Holmes tremor: a delayed complication after resection of brainstem cavernomas

2020 ◽  
pp. 1-11
Author(s):  
Marco Cenzato ◽  
Davide Colistra ◽  
Giorgia Iacopino ◽  
Christian Raftopoulos ◽  
Ulrich Sure ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Neurophysiological Monitoring ◽  
Strict Adherence ◽  
Surgical Access ◽  
Holmes Tremor ◽  
Neurophysiological Studies ◽  
Metropolitan Hospital ◽  
Delayed Complication ◽  
Brainstem Cavernoma ◽  
Predicting Factor

OBJECTIVEIn this paper, the authors aimed to illustrate how Holmes tremor (HT) can occur as a delayed complication after brainstem cavernoma resection despite strict adherence to the safe entry zones (SEZs).METHODSAfter operating on 2 patients with brainstem cavernoma at the Great Metropolitan Hospital Niguarda in Milan and noticing a similar pathological pattern postoperatively, the authors asked 10 different neurosurgery centers around the world to identify similar cases, and a total of 20 were gathered from among 1274 cases of brainstem cavernomas. They evaluated the tremor, cavernoma location, surgical approach, and SEZ for every case. For the 2 cases at their center, they also performed electromyographic and accelerometric recordings of the tremor and evaluated the postoperative tractographic representation of the neuronal pathways involved in the tremorigenesis. After gathering data on all 1274 brainstem cavernomas, they performed a statistical analysis to determine if the location of the cavernoma is a potential predicting factor for the onset of HT.RESULTSFrom the analysis of all 20 cases with HT, it emerged that this highly debilitating tremor can occur as a delayed complication in patients whose postoperative clinical course has been excellent and in whom surgical access has strictly adhered to the SEZs. Three of the patients were subsequently effectively treated with deep brain stimulation (DBS), which resulted in complete or almost complete tremor regression. From the statistical analysis of all 1274 brainstem cavernomas, it was determined that a cavernoma location in the midbrain was significantly associated with the onset of HT (p < 0.0005).CONCLUSIONSDespite strict adherence to SEZs, the use of intraoperative neurophysiological monitoring, and the immediate success of a resective surgery, HT, a severe neurological disorder, can occur as a delayed complication after resection of brainstem cavernomas. A cavernoma location in the midbrain is a significant predictive factor for the onset of HT. Further anatomical and neurophysiological studies will be necessary to find clues to prevent this complication.

Planning Method for Safety Neurosurgical and Computed Tomography Contrast-Data Set Visualization

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Husham Farouk Ismail Saied
Keyword(s):  
Computed Tomography ◽  
Tracking System ◽  
Optical Tracking ◽  
Planning System ◽  
Surgical Instrument ◽  
Optical Tracking System ◽  
Data Set ◽  
Strict Adherence ◽  
Surgical Access ◽  
The Brain

Discussed the issues' associated with the development of a computed neurosurgery planning system. An important part is to determine the value of invasive surgical access. The study purpose is to design a methodology for finding the shortest distance between surgical target and peripheral point of the brain tissue with strict adherence considering the type of the brain anatomical structure existing in the path of surgical track (risk map), these two condition used in companion to determine the risk value of the surgical access. The study method consists of two algorithms for calculating the shortest surgical access to the target and assuring the safety by avoiding high-density tissues identification method “internal map” describing the anatomy of the brain such as bones. An algorithm for automatic identification of brain vascular system also was designed. The structural diagram of the contrast data visualization system, using computed tomography data, was thoroughly discussed. Also, trying to contribute in solving issues facing developers of modern medical imaging visualization systems to select the most appropriate method from the whole arsenal of algorithms and processing models concerning displaying brain surgical zone using image registration and optical tracking system. The visualization of the target zone is carried out according to an internal reference landmark points inside the center of the brain as well as an automatic algorithm for contour recognition was applied. Moreover, the optical tracking system was used to assess the navigation accuracy of determining the position of the surgical instrument outside the patient head. Algorithms necessary for operational planning also was included, and the proposed method was applied in a pilot study with simulation mode to human brain model, in order to target a specific surgical zone, and as a result, the system suggested (24) possible surgical track, among them, were selected the best and safest access. The total error of a surgical instrument targeting was less than 3 mm (in average 2.6 mm).

scholarly journals Management of Extramedullary Intradural Spinal Tumors: The Impact of Clinical Status, Intraoperative Neurophysiological Monitoring and Surgical Approach on Outcomes in a 12-Year Double-Center Experience

2020 ◽  
Vol 11 ◽  
Author(s):  
Fabio Cofano ◽  
Carlotta Giambra ◽  
Paolo Costa ◽  
Pietro Zeppa ◽  
Andrea Bianconi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Surgical Approach ◽  
Spinal Canal ◽  
Clinical Status ◽  
Extent Of Resection ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Surgical Access ◽  
The Impact

Objective: Intradural Extramedullary (IDEM) tumors are usually treated with surgical excision. The aim of this study was to investigate the impact on clinical outcomes of pre-surgical clinical conditions, intraoperative neurophysiological monitoring (IONM), surgical access to the spinal canal, histology, degree of resection and intra/postoperative complications.Methods: This is a retrospective observational study analyzing data of patients suffering from IDEM tumors who underwent surgical treatment over a 12 year period in a double-center experience. Data were extracted from a prospectively maintained database and included: sex, age at diagnosis, clinical status according to the modified McCormick Scale (Grades I-V) at admission, discharge, and follow-up, tumor histology, type of surgical access to the spinal canal (bilateral laminectomy vs. monolateral laminectomy vs. laminoplasty), degree of surgical removal, use and type of IONM, occurrence and type of intraoperative complications, use of Ultrasonic Aspirator (CUSA), radiological follow-up.Results: A total number of 249 patients was included with a mean follow-up of 48.3 months. Gross total resection was achieved in 210 patients (84.3%) mostly in Schwannomas (45.2%) and Meningiomas (40.4%). IONM was performed in 162 procedures (65%) and D-wave was recorded in 64.2% of all cervical and thoracic locations (99 patients). The linear regression diagram for McCormick grades before and after surgery (follow-up) showed a correlation between preoperative and postoperative clinical status. A statistically significant correlation was found between absence of worsening of clinical condition at follow-up and use of IONM at follow-up (p = 0.01) but not at discharge. No associations were found between the choice of surgical approach and the extent of resection (p = 0.79), the presence of recurrence or residual tumor (p = 0.14) or CSF leakage (p = 0.25). The extent of resection was not associated with the use of IONM (p = 0.91) or CUSA (p = 0.19).Conclusion: A reliable prediction of clinical improvement could be made based on pre-operative clinical status. The use of IONM resulted in better clinical outcomes at follow-up (not at discharge), but no associations were found with the extent of resection. The use of minimally invasive approaches such as monolateral laminectomy showed to be effective and not associated with worse outcomes or increased complications.

Holmes’ tremor as a delayed complication of thalamic stroke

2016 ◽  
Vol 26 ◽  
pp. 158-159 ◽  
Author(s):  
William Alves Martins ◽  
Luiz Carlos Porcello Marrone ◽  
Helena Fussiger ◽  
Viviane Maria Vedana ◽  
Rafael do Amaral Cristovam ◽  
...  
Keyword(s):  
Thalamic Stroke ◽  
Holmes Tremor ◽  
Delayed Complication

Open-door laminoplasty for cervical stenotic myelopathy: surgical technique and neurophysiological monitoring

2000 ◽  
Vol 92 (1) ◽  
pp. 38-43 ◽  
Author(s):  
Romeo Roselli ◽  
Angelo Pompucci ◽  
Francesco Formica ◽  
Domenico Restuccia ◽  
Vincenzo Di Lazzaro ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Japanese Orthopaedic Association ◽  
Japanese Orthopaedic Association Score ◽  
Neurophysiological Monitoring ◽  
Open Door ◽  
Modified Technique ◽  
Content Type ◽  
Neurophysiological Studies ◽  
Cervical Stenotic Myelopathy ◽  
Fine Print

Object. A modified technique of open-door laminoplasty for cervical stenotic myelopathy (CSM) is described, and the role of evoked potential monitoring in selecting patients for surgery and evaluating results is discussed. Methods. Between October 1992 and October 1996, 33 patients with CSM underwent open-door laminoplasty. After surgery, in 27 patients (81.8%) different levels of clinical improvement were demonstrated, and in five of them (15%) full recovery was observed. The Japanese Orthopaedic Association score increased from 5 to 12 (mean 9.8) preoperatively to 8 to 14 (mean 11.6) postoperatively. At 1-year follow up, the N13 cervical response was restored in nine (75%) of 12 patients with isolated presurgical abnormality and in 57.1% of those with combined abnormalities of both N13 and P14 response. Although significant clinical improvement was observed in 82% of the cases, in 24 of 33 patients MEP abnormalities persisted at least at one explored level. Conclusions. Of several laminoplasty techniques, the one described here offers some advantages: preservation of biomechanical function of posterior muscular—ligamentous complex, prevention of laminar collapse, smaller degrees in reduction of range of cervical motion, stabilization of the spine with no postoperative malalignment, and maintenance of decompressive effect that avoids recurrent stenosis. Neurophysiological studies sometimes clarified neurological disorders that were only suspected on the basis of history and/or clinical examination, leading to early diagnosis.

Line Operational Evaluation (LOE) Air Carrier Scenario Based Evaluation

1997 ◽  
Vol 41 (2) ◽  
pp. 907-911 ◽  
Author(s):  
William R. Hamman ◽  
Robert W. Holt
Keyword(s):  
Statistical Analysis ◽  
Resource Management ◽  
Design Process ◽  
Reliability And Validity ◽  
Crew Resource Management ◽  
Strict Adherence ◽  
Air Carrier

This paper presents a methodology for developing Line Operational Evaluations (LOEs) which assess crew and individual pilot proficiency in the FAA's Advanced Qualification Program (AQP). Under AQP, Crew Resource Management (CRM) skills are trained and assessed along with technical maneuvers in the issuing of an Airmen type certification. The environment for assessing this technical and CRM proficiency is the LOE which must be designed and implemented under strict adherence to the requirements of AQP. The paper will discuss the five major steps in the design process, discuss the issues associated with scenario based measurement of pilot proficiency, and the application of statistical analysis to improve evaluator standardization and the reliability and validity of data.

Statistical analysis of classification

1966 ◽  
Vol 24 ◽  
pp. 188-189
Author(s):  
T. J. Deeming
Keyword(s):  
Multivariate Analysis ◽  
Statistical Analysis ◽  
Classification Scheme ◽  
Analytical Procedure ◽  
Narrow Band ◽  
Scientific Research ◽  
Maximum Amount ◽  
Amount Of Information

If we make a set of measurements, such as narrow-band or multicolour photo-electric measurements, which are designed to improve a scheme of classification, and in particular if they are designed to extend the number of dimensions of classification, i.e. the number of classification parameters, then some important problems of analytical procedure arise. First, it is important not to reproduce the errors of the classification scheme which we are trying to improve. Second, when trying to extend the number of dimensions of classification we have little or nothing with which to test the validity of the new parameters.Problems similar to these have occurred in other areas of scientific research (notably psychology and education) and the branch of Statistics called Multivariate Analysis has been developed to deal with them. The techniques of this subject are largely unknown to astronomers, but, if carefully applied, they should at the very least ensure that the astronomer gets the maximum amount of information out of his data and does not waste his time looking for information which is not there. More optimistically, these techniques are potentially capable of indicating the number of classification parameters necessary and giving specific formulas for computing them, as well as pinpointing those particular measurements which are most crucial for determining the classification parameters.

Quantitative parallel EELS spectrum imaging developed as a new tool in AEM

1992 ◽  
Vol 50 (2) ◽  
pp. 1202-1203
Author(s):  
Gianluigi Botton ◽  
Gilles L'espérance
Keyword(s):  
Statistical Analysis ◽  
Spatial Resolution ◽  
Personal Computer ◽  
Systematic Study ◽  
Present Author ◽  
Chemical Elements ◽  
Detection Limits ◽  
Research Groups ◽  
Quantitative Performance ◽  
Spectrum Imaging

As interest for parallel EELS spectrum imaging grows in laboratories equipped with commercial spectrometers, different approaches were used in recent years by a few research groups in the development of the technique of spectrum imaging as reported in the literature. Either by controlling, with a personal computer both the microsope and the spectrometer or using more powerful workstations interfaced to conventional multichannel analysers with commercially available programs to control the microscope and the spectrometer, spectrum images can now be obtained. Work on the limits of the technique, in terms of the quantitative performance was reported, however, by the present author where a systematic study of artifacts detection limits, statistical errors as a function of desired spatial resolution and range of chemical elements to be studied in a map was carried out The aim of the present paper is to show an application of quantitative parallel EELS spectrum imaging where statistical analysis is performed at each pixel and interpretation is carried out using criteria established from the statistical analysis and variations in composition are analyzed with the help of information retreived from t/γ maps so that artifacts are avoided.

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