Somatosensory Evoked Potential Monitoring During Endoscopic Endonasal Approach to Skull Base Surgery: Analysis of Observed Changes

2011 ◽  
Vol 69 (suppl_1) ◽  
pp. ons64-ons76 ◽  
Author(s):  
Parthasarathy D Thirumala ◽  
Amin B. Kassasm ◽  
Miguel Habeych ◽  
Kelley Wichman ◽  
Yue-Fang Chang ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Cranial Nerves ◽  
Neurological Deficits ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Endonasal Approach ◽  
Invasive Approach ◽  
Neurovascular Structures

Abstract BACKGROUND: Intraoperative neurophysiological monitoring, including upper- and lower-extremity somatosensory evoked potentials (SSEPs), has been used to identify and prevent injury to neurovascular structures during conventional skull base surgery. The expanded endonasal approach (EEA) is a novel minimally invasive approach to skull base surgery. However, it carries the risk of injury to neurovascular structures, including the internal carotid artery, anterior cerebral artery, and cranial nerves. OBJECTIVE: To evaluate the value of SSEP monitoring to predict and/or prevent neurovascular deficits during EEA to skull base surgery. METHODS: We retrospectively identified 999 consecutive patients who had intraoperative neurophysiological monitoring during EEA skull base surgery at our institution. A total of 976 patients had SSEP monitoring and a documented postoperative neurological examination. RESULTS: The incidence of changes in SSEP during the procedure was 20 of 976 (2%). The incidence of new postoperative neurological deficits was 5 of 976 (0.5%). The positive and negative predictive values of SSEPs during EEA to predict neurovascular deficits were 80.00% and 99.79%, respectively. CONCLUSION: Intraoperative SSEP monitoring was able to identify impending risk to neurovascular structures to prevent permanent postoperative neurological deficits. We advocate a comprehensive approach to neurophysiological monitoring during EEAs, including SSEPs, spontaneous and triggered electromyography of the cranial nerves III through XII, brainstem auditory evoked potentials, and electroencephalogram, depending on the surgical approach and location of the neural structures at risk.

scholarly journals Intraoperative Neurophysiological Monitoring for Endoscopic Endonasal Approaches to the Skull Base: A Technical Guide

Scientifica ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-20
Author(s):  
Harminder Singh ◽  
Richard W. Vogel ◽  
Robert M. Lober ◽  
Adam T. Doan ◽  
Craig I. Matsumoto ◽  
...  
Keyword(s):  
Nervous System ◽  
Evoked Potentials ◽  
Skull Base ◽  
Auditory Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Cranial Nerves ◽  
Somatosensory System ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Endoscopic Endonasal

Intraoperative neurophysiological monitoring during endoscopic, endonasal approaches to the skull base is both feasible and safe. Numerous reports have recently emerged from the literature evaluating the efficacy of different neuromonitoring tests during endonasal procedures, making them relatively well-studied. The authors report on a comprehensive, multimodality approach to monitoring the functional integrity of at risk nervous system structures, including the cerebral cortex, brainstem, cranial nerves, corticospinal tract, corticobulbar tract, and the thalamocortical somatosensory system during endonasal surgery of the skull base. The modalities employed include electroencephalography, somatosensory evoked potentials, free-running and electrically triggered electromyography, transcranial electric motor evoked potentials, and auditory evoked potentials. Methodological considerations as well as benefits and limitations are discussed. The authors argue that, while individual modalities have their limitations, multimodality neuromonitoring provides a real-time, comprehensive assessment of nervous system function and allows for safer, more aggressive management of skull base tumors via the endonasal route.

scholarly journals Intraoperative use of heads-up display in skull base surgery

2022 ◽  
Vol 6 (1) ◽  
pp. V2
Keyword(s):  
Virtual Reality ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Tumor Resection ◽  
Neurological Deficits ◽  
Neurophysiological Monitoring ◽  
Subtotal Resection ◽  
Reduce Blood Loss ◽  
Tumor Embolization ◽  
Anterior Choroidal

In this video, the authors highlight the applications of virtual reality and heads-up display in skull base surgery by presenting the case of a 45-year-old woman with an incidental large clinoid meningioma extending into the posterior fossa. The patient underwent preoperative endovascular tumor embolization to facilitate tumor resection and reduce blood loss, followed by a right pterional craniotomy. The use of intraoperative Doppler, intraoperative neurophysiological monitoring, and endoscope-assisted microsurgery is also featured. A subtotal resection was planned given tumor encasement of the posterior communicating and anterior choroidal arteries. No new neurological deficits were noted after the surgical procedure. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21177

Transvertebral Transposition of the Spinal Cord for Recovery of Motor Evoked Potentials and Somatosensory Evoked Potentials After Acute Paraplegia During Kyphoscoliosis Surgery: Technique Note, Case Reports and Literature Review

2020 ◽  
Author(s):  
Chao Chen ◽  
Jing Li ◽  
Bingjin Wang ◽  
Lingwei Zhu ◽  
Yong Gao ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Evoked Potentials ◽  
Somatosensory Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Case Reports ◽  
Deformity Correction ◽  
Neurological Deficits ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Acute Paraplegia

Abstract Background: Neurological impairment during spinal deformity surgery was the most serious complication. When confronting intraoperative neurophysiological monitoring alerts, various surgical management methods such as the release of implants and decompression of the spinal cord are always performed. Transvertebral transposition of the spinal cord is rarely performed, and its role in the management of acute paraplegia is seldom reported.Methods: The authors present two patients with kyphoscoliosis experienced intraoperatively or postoperatively neurological deficits and abnormal neurological monitoring was detected during correction surgery. Acute paraplegia was confirmed by a wake-up test. Subsequent spinal cord transposition was performed. Intraoperative neurophysiological monitoring motor evoked potentials (MEP) and somatosensory evoked potentials (SEP) was performed to detect the changes during the process.Results: After transvertebral transposition of the spinal cord, the MEPs and SEPs were significantly improved in both patients during surgery. The spinal cord function was restored postoperatively and recovered to normal at the final follow-up in two patients. Conclusions： This case demonstrated that instead of decreasing the correction ratio of kyphoscoliosis, transvertebral transposition of the spinal cord under intraoperative neurophysiological monitoring could be an effective therapeutic strategy for acute spinal cord dysfunction caused by deformity correction surgeries.

Bone Removal With a New Ultrasonic Bone Curette During Endoscopic Endonasal Approach to the Sellar-Suprasellar Area: Technical Note

2010 ◽  
Vol 66 (suppl_1) ◽  
pp. ons-E118-ons-E118 ◽  
Author(s):  
Paolo Cappabianca ◽  
Luigi M. Cavallo ◽  
Isabella Esposito ◽  
Mohamed Barakat ◽  
Felice Esposito
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Technical Note ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Bone Removal ◽  
Hand Piece ◽  
Skull Base Lesions ◽  
Neurovascular Structures

Abstract Background: Accessing intradural lesions via an extended endoscopic endonasal approach requires a relatively large bony removal over the skull base. Objective: We describe the Sonopet ultrasonic bone curette with a new dedicated endonasal hand-piece. Materials and Methods: We used this ancillary device in 27 nonconsecutive endonasal procedures for different skull base lesions (18 standard pituitary operations and 9 extended approaches for either meningiomas or craniopharyngiomas). Results: The ultrasonic bone curette with endonasal hand-piece was easy to use and effective during the removal of the bone covering or when close to the carotid and optic prominences, as well as in preserving the integrity of the superior intercavernous sinus. In only 1 case was small tearing of the dura mater observed during the bony removal. No cases of injury to the major neurovascular structures occurred. Conclusion: The Sonopet ultrasonic bone curette is a useful tool during endoscopic endonasal skull base surgery.

Evoked Potentials of Caudal Cranial Nerves and Functional Outcomes in Skull Base Surgery

2017 ◽  
Vol 99 ◽  
pp. 801
Author(s):  
Vinícius Trindade Gomes Silva ◽  
Marcelo Prudente ◽  
Manoel J. Teixeira ◽  
Wellingson S. Paiva
Keyword(s):  
Evoked Potentials ◽  
Skull Base ◽  
Functional Outcomes ◽  
Skull Base Surgery ◽  
Cranial Nerves

scholarly journals The Efficacy of Intraoperative Neurophysiological Monitoring to Detect Postoperative Neurological Deficits in Transforaminal Lumbar Interbody Fusion Surgery

2018 ◽  
Vol 16 (1) ◽  
pp. 71-78 ◽  
Author(s):  
Joung Heon Kim ◽  
Svetlana Lenina ◽  
Grace Mosley ◽  
Joshua Meaike ◽  
Benjamin Tran ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Sensitivity And Specificity ◽  
Interbody Fusion ◽  
High Sensitivity ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Neurological Deficits ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Motor Deficits ◽  
Lumbar Interbody Fusion

Abstract BACKGROUND Despite the extensive use of intraoperative neurophysiological monitoring (IONM) in spinal procedures, there is no standard guideline for what types of IONM tests should be monitored during lumbar procedures with instrumentation. Moreover, the efficacy of IONM during transforaminal lumbar interbody fusion (TLIF) surgery in detecting postoperative neurological deficits has not been well described. OBJECTIVE To analyze waveform changes from individual IONM tests (somatosensory evoked potentials [SSEP], motor evoked potentials [MEP], and electromyography [EMG]) during TLIF and compare the sensitivity and specificity of these tests in order to determine the best combination to detect postoperative neurological deficits. METHODS Two hundred seventy-five consecutive TLIF cases with IONM between 2010 and 2014 were reviewed, and new postoperative sensory and motor deficits were documented. Sensitivity and specificity for each IONM test in detecting postoperative sensory and/or motor deficits were analyzed. RESULTS SSEP and EMG tests were performed on all 275 patients with 66 patients undergoing additional MEP tests. A total of 7 postoperative deficits have been reported: 2 sensory and 5 motor deficits. MEP test had high sensitivity (80.0%) and specificity (100%) in detecting motor deficits. However, SSEP changes failed to detect sensory deficits and EMG test had high false-positive rates for detecting both sensory (100%) and motor deficits (97.3%). CONCLUSION MEP test should be incorporated in monitoring protocols during spinal procedures that involve instrumentations below vertebral level L1 such as TLIF, as it provides high sensitivity and specificity in detecting postoperative motor deficits. In addition, we propose modifying the standard lower extremity SSEP monitoring protocol to correspond to the vertebral levels being operated on.

A Look Beyond the Sella: The Expanded Endonasal Approach and a Systematic Arrangement of the Coronal Plane in Skull Base Surgery

Skull Base ◽  
2008 ◽  
Vol 18 (S 01) ◽  
Author(s):  
Ricky Madhok ◽  
Daniel Prevedello ◽  
Paul Gardner ◽  
Carl Snyderman ◽  
Ricardo Carrau ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Coronal Plane ◽  
Endonasal Approach ◽  
Expanded Endonasal Approach

Full tractography for detecting the position of cranial nerves in preoperative planning for skull base surgery: technical note

2020 ◽  
Vol 132 (5) ◽  
pp. 1642-1652 ◽  
Author(s):  
Timothee Jacquesson ◽  
Fang-Chang Yeh ◽  
Sandip Panesar ◽  
Jessica Barrios ◽  
Arnaud Attyé ◽  
...  
Keyword(s):  
Skull Base ◽  
Preoperative Planning ◽  
Skull Base Surgery ◽  
Cranial Nerves ◽  
Patient Specific ◽  
Small Scale ◽  
Skull Base Tumor ◽  
Skull Base Tumors ◽  
Brain White Matter ◽  
Human Connectome Project

OBJECTIVEDiffusion imaging tractography has allowed the in vivo description of brain white matter. One of its applications is preoperative planning for brain tumor resection. Due to a limited spatial and angular resolution, it is difficult for fiber tracking to delineate fiber crossing areas and small-scale structures, in particular brainstem tracts and cranial nerves. New methods are being developed but these involve extensive multistep tractography pipelines including the patient-specific design of multiple regions of interest (ROIs). The authors propose a new practical full tractography method that could be implemented in routine presurgical planning for skull base surgery.METHODSA Philips MRI machine provided diffusion-weighted and anatomical sequences for 2 healthy volunteers and 2 skull base tumor patients. Tractography of the full brainstem, the cerebellum, and cranial nerves was performed using the software DSI Studio, generalized-q-sampling reconstruction, orientation distribution function (ODF) of fibers, and a quantitative anisotropy–based generalized deterministic algorithm. No ROI or extensive manual filtering of spurious fibers was used. Tractography rendering was displayed in a tridimensional space with directional color code. This approach was also tested on diffusion data from the Human Connectome Project (HCP) database.RESULTSThe brainstem, the cerebellum, and the cisternal segments of most cranial nerves were depicted in all participants. In cases of skull base tumors, the tridimensional rendering permitted the visualization of the whole anatomical environment and cranial nerve displacement, thus helping the surgical strategy.CONCLUSIONSAs opposed to classical ROI-based methods, this novel full tractography approach could enable routine enhanced surgical planning or brain imaging for skull base tumors.

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