scholarly journals Neurophysiological Monitoring During Large Femoral and Pelvic Tumoral Resections

2020 ◽  
pp. 1-5
Author(s):  
Camilla Arvinius ◽  
Camilla Arvinius ◽  
Elena Manrique-Gamo ◽  
Hector Marcelo ◽  
Juan-Luis Cebrian ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Evoked Potentials ◽  
Nerve Injury ◽  
Neurological Injury ◽  
Neurophysiological Monitoring ◽  
Case Presentation ◽  
Neurophysiologic Monitoring ◽  
Intraoperative Neurophysiologic Monitoring ◽  
Postoperative Control ◽  
A Prospective Study

Background: Oncological femoral or pelvic resections and reconstruction have become an alternative to large amputations. However, one of the frequent risks is the neurological injury. The use of intraoperative evoked potentials allows its control in order to modify the surgical gestures. The purpose of this study was to evaluate the results of intraoperative neurophysiologic monitoring in large reconstructive arthroplasty surgeries. Case presentation: A prospective study (2012-2018) was performed, including 8 patients with 6 complete resections of the femur and 2 resections of the pelvis. In all cases, intraoperative lumbar plexus monitoring was performed using evoked potentials in order to analyze variations during surgery as well as a postoperative control. 100% could be correctly monitored throughout the surgery. In 4 cases, intraoperative anomalies were detected requiring modification of the surgery. Of these, postoperatively only one nerve injury persisted: a complete sciatic nerve injury due to an intraoperative vascular injury. Conclusion: Intraoperative neurophysiological monitoring is a very useful resource in large oncological resection, allowing detection of nerve distress due to manipulation or excessive limb traction during reconstruction. The use of somatosensory evoked potentials in large oncological resections can predict and minimize the risk of relevant postoperative nerve complications

An Unusual Neurological Complication following Internal Fixation of Pertrochanteric Fracture Neck of the Femur

2002 ◽  
Vol 12 (4) ◽  
pp. 400-402
Author(s):  
R. Dharmarajan ◽  
R. Vadivelu ◽  
T. Lawrence
Keyword(s):  
Sciatic Nerve ◽  
Femoral Neck ◽  
Nerve Injury ◽  
Neurological Complication ◽  
The Elderly ◽  
Femoral Neck Fractures ◽  
Sciatic Nerve Injury ◽  
Foot Drop ◽  
Pertrochanteric Fracture ◽  
Neurological Injury

Fracture of the femoral neck is a common injury in the elderly population and may be associated with significant morbidity. More than 25,000 patients per year in the UK receive treatment for femoral neck fractures. Neurological injury associated with pertrochanteric fracture of the neck of the femur is rare. Sciatic nerve injury following isolated pertrochanteric femoral neck fractures is very rare and has not previously been reported in the literature. We describe a case of foot drop secondary to sciatic nerve injury following fracture of neck of the femur, with recovery after surgical exploration and nerve release.

scholarly journals THE ROLE OF INTRAOPERATIVE NEUROPHYSIOLOGIC MONITORING TO ENHANCE SUCCESSFUL ORTHOPEDIC SURGERY

2022 ◽  
Vol 8 (1) ◽  
pp. 35-38
Author(s):  
Panji Sananta ◽  
Anindita Eka Pramana Wijaya ◽  
Marvin Anthony Putera
Keyword(s):  
Nerve Injury ◽  
Surgical Procedure ◽  
Orthopaedic Surgery ◽  
Injury Risk ◽  
Operative Procedure ◽  
Surgical Techniques ◽  
Literature Study ◽  
Neurophysiologic Monitoring ◽  
Intraoperative Neurophysiologic Monitoring ◽  
And Function

One of the main advance in orthopaedic surgery domain has a goal to investigates the safest and harmless method in surgical procedures. Less complications means a better outcome of surgery. One of the commonest risks at orthopaedic surgery is central and peripheral nerve injury. The modality of Intraoperative Neurophysiologic Monitoring (IONM) which act to limit the risk of nerve injury during operative procedure through the evaluation of nerve integrity and function enable the surgeon to decrease injury to the nerve associated with orthopaedic surgical procedure in the operating room. This article aims to explain and describe the latest modality of IONM, its basic concept and its function at surgery. The last part of the article discussed about orthopaedic surgical techniques which use IONM. The authors hope that this article will enhance the knowledge of all the readers about IONM. This article was written based on literature study searched at Google Scholar, Medline and PubMed. The references were taken from a relatively up to date study ranging from 2013-2018. The article was selected according to the authors inclusion criteria and six articles was chosen as the references for this review. As a conclusion, IONM has an important role to increase successful rate of surgery through minimizing nerve injury risk during surgical procedure.

Neurophysiologic Monitoring

2018 ◽  
Author(s):  
Antoun Koht ◽  
Tod B. Sloan
Keyword(s):  
Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Auditory Brainstem ◽  
Auditory Brainstem Responses ◽  
Corrective Surgery ◽  
Neurophysiologic Monitoring ◽  
Intraoperative Neurophysiologic Monitoring ◽  
Evoked Electromyography ◽  
Signal Evaluation

Intraoperative neurophysiologic monitoring is used for monitoring and mapping of neurological structures during surgery and procedures where the neurological structures are at risk. Among the most commonly used techniques are electrophysiologic techniques, which include spontaneous and evoked electromyography, somatosensory evoked potentials, motor evoked potentials, electroencephalography, and auditory brainstem responses. These methods differ in their responses to anesthesia and in their clinical contribution to monitoring because of differing anatomy. Their use in spinal corrective surgery highlights the role of the anesthesiologist during cases when these techniques are utilized. Optimization of anesthesia, position, and physiology provide better monitoring conditions, enhance signal evaluation, and may lead to better neurological outcome.

scholarly journals Peripheral leg ischemia detected via intraoperative neurophysiological monitoring during a multilevel complex anterior and posterior operation

2020 ◽  
Vol 2020 (5) ◽  
Author(s):  
Bobak Rasouli ◽  
Kristine Pederson ◽  
Marshall F Wilkinson ◽  
Mohammad Zarrabian
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
Neurophysiological Monitoring ◽  
Lower Limb Ischemia ◽  
Neurophysiologic Monitoring ◽  
Intraoperative Neurophysiologic Monitoring ◽  
Peripheral Ischemia ◽  
Metastatic Involvement ◽  
The Right ◽  
Leg Ischemia

Abstract Intraoperative neurophysiologic monitoring is a technique utilized during spinal operations to minimize sensory and motor function morbidity. We herein report a case of a 73-year-old female with renal cell carcinoma and metastatic involvement of the cervical and thoracic spine, who underwent a multilevel complex anterior and posterior operation. Neurophysiological monitoring was able to localize the lower limb ischemia utilizing somatosensory evoked potentials. This prompted intraoperative investigation of the peripheral ischemia, and the patient was found to have an Angio-Seal device embolus in the right popliteal artery that dislodged from the right femoral artery.

Neurophysiologic Monitoring for Neurosurgery

2019 ◽  
pp. 137-148
Author(s):  
Antoun Koht ◽  
Laura B. Hemmer ◽  
J. Richard Toleikis ◽  
Tod B. Sloan
Keyword(s):  
Patient Outcome ◽  
Decision Making ◽  
Spinal Cord ◽  
Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Neurophysiological Monitoring ◽  
New Techniques ◽  
Neurophysiologic Monitoring ◽  
Supportive Role ◽  
Improve Patient

Intra-operative neurophysiological monitoring (IOM) has evolved substantially since its beginnings in the 1970s with somatosensory evoked potentials (SSEP) and facial nerve electromyography (EMG). The introduction of new techniques (especially motor evoked potentials [MEP]) and refinements of older techniques have become important tools that the surgeon can use to enhance intra-operative decision making and improve patient outcome of surgical (e.g., intracranial, neurovascular, skull base and brainstem, spine and spinal cord, peripheral nerve) procedures. These monitoring modalities are used to map the anatomic location of neural structures and monitor the functional status of the neural tracts. The anaesthetist plays a key supportive role in monitoring and management when IOM indicates potential neural compromise.

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.

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