽  
Peripheral Nervous System ◽  
Mild Stress ◽  
System Programming
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