scholarly journals Valuableness of introduction of laryngeal abductor reflex intraoperative neuromonitoring technique in lower brainstem lesion

2020 ◽  
Vol 11 ◽  
pp. 425
Author(s):  
Vizmary Montes ◽  
Turki Elarjani ◽  
Sami Khairy ◽  
David Pinilla ◽  
Helena Benito ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Facial Palsy ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Intraoperative Neuromonitoring ◽  
Nerve Function ◽  
Case Description ◽  
Amplitude Response ◽  
Brainstem Lesion ◽  
Laryngeal Adductor Reflex

Background: Our aim is to evaluate the use of laryngeal adductor reflex (LAR) for posterior fossa and brainstem surgeries in conjunction with current intraoperative neuromonitoring (IONM) techniques. Case Description: The patient is a 62-year-old woman who complained of decreased hearing on her left side, dizziness, and left facial palsy. After proper investigation, she was found to have a left vestibular schwannoma. She was scheduled for the left retrosigmoid approach and electrodes embedded on the surface of the endotracheal tube were inserted to monitor for LAR. Preoperative baseline monitoring was recorded. During intraoperative resection of tumor, a significant bilateral amplitude response decrease of the LAR was noted, along with left side decrease in vocal muscle motor evoked potential amplitude responses and bradycardia. Following the LAR event, owed to numerous other IONM changes, surgery was terminated to avoid any complications. Conclusion: LAR is an integral tool to constantly monitor vagus nerve function that can be used in combination with other IONM modalities during lower brainstem and posterior fossa surgeries. We advocate the IONM use of LAR in brainstem surgeries.

Role of Facial Nerve Motor-Evoked Potential Ratio in Predicting Facial Nerve Function in Vestibular Schwannoma Surgery Both Immediate and at 1 Year

2016 ◽  
Vol 37 (8) ◽  
pp. 1162-1167 ◽  
Author(s):  
Sanjiv K. Bhimrao ◽  
Trung N. Le ◽  
Charles C. Dong ◽  
Serge Makarenko ◽  
Sarin Wongprasartsuk ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Nerve Function ◽  
Facial Nerve Function

T99. Assessing lower brainstem and vagal nerve integrity during posterior fossa surgery by using the laryngeal adductor reflex. Escalating intraoperative neuromonitoring of the lower brainstem

2018 ◽  
Vol 129 ◽  
pp. e40
Author(s):  
Vizmary J. Montes Peña ◽  
Jose Luis Boada Cuellar ◽  
Diego Rodriguez MenA ◽  
Jesus Aguas Valiente ◽  
Juan F. Sanchez Ortega ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Intraoperative Neuromonitoring ◽  
Vagal Nerve ◽  
Posterior Fossa Surgery ◽  
Laryngeal Adductor Reflex

Quantitative parameters of facial motor evoked potential during vestibular schwannoma surgery predict postoperative facial nerve function

2011 ◽  
Vol 153 (6) ◽  
pp. 1169-1179 ◽  
Author(s):  
Marcus André Acioly ◽  
Alireza Gharabaghi ◽  
Marina Liebsch ◽  
Carlos Henrique Carvalho ◽  
Paulo Henrique Aguiar ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Quantitative Parameters

scholarly journals The influence of anaesthesia on intraoperative neuromonitoring changes in high-risk spinal surgery

2017 ◽  
Vol 04 (03) ◽  
pp. 159-166
Author(s):  
Nathan Royan ◽  
Nancy Lu ◽  
Pirjo Manninen ◽  
Lakshmikumar Venkatraghavan
Keyword(s):  
High Risk ◽  
Spinal Surgery ◽  
Statistical Difference ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Intraoperative Neuromonitoring ◽  
Neurological Deficits ◽  
Neurophysiological Monitoring ◽  
Surgical Interventions ◽  
Neurological Outcomes

Abstract Background: The use of intraoperative neuromonitoring is a well-established method of detecting neurologic injuries during spine surgery. Anaesthesia, especially inhalational agents, influence motor evoked potential (MEP) monitoring. The aim of our study was to compare the effect of balanced anaesthesia (BA) (intravenous plus inhalational anaesthesia) and total intravenous anaesthesia (TIVA) on the incidence of intraoperative neuromonitoring changes, interventions performed and neurological outcomes of patients following high-risk spinal surgery. Methods: After Research and Ethics Board approval, a retrospective review of 155 patients who underwent spinal surgery with MEP was performed. Data were collected on changes in MEP and/or somatosensory evoked potential, interventions performed and neurological outcomes. Patients were divided into BA and TIVA groups and data were analysed. Results: A total of 152 patients were eligible for the study (mean age 54 ± 17, male: female 45:55). A BA technique was used in 62% and TIVA in 38%. Desflurane (<0.5 minimum alveolar concentration [MAC]) was used in 85% BA cases. Intraoperative neuromonitoring changes occurred in 11.8% (18/152) of cases. There was no statistical difference in the incidence of monitoring changes between BA (78%) and TIVA (22%) groups (P = 0.197). Anaesthetic or surgical interventions were performed in 12 patients, with a resolution of changes in 50% (P = 0.455). All 5 patients with persistent MEP changes had worsening of existing neurological deficits postoperatively; 8 had transient MEP changes, and 2 experienced worsening of existing neurological deficits. Conclusions: We found that intraoperative neurophysiological monitoring can be performed with both BA (MAC <0.5) and TIVA in high-risk spinal surgery with no statistical difference in the incidence of intraoperative monitoring changes.

scholarly journals Intraoperative Neuromonitoring During Resection of Gliomas Involving Eloquent Areas

2021 ◽  
Vol 12 ◽  
Author(s):  
Hao You ◽  
Hui Qiao
Keyword(s):  
Evoked Potential ◽  
Life Quality ◽  
Motor Evoked Potential ◽  
Extent Of Resection ◽  
Intraoperative Neuromonitoring ◽  
Eloquent Areas ◽  
Combined Use ◽  
Neurological Protection ◽  
Equal Consideration

In the case of resection of gliomas involving eloquent areas, equal consideration should be given to maintain maximal extent of resection (EOR) and neurological protection, for which the intraoperative neuromonitoring (IONM) proves an effective and admirable approach. IONM techniques applied in clinical practice currently consist of somatosensory evoked potential (SSEP), direct electrical stimulation (DES), motor evoked potential (MEP), electromyography (EMG), and electrocorticography (ECoG). The combined use of DES and ECoG has been adopted widely. With the development of technology, more effective IONM tactics and programs would be proposed. The ultimate goal would be strengthening the localization of eloquent areas and epilepsy foci, reducing the incidence of postoperative dysfunction and epilepsy improving the life quality of patients.

Geographic Differences is Intraoperative Neuromonitoring During Minimally Invasive Lateral Spine Surgery

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Sheeraz Qureshi ◽  
Luke Ricci ◽  
Avani Vaishnav ◽  
Steven Mcanany ◽  
Sravisht Iyer ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spine Surgery ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Clinical Information ◽  
The United States ◽  
Intraoperative Neuromonitoring ◽  
Neurologic Injury ◽  
Lateral Spine ◽  
Minimally Invasive Spine

Abstract INTRODUCTION The purpose of this study was to see if the rate of usage of each modality was the same between geographic regions. METHODS Demographic information (age, gender, and region within the United States) as well as clinical information (type of intraoperative neuromonitoring and rates of alerts) were assessed. A total of 841 patients with an average age of 61 yr (range 12-88 yr) had intraoperative neuromonitoring during minimally invasive spine surgery (MIS) LLIF/XLIF procedures. A total of 314 were from the Southeast and 527 from the Northeast. RESULTS Overall, alerts for each modality occurred at different rates (P < .05). Between regions, there was no difference in motor evoked potential (MEP) alerts (P = .83) but electromyography (EMG) and somatosensory evoked potential (SSEP) alerts occurred at different rates, with both alerts seen more frequently in the Northeast, (P < .05). Four cases had an alert occur in 2 modalities, 2 cases had SSEP and EMG alerts, and 2 other cases had SSEP and MEP alerts. No common cause was found to trigger any of the alerts. CONCLUSION The rate of usage for all 3 monitoring modalities was different between regions as MEP and SSEP were used more often in the Northeast and EMG was used more often in the Southeast. This regional variation indicates potential opportunity for standardization of monitoring indications. Although the alerts for each modality were seen at different rates, an alert from one modality was rarely seen in the same case as an alert from a different modality. In the few instances with alerts from more than one modality within the same case, the alerts did not seem to have the same cause. Because of this, utilizing different intraoperative neuromonitoring modalities has the potential to increase detection of potential neurologic injury.

Intraoperative facial motor evoked potential monitoring for pontine cavernous malformation resection

2020 ◽  
Vol 132 (1) ◽  
pp. 265-271
Author(s):  
Ridzky Firmansyah Hardian ◽  
Tetsuya Goto ◽  
Yu Fujii ◽  
Kohei Kanaya ◽  
Tetsuyoshi Horiuchi ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Cavernous Malformation ◽  
Motor Evoked Potentials ◽  
Motor Evoked Potential ◽  
Warning Signs ◽  
Constant Current ◽  
Karnofsky Performance Scale ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Cavernous Malformations

OBJECTIVEThe aim of this study was to predict postoperative facial nerve function during pontine cavernous malformation surgery by monitoring facial motor evoked potentials (FMEPs).METHODSFrom 2008 to 2017, 10 patients with pontine cavernous malformations underwent total resection via the trans–fourth ventricle floor approach with FMEP monitoring. House-Brackmann grades and Karnofsky Performance Scale (KPS) scores were obtained pre- and postoperatively. The surgeries were performed using one of 2 safe entry zones into the brainstem: the suprafacial triangle and infrafacial triangle approaches. Six patients underwent the suprafacial triangle approach, and 4 patients underwent the infrafacial triangle approach. A cranial peg screw electrode was used to deliver electrical stimulation for FMEP by a train of 4 or 5 pulse anodal constant current stimulation. FMEP was recorded from needle electrodes on the ipsilateral facial muscles and monitored throughout surgery by using a threshold-level stimulation method.RESULTSFMEPs were recorded and analyzed in 8 patients; they were not recorded in 2 patients who had severe preoperative facial palsy and underwent an infrafacial triangle approach. Warning signs appeared in all patients who underwent the suprafacial triangle approach. However, after temporarily stopping the procedures, FMEP findings during surgery showed recovery of the thresholds. FMEPs in patients who underwent the infrafacial triangle approach were stable during the surgery. House-Brackmann grades were unchanged postoperatively in all patients. Postoperative KPS scores improved in 3 patients, decreased in 1, and remained the same in 6 patients.CONCLUSIONSFMEPs can be used to monitor facial nerve function during surgery for pontine cavernous malformations, especially when the suprafacial triangle approach is performed.

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