scholarly journals Continuous Dynamic Mapping of Cranial Nerve Pathways and Long Tracts Inside the Brainstem: Useful Technique of Intraoperative Neurophysiological Monitoring

2021 ◽  
Vol 15 ◽  
pp. 334-341
Author(s):  
Volodymyr I. Smolanka ◽  
Andrey V. Smolanka ◽  
Oleksandr S. Sechko ◽  
Olga S. Herasymenko
Keyword(s):  
Neurological Status ◽  
Practical Significance ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Brainstem Lesions ◽  
Brainstem Surgery ◽  
Medical Reports ◽  
On Line ◽  
Continuous Dynamic ◽  
Surgical Manipulations

Surgery of intrinsic brainstem lesions is extremely dangerous, consequently the knowledge of anatomy and safe entry zones is extremely important. The technological progress was achieved with the widespread clinical use of intraoperative neurophysiological monitoring (IONM) which has proven to further improve the safety of operating on intrinsic brainstem lesions. The relevance of the study is conditioned by the fact that the tumor alters the normal anatomy and distorts the location of well-known landmarks and structures. In this regard, this paper is directed at identification of the placement of conductive pathways in the thickness of the brain stem and directly in the depth of the lesion (in the tumor or cavern), respectively to the surgical manipulations aimed at injury prevention. The results were achieved by a retrospective review of medical reports. The paper represents the results of surgical treatment of 42 patients with brainstem lesions, reviews the localization of the lesion and neurological status of patients, describes available methods of intraoperative monitoring (IOM) and on-line techniques for the brainstem surgery. The materials of the paper are of practical significance for the development of brainstem surgery with IONM modifications for wider and more comfortable use by neurosurgeons.

Intraoperative neurophysiological monitoring in patients undergoing tethered cord surgery after fetal myelomeningocele repair

2014 ◽  
Vol 13 (4) ◽  
pp. 355-361 ◽  
Author(s):  
Eric M. Jackson ◽  
Daniel M. Schwartz ◽  
Anthony K. Sestokas ◽  
Deborah M. Zarnow ◽  
N. Scott Adzick ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Motor Evoked Potential ◽  
Tethered Cord ◽  
Neurological Status ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Neural Function ◽  
Lower Extremity Function ◽  
Fetal Repair ◽  
Myelomeningocele Repair

Object Fetal myelomeningocele closure has been shown to be advantageous in a number of areas. In this study, the authors report on neural function in patients who had previously undergone fetal myelomeningocele repair and returned to the authors' institution for further surgery that included intraoperative neurophysiological monitoring. Methods The authors retrospectively reviewed data obtained in 6 cases involving patients who underwent fetal myelomeningocele repair and later returned to their institution for spinal cord untethering. (In 4 of the 6 cases, the patients also underwent removal of a dermoid cyst [3 cases] or removal of an epidermoid cyst [1 case] during the untethering procedure.) Records and imaging studies were reviewed to identify the anatomical level of the myelomeningocele as well as the functional status of each patient. Stimulated electromyography (EMG) and transcranial motor evoked potential (tcMEP) recordings obtained during surgery were reviewed to assess the functional integrity of the nerve roots and spinal cord. Results During reexploration, all patients had reproducible signals at or below their anatomical level on stimulated EMG and tcMEP recordings. Corresponding to these findings, prior to tethering, all patients had antigravity muscle function below their anatomical level. Conclusions All 6 patients had lower-extremity function and neurophysiological monitoring recording signals at or below their anatomical level. These cases provide direct evidence of spinal cord and nerve root conductivity and functionality below the anatomical level of the myelomeningocele, further supporting that neurological status improves with fetal repair.

scholarly journals ANALYSIS OF THE RESULTS OF INTRAOPERATIVE NEUROPHYSIOLOGICAL MONITORING IN THE CENTER OF NEUROSURGERY OF RAILWAY CLINICAL HOSPITAL AT THE IRKUTSK-PASSAZHIRSKIY RAILWAY STATION OF RUSSIAN RAILWAYS LTD.

2016 ◽  
Vol 1 (4) ◽  
pp. 46-50
Author(s):  
Борисов ◽  
Aleksey Borisov ◽  
Левина ◽  
Galina Levina ◽  
Калинин ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Postoperative Period ◽  
Neurological Disorders ◽  
Early Postoperative Period ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Postoperative Complication Rate ◽  
Railway Station ◽  
Clinical Hospital ◽  
Surgical Manipulations

The reduction of postoperative complication rate is a significant trend in modern surgery. One of the most important methods of intraoperative diagnostics is intraoperative neurophysiological monitoring (IONM). The aim of the research was to assess capabilities of intraoperative neurophysiological monitoring in neurosurgical practice considering literature data and experience of IONM application in the Center of Neurosurgery Railway Clinical Hospital at the Ir-kutsk-Passazhirskiy Railway Station of Russian Railways Ltd. We conducted 17 surgeries using IONM. We described the procedure, analyzed data of monitoring and patients’ condition in early postoperative period. No deviations requiring modifications in surgical manipulations were found during neuromonitoring. No iatrogenic neurological disorders were registered in postoperative period. Intraoperative neurophysiological monitoring is an additional effective method which allows reducing the risk of postoperative complications and indirectly improving the results of surgical manipulations.

Continuous Intraoperative Neurophysiological Monitoring of the Motor Pathways Using Depth Electrodes During Surgical Resection of an Epileptogenic Lesion: A Novel Technique

2021 ◽  
Author(s):  
Denise F Chen ◽  
Jon T Willie ◽  
David Cabrera ◽  
Katie L Bullinger ◽  
Ioannis Karakis
Keyword(s):  
Motor Cortex ◽  
Surgical Resection ◽  
Radiation Necrosis ◽  
World Health ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Epileptogenic Zone ◽  
Motor Pathways ◽  
Depth Electrodes ◽  
Epileptogenic Lesion

Abstract BACKGROUND AND IMPORTANCE Intraoperative neurophysiological monitoring of the motor pathways during epilepsy surgery is essential to safely achieve maximal resection of the epileptogenic zone. Motor evoked potential (MEP) recording is usually performed intermittently during resection using a handheld stimulator or continuously through an electrode array placed on the motor cortex. We present a novel variation of continuous MEP acquisition through previously implanted depth electrodes in the perirolandic cortex. CLINICAL PRESENTATION A 60-yr-old woman with a history of a left frontal meningioma (World Health Organization [WHO] grade II) treated with surgical resection and radiation presented with residual right hemiparesis and refractory epilepsy. Imaging demonstrated a perirolandic lesion with surrounding edema and mass effect in the prior surgical site, suspicious for radiation necrosis versus tumor recurrence. Presurgical electrocorticography (ECoG) with orthogonal, stereotactically implanted depth electrodes (stereoelectroencephalography [SEEG]) of the perirolandic cortex captured seizure onsets from the supplementary motor area (SMA) and primary motor cortex (PMC). The patient underwent a left frontal craniotomy for repeat resection and tissue diagnosis. Intraoperative ECoG and MEPs were obtained continuously with direct cortical stimulation through the indwelling SEEG electrodes in the PMC. Maximal resection was achieved with preservation of direct cortical MEPs and without deterioration of her baseline hemiparesis. Biopsy revealed radiation necrosis. At 30-mo follow-up, the patient had only rare seizures (Engel class IIB). CONCLUSION Intraoperative cortical MEP acquisition through implanted SEEG electrode arrays is a potentially safe and effective alternative approach to continuously monitor the motor pathways during the resection of a perirolandic epileptogenic lesion, without the need for surgical interruptions.

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