scholarly journals A Real-Time Monitoring System for the Facial Nerve

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1064-1073 ◽  
Author(s):  
Julian Prell ◽  
Jens Rachinger ◽  
Christian Scheller ◽  
Alex Alfieri ◽  
Christian Strauss ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Functional Outcome ◽  
Real Time ◽  
Operative Procedure ◽  
Real Time Monitoring ◽  
Time Analysis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Real Time Analysis

Abstract OBJECTIVE Damage to the facial nerve during surgery in the cerebellopontine angle is indicated by A-trains, a specific electromyogram pattern. These A-trains can be quantified by the parameter “traintime,” which is reliably correlated with postoperative functional outcome. The system presented was designed to monitor traintime in real-time. METHODS A dedicated hardware and software platform for automated continuous analysis of the intraoperative facial nerve electromyogram was specifically designed. The automatic detection of A-trains is performed by a software algorithm for real-time analysis of nonstationary biosignals. The system was evaluated in a series of 30 patients operated on for vestibular schwannoma. RESULTS A-trains can be detected and measured automatically by the described method for real-time analysis. Traintime is monitored continuously via a graphic display and is shown as an absolute numeric value during the operation. It is an expression of overall, cumulated length of A-trains in a given channel; a high correlation between traintime as measured by real-time analysis and functional outcome immediately after the operation (Spearman correlation coefficient [ρ] = 0.664, P < .001) and in long-term outcome (ρ = 0.631, P < .001) was observed. CONCLUSION Automated real-time analysis of the intraoperative facial nerve electromyogram is the first technique capable of reliable continuous real-time monitoring. It can critically contribute to the estimation of functional outcome during the course of the operative procedure.

Facial Nerve EMG: Low-Tech Monitoring with a Stopwatch

2021 ◽  
Author(s):  
Julian Prell ◽  
Christian Scheller ◽  
Sebastian Simmermacher ◽  
Christian Strauss ◽  
Stefan Rampp
Keyword(s):  
Facial Nerve ◽  
Real Time ◽  
Random Order ◽  
Automated Analysis ◽  
Data Sets ◽  
Time Analysis ◽  
Frequency Pattern ◽  
Real Time Analysis ◽  
Offline Analysis ◽  
Automated Algorithms

Abstract Objective The quantity of A-trains, a high-frequency pattern of free-running facial nerve electromyography, is correlated with the risk for postoperative high-grade facial nerve paresis. This correlation has been confirmed by automated analysis with dedicated algorithms and by visual offline analysis but not by audiovisual real-time analysis. Methods An investigator was presented with 29 complete data sets measured during actual surgeries in real time and without breaks in a random order. Data were presented either strictly via loudspeaker (audio) or simultaneously by loudspeaker and computer screen (audiovisual). Visible and/or audible A-train activity was then quantified by the investigator with the computerized equivalent of a stopwatch. The same data were also analyzed with quantification of A-trains by automated algorithms. Results Automated (auto) traintime (TT), known to be a small, yet highly representative fraction of overall A-train activity, ranged from 0.01 to 10.86 s (median: 0.58 s). In contrast, audio-TT ranged from 0 to 1,357.44 s (median: 29.69 s), and audiovisual-TT ranged from 0 to 786.57 s (median: 46.19 s). All three modalities were correlated to each other in a highly significant way. Likewise, all three modalities correlated significantly with the extent of postoperative facial paresis. As a rule of thumb, patients with visible/audible A-train activity < 1 minute presented with a more favorable clinical outcome than patients with > 1 minute of A-train activity. Conclusion Detection and even quantification of A-trains is technically possible not only with intraoperative automated real-time calculation or postoperative visual offline analysis, but also with very basic monitoring equipment and real-time good quality audiovisual analysis. However, the investigator found audiovisual real-time-analysis to be very demanding; thus tools for automated quantification can be very helpful in this respect.

scholarly journals Functional Long-Term Outcome after Left- versus Right-Sided Intracerebral Hemorrhage

2017 ◽  
Vol 43 (3-4) ◽  
pp. 117-123 ◽  
Author(s):  
Vanessa D. Beuscher ◽  
Joji B. Kuramatsu ◽  
Stefan T. Gerner ◽  
Julia Köhn ◽  
Hannes Lücking ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Outcome Measures ◽  
A Priori ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Excellent Outcome ◽  
Confounding Variables ◽  
Baseline Characteristics

Background and Purpose: Hemispheric location might influence outcome after intracerebral hemorrhage (ICH). INTERACT suggested higher short-term mortality in right hemispheric ICH, yet statistical imbalances were not addressed. This study aimed at determining the differences in long-term functional outcome in patients with right- vs. left-sided ICH with a priori-defined sub-analysis of lobar vs. deep bleedings. Methods: Data from a prospective hospital registry were analyzed including patients with ICH admitted between January 2006 and August 2014. Data were retrieved from institutional databases. Outcome was assessed using the modified Rankin Scale (mRS) score. Outcome measures (long-term mortality and functional outcome at 12 months) were correlated with ICH location and hemisphere, and the imbalances of baseline characteristics were addressed by propensity score matching. Results: A total of 831 patients with supratentorial ICH (429 left and 402 right) were analyzed. Regarding clinical baseline characteristics in the unadjusted overall cohort, there were differences in disfavor of right-sided ICH (antiplatelets: 25.2% in left ICH vs. 34.3% in right ICH; p < 0.01; previous ischemic stroke: 14.7% in left ICH vs. 19.7% in right ICH; p = 0.057; and presence/extent of intraventricular hemorrhage: 45.0% in left ICH vs. 53.0% in right ICH; p = 0.021; Graeb-score: 0 [0-4] in left ICH vs. 1 [0-5] in right ICH; p = 0.017). While there were no differences in mortality and in the proportion of patients with favorable vs. unfavorable outcome (mRS 0-3: 142/375 [37.9%] in left ICH vs. 117/362 [32.3%] in right ICH; p = 0.115), patients with left-sided ICH showed excellent outcome more frequently (mRS 0-1: 64/375 [17.1%] in left ICH vs. 43/362 [11.9%] in right ICH; p = 0.046) in the unadjusted analysis. After adjusting for confounding variables, a well-balanced group of patients (n = 360/hemisphere) was compared showing no differences in long-term functional outcome (mRS 0-3: 36.4% in left ICH vs. 33.9% in right ICH; p = 0.51). Sub-analyses of patients with deep vs. lobar ICH revealed also no differences in outcome measures (mRS 0-3: 53/151 [35.1%] in left deep ICH vs. 53/165 [32.1%] in right deep ICH; p = 0.58). Conclusion: Previously described differences in clinical end points among patients with left- vs. right-hemispheric ICH may be driven by different baseline characteristics rather than by functional deficits emerging from different hemispheric functions affected. After statistical corrections for confounding variables, there was no impact of hemispheric location on functional outcome after ICH.

scholarly journals Hypospadias: clinical approach, surgical technique and long-term outcome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pier Luca Ceccarelli ◽  
Laura Lucaccioni ◽  
Francesca Poluzzi ◽  
Anastasia Bianchini ◽  
Diego Biondini ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Surgical Repair ◽  
Adult Life ◽  
Clinical Approach ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Initial Surgery ◽  
Significant Difference ◽  
Corrective Procedures

Abstract Background Hypospadias is one of the most common congenital abnormalities in male newborn. There is no universal approach to hypospadias surgical repair, with more than 300 corrective procedures described in current literature. The reoperation rate within 6–12 months of the initial surgery is most frequently used as an outcome measure. These short-term outcomes may not reflect those encountered in adolescence and adult life. This study aims to identify the long-term cosmetic, functional and psychosexual outcomes. Methods Medical records of boys who had undergone surgical repair of hypospadias by a single surgical team led by the same surgeon at a single centre between August 2001 and December 2017 were reviewed. Families were contacted by telephone and invited to participate. Surgical outcome was assessed by combination of clinical examination, a life-related interview and 3 validated questionnaires (the Penile Perception Score-PPS, the Hypospadias Objective Score Evaluation-HOSE, the International Index of Erectile Function-5-IIEF5). Outcomes were compared according to age, severity of hypospadias, and respondent (child, parent and surgeon). Results 187 children and their families agreed to participate in the study. 46 patients (24.6%) presented at least one complication after the repair, with a median elapsed time of 11.5 months (6.5–22.5). Longitudinal differences in surgical corrective procedures (p < 0.01), clinical approach (p < 0.01), hospitalisation after surgery (p < 0.01) were found. Cosmetic data from the PPS were similar among children and parents, with no significant differences in child’s age or the type of hypospadias: 83% of children and 87% of parents were satisfied with the cosmetic result. A significant difference in functional outcome related to the type of hypospadias was reflected responses to HOSE amongst all groups of respondents: children (p < 0.001), parents (p=0.02) and surgeon (p < 0.01). The child’s HOSE total score was consistently lower than the surgeon (p < 0.01). The HOSE satisfaction rate on functional outcome was 89% for child and 92% for parent respondents. Conclusion Surgeons and clinicians should be cognizant of the long-term outcomes following hypospadias surgical repair and this should be reflected in a demand for a standardised approach to repair and follow-up.

scholarly journals Assessment of the Subarachnoid Hemorrhage International Trialists (SAHIT) Models for Dichotomized Long-Term Functional Outcome Prediction After Aneurysmal Subarachnoid Hemorrhage in a United Kingdom Multicenter Cohort Study

Neurosurgery ◽  
2020 ◽  
Author(s):  
Isabel C Hostettler ◽  
Menelaos Pavlou ◽  
Gareth Ambler ◽  
Varinder S Alg ◽  
Stephen Bonner ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Functional Outcome ◽  
Outcome Prediction ◽  
Prediction Models ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Predictive Performance ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Fisher Grade

Abstract BACKGROUND Long-term outcome after subarachnoid hemorrhage, beyond the first few months, is difficult to predict, but has critical relevance to patients, their families, and carers. OBJECTIVE To assess the performance of the Subarachnoid Hemorrhage International Trialists (SAHIT) prediction models, which were initially designed to predict short-term (90 d) outcome, as predictors of long-term (2 yr) functional outcome after aneurysmal subarachnoid hemorrhage (aSAH). METHODS We included 1545 patients with angiographically-proven aSAH from the Genetic and Observational Subarachnoid Haemorrhage (GOSH) study recruited at 22 hospitals between 2011 and 2014. We collected data on age, WNFS grade on admission, history of hypertension, Fisher grade, aneurysm size and location, as well as treatment modality. Functional outcome was measured by the Glasgow Outcome Scale (GOS) with GOS 1 to 3 corresponding to unfavorable and 4 to 5 to favorable functional outcome, according to the SAHIT models. The SAHIT models were assessed for long-term outcome prediction by estimating measures of calibration (calibration slope) and discrimination (area under the receiver-operating characteristic curve [AUC]) in relation to poor clinical outcome. RESULTS Follow-up was standardized to 2 yr using imputation methods. All 3 SAHIT models demonstrated acceptable predictive performance for long-term functional outcome. The estimated AUC was 0.71 (95% CI: 0.65-0.76), 0.73 (95% CI: 0.68-0.77), and 0.74 (95% CI: 0.69-0.79) for the core, neuroimaging, and full models, respectively; the calibration slopes were 0.86, 0.84, and 0.89, indicating good calibration. CONCLUSION The SAHIT prediction models, incorporating simple factors available on hospital admission, show good predictive performance for long-term functional outcome after aSAH.

scholarly journals Decreased Time to Evacuation Improves Long Term Functional Outcome in Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Christopher P Kellner ◽  
Rui Song ◽  
Dominic A Nistal ◽  
Ian T McNeill ◽  
Hasitha M Samarage ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
National Institutes Of Health ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Clinical Criteria ◽  
Poor Outcome ◽  
Deep Location

Abstract INTRODUCTION Preclinical and preliminary clinical data suggests that early minimally invasive intracerebral hemorrhage evacuation may convey a functional outcome benefit. Ongoing clinical trials permit an operative window extending out to 72 h. Here we present long term functional outcome after MIS endoscopic ICH evacuation with a focus on time to evacuation. METHODS Minimally invasive endoscopic ICH evacuation was performed on patients with supratentorial ICH who fit previously published clinical criteria including age = 18, National Institutes of Health Stroke Scale (NIHSS) = 6, hematoma volume = 15, and baseline modified Rankin Score (mRS) = 3 with a CTA negative for vascular malformation. Retrospective review was performed on patients who were treated in a single health system from December 2015 to August 2018. Demographic, clinical and radiographic previously demonstrated to impact ICH outcome were included in a multivariate logistic regression to identify factors predicting poor outcome (modified Rankin scale (mRS) 4-6) at 6 mo. RESULTS A total of 97 patients underwent minimally invasive endoscopic ICH evacuation. In a multivariate analysis, factors that predicted poor outcome included age (OR 1.81 (CI 1.15-3.08) P = .016), deep location (OR 11.1 (2.41-67.8) P = .004), presence of intraventricular hemorrhage (OR 5.81 (1.765-22.39) P = .006) and increased time to evacuation measured in hours (OR 1.048 (CI 1.017-1.084) P = .004). CONCLUSION Time to evacuation significantly impacts long term outcome in minimally invasive endoscopic ICH evacuation. Every minute counts.

scholarly journals Non-invasive long-term and real-time analysis of endocrine cells on micro-electrode arrays

2012 ◽  
Vol 590 (5) ◽  
pp. 1085-1091 ◽  
Author(s):  
Matthieu Raoux ◽  
Yannick Bornat ◽  
Adam Quotb ◽  
Bogdan Catargi ◽  
Sylvie Renaud ◽  
...  
Keyword(s):  
Real Time ◽  
Endocrine Cells ◽  
Electrode Arrays ◽  
Time Analysis ◽  
Non Invasive ◽  
Real Time Analysis ◽  
Micro Electrode Arrays

scholarly journals Evaluation of functional outcomes of vertebrobasilar infarction depending on the aff ected intracranial vascular territory of the posterior circulation

2019 ◽  
Vol 27 (3) ◽  
pp. 26-33
Author(s):  
Mariia Prokopiv
Keyword(s):  
Statistical Analysis ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Posterior Circulation ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Thalamic Infarction ◽  
Vertebrobasilar Infarction

The aim of the work is to examine the features of recovery of lost neurological functions and the quali ty of life of patients with acute vertebrobasilar infarction, to evaluate and compare the short-term and long-term outcome of a stroke depending on the aff ected intracranial anatomical areas of the posterior circulation basin. 120 patients with acute vertebrobasilar infarction were examined, among them 22 (18.3 %) patients had a cerebral infarction, 38 (31.7 %) — pontine infarction, 13 (10.8 %) — midbrain infarction, 22 (18.3 %) — thalamic infarction and 25 (20.8 %) patients — cerebellar infarction. Strokes were distributed into three intracranial anatomical territories of the posterior circular basin: proximal, medial, distal. The diagnosis was established on the basis of data from the neurological clinic and magnetic resonance imaging in standard and DV modes. Clinical and neurological comparisons and a comparative statistical analysis of the functional outcomes of infarctions on the 21st and 90th day of a prospective observation. Despite the fact that there is no clear functional boundary between the proximal, medial and distal intracranial anatomical territories of the posterior circulation basin, which once again confi rms their functional unity, the potential for resuming lost neurological functions, a short-term and long-term outcome after infarction of diff erent anatomical and topographic areas of posterior circulation basin do not always match. Statistical analysis pointed that the short-term and long-term functional outcome after a infarction in diff erent intracranial vascular territories of the posterior circulation basin had certain features of the evolution of functional and neurological recovery. In particular, cerebellar infarctions had a signifi cantly better functional outcome compared to infarctions of the medulla oblongata in the short and long term perspective and midbrain infarctions — on the 90th day of the prospective observation (p <0.05). Paired comparisons of functional consequences between cere bellar, pontine and thalamic infarction did not reveal a statistically signifi cant (p > 0.05) correlation between factorial and eff ective signs during short-term and longterm follow-up.

P4764Relationship of the duration of pulmonary vein isolation-refractory non-paroxysmal atrial fibrillation to the middle- to long-term outcome of the ExTRa Mapping-guided ablation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Okuyama ◽  
T Ashihara ◽  
T Ozawa ◽  
Y Fujii ◽  
K Kato ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Real Time ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
High Density ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Mapping System ◽  
Phase Mapping

Abstract Introduction It is reported that for patients with non-paroxysmal (persistent or long-standing persistent) atrial fibrillation (Non-PAF), extended ablation to atrial walls in addition to pulmonary vein isolation (PVI) did not improve the long-term outcome. On the other hand, modulation of Non-PAF drivers (or perpetuators) has been proposed as one of the alternative effective ablation strategies for Non-PAF. Purpose To clarify whether the rotor ablation under online real-time high-density phase mapping system is effective for PVI-refractory Non-PAF ablation. Methods Under such circumstances, our academic group had recently developed the online real-time high-density phase mapping system (ExTRa Mapping™) by industrial alliance. The phase map moving images were based on 41 intra-atrial bipolar signals recorded by a 20-pole spiral-shaped catheter (2.5 cm in diameter) and on in silicorapid prediction of spatio-temporal atrial excitations (artificial intelligence system). Then we applied the ExTRa Mapping to clinical practice in order to directly visualize rotors in patients with Non-PAF, and investigated the middle- to long-term outcome of the ExTRa Mapping-guided rotor ablation (ExTRa-ABL). Results Thirty-eight patients (63±8 y/o, 30 males) with Non-PAF demonstrating refractoriness to PVI were enrolled in this study. Ablation for cavo-tricuspid isthmus and/or superior vena cava isolation was additionally performed at physicians' discretion. After these procedures, the ExTRa-ABL was performed in order to modify Non-PAF substrates, causing rotor control. The modification of the rotors was evaluated by re-mapping with the use of the ExTRa Mapping at the end of each ablation session. Patients were followed at 1, 3, 6 months and every year after the procedure. All of them were followed for 21±8 months. During the follow-up period, Non-PAF was recurred in only 8 of 38 (21%). Furthermore, we found if PVI-refractory Non-PAF duration was shorter than 6 years, the non-recurrence rate remained ≥80% (see Figure), which was markedly better outcome comparing with previous reports with regard to Non-PAF ablation. Figure 1 Conclusion Comparing with conventional Non-PAF ablation strategies, our novel approach with the use of the online real-time high-density phase mapping system might improve medium- to long-term outcome of PVI-refractory Non-PAF treatment.

scholarly journals Presence of Concomitant Systemic Cancer is Not Associated with Worse Functional Long-Term Outcome in Patients with Intracerebral Hemorrhage

2017 ◽  
Vol 44 (3-4) ◽  
pp. 186-194 ◽  
Author(s):  
Maximilian I. Sprügel ◽  
Joji B. Kuramatsu ◽  
Stefan T. Gerner ◽  
Jochen A. Sembill ◽  
Julius Hartwich ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
De Novo ◽  
Clinical History ◽  
Term Outcome ◽  
Cancer Disease ◽  
Long Term Outcome ◽  
Patients With Cancer ◽  
Treatment Restrictions

Background: Data on clinical characteristics and outcome of patients with intracerebral hemorrhage (ICH) and concomitant systemic cancer disease are very limited. Methods: Nine hundred and seventy three consecutive primary ICH patients were analyzed using our prospective institutional registry over a period of 9 years (2006-2014). We compared clinical and radiological parameters as well as outcome - scored using the modified Rankin Scale (mRS) and analyzed in a dichotomized fashion as favorable outcome (mRS = 0-3) and unfavorable outcome (mRS = 4-6) - of ICH patients with and without cancer. Relevant imbalances in baseline clinical and radiological characteristics were adjusted using propensity score (PS) matching. Results: Prevalence of systemic cancer among patients with ICH was 8.5% (83/973). ICH patients with cancer were older (77 [70-82] vs. 72 [63-80] years; p = 0.002), had more often prior renal dysfunction (19/83 [22.9%] vs.107/890 [12.0%]; p = 0.005), and smaller hemorrhage volumes (10.1 [4.8-24.3] vs. 15.3 [5.4-42.9] mL; p = 0.017). After PS-matching there were no significant differences neither in mortality nor in functional outcome both at 3 months (mortality: 33/81 [40.7%] vs. 55/158 [34.8%]; p = 0.368; mRS = 0-3: 28/81 [34.6%] vs. 52/158 [32.9%]; p = 0.797) and 12 months (mortality: 39/78 [50.0%] vs. 70/150 [46.7%]; p = 0.633; mRS = 0-3: 25/78 [32.1%] vs. 53/150 [35.3%]; p = 0.620) among patients with and without concomitant systemic cancer. ICH volume tended to be highest in patients with hematooncologic malignancy and smallest in urothelial cancer. Conclusions: Patients with ICH and concomitant systemic cancer on average are older; however, they show smaller ICH volumes compared to patients without cancer. Yet, mortality and functional outcome is not different in ICH patients with and without cancer. Thus, the clinical history or the de novo diagnosis of concomitant malignancies in ICH patients should not lead to unjustified treatment restrictions.

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