scholarly journals Modern Views on the Role of Intraoperative Neurophysiological Monitoring in Brain Tumour Surgery

2019 ◽  
Vol 26 (5) ◽  
pp. 105-115
Author(s):  
Vladislav Yu. Murunov ◽  
Lyudmila V. Kovalenko
Keyword(s):  
Cerebral Cortex ◽  
Motor Evoked Potentials ◽  
Conscious State ◽  
Historical Background ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Subcortical Structures ◽  
Brain Tumour Surgery ◽  
Stimulation Of

The article defines the role of intraoperative neurophysiological monitoring (IONM) in neurosurgery, provides a brief historical background, as well as describes the main methods of IONM — somatosensory and motor evoked potentials. The authors describe electrical stimulation of the cerebral cortex and subcortical structures under general anaesthesia and in the conscious state. IONM is an integral part of neurosurgery, with its importance growing in orthopaedics and cavity surgery, where there is a risk of damaging nerve structures.

scholarly journals Intraoperative neurophysiological monitoring in spine surgery: indications, efficacy, and role of the preoperative checklist

2012 ◽  
Vol 33 (5) ◽  
pp. E10 ◽  
Author(s):  
Rishi R. Lall ◽  
Rohan R. Lall ◽  
Jason S. Hauptman ◽  
Carlos Munoz ◽  
George R. Cybulski ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Spine Surgery ◽  
Motor Evoked Potentials ◽  
Neurological Injury ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Free Running ◽  
Evidence Based Guidelines ◽  
Medicolegal Issues

Spine surgery carries an inherent risk of damage to critical neural structures. Intraoperative neurophysiological monitoring (IONM) is frequently used to improve the safety of spine surgery by providing real-time assessment of neural structures at risk. Evidence-based guidelines for safe and efficacious use of IONM are lacking and its use is largely driven by surgeon preference and medicolegal issues. Due to this lack of standardization, the preoperative sign-in serves as a critical opportunity for 3-way discussion between the neurosurgeon, anesthesiologist, and neuromonitoring team regarding the necessity for and goals of IONM in the ensuing case. This analysis contains a review of commonly used IONM modalities including somatosensory evoked potentials, motor evoked potentials, spontaneous or free-running electromyography, triggered electromyography, and combined multimodal IONM. For each modality the methodology, interpretation, and reported sensitivity and specificity for neurological injury are addressed. This is followed by a discussion of important IONM-related issues to include in the preoperative checklist, including anesthetic protocol, warning criteria for possible neurological injury, and consideration of what steps to take in response to a positive alarm. The authors conclude with a cost-effectiveness analysis of IONM, and offer recommendations for IONM use during various forms of spine surgery, including both complex spine and minimally invasive procedures, as well as lower-risk spinal operations.

scholarly journals Pre-motor versus motor cerebral cortex neuromodulation for chronic neuropathic pain

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Igor Lavrov ◽  
Timur Latypov ◽  
Elvira Mukhametova ◽  
Brian Lundstrom ◽  
Paola Sandroni ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Cerebral Cortex ◽  
Motor Cortex ◽  
Initial Assessment ◽  
Motor Cortex Stimulation ◽  
Chronic Neuropathic Pain ◽  
Long Term Effect ◽  
Stimulation Of

AbstractElectrical stimulation of the cerebral cortex (ESCC) has been used to treat intractable neuropathic pain for nearly two decades, however, no standardized approach for this technique has been developed. In order to optimize targeting and validate the effect of ESCC before placing the permanent grid, we introduced initial assessment with trial stimulation, using a temporary grid of subdural electrodes. In this retrospective study we evaluate the role of electrode location on cerebral cortex in control of neuropathic pain and the role of trial stimulation in target-optimization for ESCC. Location of the temporary grid electrodes and location of permanent electrodes were evaluated in correlation with the long-term efficacy of ESCC. The results of this study demonstrate that the long-term effect of subdural pre-motor cortex stimulation is at least the same or higher compare to effect of subdural motor or combined pre-motor and motor cortex stimulation. These results also demonstrate that the initial trial stimulation helps to optimize permanent electrode positions in relation to the optimal functional target that is critical in cases when brain shift is expected. Proposed methodology and novel results open a new direction for development of neuromodulation techniques to control chronic neuropathic pain.

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.

scholarly journals Feasibility of Using Intraoperative Neuromonitoring in the Prophylaxis of Dysesthesia in Transforaminal Endoscopic Discectomies of the Lumbar Spine

2020 ◽  
Vol 10 (8) ◽  
pp. 522
Author(s):  
Paulo Sérgio Teixeira de Carvalho ◽  
Max Rogério Freitas Ramos ◽  
Alcy Caio da Silva Meireles ◽  
Alexandre Peixoto ◽  
Paulo de Carvalho ◽  
...  
Keyword(s):  
Nerve Root ◽  
Statistical Power ◽  
Motor Evoked Potentials ◽  
Lumbar Disc ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Control Group ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Sensory Evoked

(1) Background: Postoperative nerve root injury with dysesthesia is the most frequent sequela following lumbar endoscopic transforaminal discectomy. At times, it may be accompanied by transient and rarely by permanent motor weakness. The authors hypothesized that direct compression of the exiting nerve root and its dorsal root ganglion (DRG) by manipulating the working cannula or endoscopic instruments may play a role. (2) Objective: To assess whether intraoperative neurophysiological monitoring can help prevent nerve root injury by identifying neurophysiological events during the initial placement of the endoscopic working cannula and the directly visualized video endoscopic procedure. (3) Methods: The authors performed a retrospective chart review of 65 (35 female and 30 male) patients who underwent transforaminal endoscopic decompression for failed non-operative treatment of lumbar disc herniation from 2012 to 2020. The patients’ age ranged from 22 to 86 years, with an average of 51.75 years. Patients in the experimental group (32 patients) had intraoperative neurophysiological monitoring recordings using sensory evoked (SSEP), and transcranial motor evoked potentials (TCEP), those in the control group (32 patients) did not. The SSEP and TCMEP data were analyzed and correlated to the postoperative course, including dysesthesia and clinical outcomes using modified Macnab criteria, Oswestry disability index (ODI), visual analog scale (VAS) for leg and back pain. (4) Results: The surgical levels were L4/L5 in 44.6%, L5/S1 in 23.1%, and L3/L4 in 9.2%. Of the 65 patients, 56.9% (37/65) had surgery on the left, 36.9% (24/65) on the right, and the remaining 6.2% (4/65) underwent bilateral decompression. Postoperative dysesthesia occurred in 2 patients in the experimental and six patients in the control group. In the experimental neuromonitoring group, there was electrodiagnostic evidence of compression of the exiting nerve root’s DRG in 24 (72.7%) of the 32 patients after initial transforaminal placement of the working cannula. A 5% or more decrease and a 50% or more decrease in amplitude of SSEPs and TCEPs recordings of the exiting nerve root were resolved by repositioning the working cannula or by pausing the root manipulation until recovery to baseline, which typically occurred within an average of 1.15 min. In 15 of the 24 patients with such latency and amplitude changes, a foraminoplasty was performed before advancing the endoscopic working cannula via the transforaminal approach into the neuroforamen to avoid an impeding nerve root injury and postoperative dysesthesia. (5) Conclusion: Neuromonitoring enabled the intraoperative diagnosis of DRG compression during the initial transforaminal placement of the endoscopic working cannula. Future studies with more statistical power will have to investigate whether employing neuromonitoring to avoid intraoperative compression of the exiting nerve root is predictive of lower postoperative dysesthesia rates in patients undergoing videoendoscopic transforaminal discectomy.

P326 The role of intraoperative neurophysiological monitoring in carotid endarterectomy (CEE)

2017 ◽  
Vol 128 (9) ◽  
pp. e283-e284
Author(s):  
Podgurskaia Gennadievna ◽  
Ivanova Sergeevna ◽  
Vinogradov Ivanovich ◽  
Muhba Vasilievna ◽  
Nikitin Sergeevich
Keyword(s):  
Carotid Endarterectomy ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring

Role of multimodal intraoperative neurophysiological monitoring during positioning of patient prior to cervical spine surgery

2015 ◽  
Vol 126 (6) ◽  
pp. 1264-1270 ◽  
Author(s):  
Julio Plata Bello ◽  
Pedro Javier Pérez-Lorensu ◽  
Héctor Roldán-Delgado ◽  
Liberto Brage ◽  
Verónica Rocha ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Cervical Spine Surgery

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.

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