scholarly journals The use of intraoperative neurophysiological monitoring in dorsal resection of hemivertebrae

2021 ◽  
Vol 9 (3) ◽  
pp. 267-276
Author(s):  
Sergei V. Vissarionov ◽  
Ayrat R. Syundyukov ◽  
Nikolay S. Nikolaev ◽  
Valentina A. Kuzmina ◽  
Pavel N. Kornyakov ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Age Groups ◽  
Neurological Complications ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Congenital Deformity ◽  
Transcranial Electrical Stimulation ◽  
Abdominal Muscles ◽  
Thoracic Level

BACKGROUND: Congenital disorders of vertebrae formation are a common pathology in children. Intraoperative neurophysiological monitoring is a mandatory procedure, although it may not be effective enough due to the immature neural structures and the use of inhalation anesthetics in young children. AIM: To study aims to investigate the characteristic features of intraoperative neurophysiological monitoring in children with a congenital deformity of the spine during dorsal resection of the hemivertebrae. MATERIALS AND METHODS: 42 patients aged 117 years with a congenital deformity of the spine underwent 46 resections of the abnormal vertebra from an isolated dorsal approach (egg-shell technique). Intraoperative neurophysiological monitoring at the stages of the operation included a muscle relaxant test (TOF), transcranial electrical stimulation of the motor cortex (TCeMEP), control of the approach to the nerve (N. Proxy), correct placement of the pedicle screw (Screw Integrity), and EMG recording of the electromyogram. The accuracy of the screw placement was assessed by the Gerzbien method, and the presence of neurological disorders was tested by the Frenkel scale. The effect of inhalation anesthetic (sevoran) on motor evoked potentials was monitored by regulating its delivery, and the dependence on the age of patients was evaluated. RESULTS: The average age of patients was 7.7 4.5 years, and the TOF value was 80.5 17%. In 41 patients, the N. Proxy test was unremarkable, while in one patient, the 812 mA value did not require a change in the trajectory of the screws. From the beginning of sevoran and intraoperatively, motor evoked potentials from all tested muscles were recorded in 54.8% of patients; in children over 8 years old, this was observed in 92.8%, in children under 8 years old in 35.7% of cases in their age groups. In other patients, motor evoked potentials were most often not recorded from the muscles of the thigh and lower leg after sevoran administration. In children over 8 years old in 7.2%, under 8 years old in 83.3% of patients; Interestingly, in 7.2% of patients who are under 8 years of age, motor evoked potentials were not initially recorded from any muscle. Withdrawal of sevorane in 30.9% of patients allowed intraoperative motor evoked potentials to be obtained from all tested muscles in 100% of cases. For adequate management of anesthesia, 5 patients (50%) 14 years old and one patient 6 years old (5.6%) did not receive sevoran, and motor evoked potentials were recorded from the abdominal muscles. This allowed to assess the conduction only at the thoracic level and are required increased vigilance of surgeons when carrying out any corrective manipulations. CONCLUSIONS: Intraoperative neurophysiological monitoring with dorsal hemivertebra resection is an effective method that allows controlling the neurological complications during manipulations on the spine.

scholarly journals Intra-operative neurophysiological monitoring

2015 ◽  
Vol 02 (03) ◽  
pp. 179-192
Author(s):  
Zulfiqar Ali ◽  
Parmod Bithal
Keyword(s):  
Evoked Potentials ◽  
Surgical Procedures ◽  
Complication Rate ◽  
Motor Evoked Potentials ◽  
Neurological Complication ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Sensory Evoked Potentials ◽  
Sensory Evoked

AbstractIntraoperative neurophysiological monitoring has achieved importance due to complexity of cranio-spinal surgical procedures being performed frequently these days. Many studies have proven a decreased neurological complication rate after its introduction. It is broadly of two types: Sensory evoked potentials and motor evoked potentials which are further sub-divided. Its use during surgery requires a controlled anaesthesia technique with no or minimal influence on its recording. Its success depends upon three way communication among the surgeon the neurophysiologist and the anaesthesiologist.

Intraoperative neurophysiological monitoring

2010 ◽  
pp. 188-193
Author(s):  
George Samandouras
Keyword(s):  
Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Sensory Evoked Potentials ◽  
Sensory Evoked

Chapter 4.3 covers sensory evoked potentials, motor evoked potentials (MEPs), electromyography, and the wake-up test.

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.

scholarly journals The influence of depth of anesthesia and blood pressure on muscle recorded motor evoked potentials in spinal surgery. A prospective observational study protocol

2021 ◽  
Author(s):  
Sebastiaan E. Dulfer ◽  
M. M. Sahinovic ◽  
F. Lange ◽  
F. H. Wapstra ◽  
D. Postmus ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Evoked Potentials ◽  
Study Protocol ◽  
False Positive ◽  
Motor Evoked Potentials ◽  
Neurological Injury ◽  
Neurophysiological Monitoring ◽  
Transcranial Electrical Stimulation ◽  
Depth Of Anesthesia ◽  
Registration Number

AbstractFor high-risk spinal surgeries, intraoperative neurophysiological monitoring (IONM) is used to detect and prevent intraoperative neurological injury. The motor tracts are monitored by recording and analyzing muscle transcranial electrical stimulation motor evoked potentials (mTc-MEPs). A mTc-MEP amplitude decrease of 50–80% is the most common warning criterion for possible neurological injury. However, these warning criteria often result in false positive warnings. False positives may be caused by inadequate depth of anesthesia and blood pressure on mTc-MEP amplitudes. The aim of this paper is to validate the study protocol in which the goal is to investigate the effects of depth of anesthesia (part 1) and blood pressure (part 2) on mTc-MEPs. Per part, 25 patients will be included. In order to investigate the effects of depth of anesthesia, a processed electroencephalogram (pEEG) monitor will be used. At pEEG values of 30, 40 and 50, mTc-MEP measurements will be performed. To examine the effect of blood pressure on mTc-MEPs the mean arterial pressure will be elevated from 60 to 100 mmHg during which mTc-MEP measurements will be performed. We hypothesize that by understanding the effects of depth of anesthesia and blood pressure on mTc-MEPs, the mTc-MEP monitoring can be interpreted more reliably. This may contribute to fewer false positive warnings. By performing this study after induction and prior to incision, this protocol provides a unique opportunity to study the effects of depths of anesthesia and blood pressure on mTc-MEPs alone with as little confounders as possible.Trial registration number NL7772.

Monitoring of muscle motor evoked potentials during cerebral aneurysm surgery: intraoperative changes and postoperative outcome

2006 ◽  
Vol 105 (5) ◽  
pp. 675-681 ◽  
Author(s):  
Andrea Szelényi ◽  
David Langer ◽  
Karl Kothbauer ◽  
Adauri Bueno de Camargo ◽  
Eugene S. Flamm ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Cerebral Aneurysm ◽  
Motor Evoked Potentials ◽  
Cortical Stimulation ◽  
Constant Current ◽  
Motor Deficit ◽  
Neurophysiological Monitoring ◽  
Transcranial Electrical Stimulation ◽  
Aneurysm Surgery ◽  
Direct Cortical Stimulation

Object The authors in this study evaluated muscle motor evoked potentials (MMEPs) elicited by transcranial electrical stimulation (TES) and direct cortical stimulation as a means of monitoring during cerebral aneurysm surgery. The analysis focused on the value and frequencies of any intraoperative changes and their correlation to the postoperative motor status. Methods One hundred nineteen patients undergoing surgery for 148 cerebral aneurysms were included in the study. Muscle motor evoked potentials were elicited by a train of five constant-current anodal stimuli with an individual pulse duration of 0.5 msec and a stimulation rate of 2 Hz. Stimulation intensity was up to 240 mA for TES and up to 33 mA for direct cortical stimulation. The MMEPs were continuously recorded from the abductor pollicis brevis and tibialis anterior muscles bilaterally and from the biceps brachii and extensor digitorum communis muscles contralateral to the surgical side. The motor status was evaluated immediately after surgery and 7 days later. In 97% of the patients MMEPs were recordable for continuous neurophysiological monitoring of the vascular territory of interest throughout the surgery. In 14 patients significant intraoperative MMEP changes occurred, resulting in a transient motor deficit in one patient and a permanent motor deficit in six. The permanent loss of MMEPs in three patients was followed by a permanent severe motor deficit in one patient and severe clinical deterioration in the other two. Conclusions Data in this study demonstrated that MMEPs are a useful means of intraoperative neurophysiological monitoring of motor pathway integrity and predicting postoperative motor status. The intraoperative loss of MMEPs reliably predicts both severe and permanent postoperative motor deficits.

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.

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