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.

scholarly journals Successful Resection of Arteriovenous Malformations in Eloquent Areas Diagnosed by Surface Anatomy Scanning and Motor Evoked Potential

1998 ◽  
Vol 38 (suppl) ◽  
pp. 217-221 ◽  
Author(s):  
Yoko KATO ◽  
Hirotoshi SANO ◽  
Narimasu KANAOKA ◽  
Fumihiro IMAI ◽  
Kazuhiro KATADA ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Eloquent Areas ◽  
Surface Anatomy

Awake Mapping Optimizes the Extent of Resection for Low-Grade Gliomas in Eloquent Areas

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1074-1084 ◽  
Author(s):  
Alessandro De Benedictis ◽  
Sylvie Moritz-Gasser ◽  
Hugues Duffau
Keyword(s):  
Extent Of Resection ◽  
Low Grade Glioma ◽  
Awake Surgery ◽  
Low Grade ◽  
Functional Sites ◽  
Social Lives ◽  
Eloquent Areas ◽  
Functional Regions ◽  
First Time

Abstract BACKGROUND Awake craniotomy with intraoperative electrical mapping is a reliable method to minimize the risk of permanent deficit during surgery for low-grade glioma located within eloquent areas classically considered inoperable. However, it could be argued that preservation of functional sites might lead to a lesser degree of tumor removal. To the best of our knowledge, the extent of resection has never been directly compared between traditional and awake procedures. OBJECTIVE We report for the first time a series of patients who underwent 2 consecutive surgeries without and with awake mapping. METHODS Nine patients underwent surgery for a low-grade glioma in functional sites under general anesthesia in other institutions. The resection was subtotal in 3 cases and partial in 6 cases. There was a postoperative worsening in 3 cases. We performed a second surgery in the awake condition with intraoperative electrostimulation. The resection was performed according to functional boundaries at both the cortical and subcortical levels. RESULTS Postoperative magnetic resonance imaging showed that the resection was complete in 5 cases and subtotal in 4 cases (no partial removal) and that it was improved in all cases compared with the first surgery (P = .04). There was no permanent neurological worsening. Three patients improved compared with the presurgical status. All patients returned to normal professional and social lives. CONCLUSION Our results demonstrate that awake surgery, known to preserve the quality of life in patients with low-grade glioma, is also able to significantly improve the extent of resection for lesions located in functional regions.

Awake Surgery for Nonlanguage Mapping

Neurosurgery ◽  
2010 ◽  
Vol 66 (3) ◽  
pp. 523-529 ◽  
Author(s):  
Hugues Duffau
Keyword(s):  
Language Processing ◽  
Cognitive Deficits ◽  
Extent Of Resection ◽  
Awake Surgery ◽  
Surgical Removal ◽  
Eloquent Areas ◽  
The Past ◽  
Neuropsychological Assessments ◽  
Language Areas

Abstract OBJECTIVE During the past decade, numerous reports have supported the contribution of awake mapping in surgical removal of brain lesions in eloquent areas, with a significant increase of the extent of resection while minimizing the risk of permanent deficit—and even improving quality of life. METHODS Most of these awake procedures were performed in patients with lesions in language areas, to avoid postoperative aphasia. Surprisingly, mapping of nonlanguage functions received less attention, despite the possible consequences of deficits other than aphasia on daily life. Visuospatial and cognitive deficits are reported after brain surgery, because of more objective and extensive neuropsychological assessments. RESULTS AND CONCLUSION This review provides new insights into the indications of awake craniotomies for nonlanguage mapping in surgery for lesions in areas not related to language processing.

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 Evaluation of Combined Use of Transcranial and Direct Cortical Motor Evoked Potential Monitoring During Unruptured Aneurysm Surgery

2011 ◽  
Vol 51 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Yasushi MOTOYAMA ◽  
Masahiko KAWAGUCHI ◽  
Shuichi YAMADA ◽  
Ichiro NAKAGAWA ◽  
Fumihiko NISHIMURA ◽  
...  
Keyword(s):  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Unruptured Aneurysm ◽  
Aneurysm Surgery ◽  
Cortical Motor ◽  
Combined Use ◽  
Evoked Potential Monitoring ◽  
Potential Monitoring

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.

scholarly journals Clinical and electromyographic evaluation of the effectiveness of the use of interference currents and traction therapy in the treatment of patients with vertebral radiculopathy

2020 ◽  
Vol 19 (6) ◽  
pp. 384-390
Author(s):  
Parvis Yа. Akhundov ◽  
Sadagat G. Huseynova
Keyword(s):  
Compound Muscle Action Potential ◽  
Combined Therapy ◽  
Life Quality ◽  
Pain Syndrome ◽  
Control Group ◽  
Complex Treatment ◽  
Treatment Methods ◽  
Rehabilitative Treatment ◽  
Combined Use

Background. Relevance of elaboration of lumbosacral radiculopathy (LSR) treatment methods is сonditioned by widespread of this pathology. Pain syndrome (PS) reducing activity and life quality of workable patients is the most prevailing clinical manifestation of this disease. Сonservative treatment methods of LSR directed to decrease pain, oedema and compression of nerve roots as well as contributing to сonductivity improvement include medication, physiotherapeutic and orthopaedic treatment. Aims: Clinical neurophysiological justification of combined use of interference therapy (IT) and spine traction (ST) in complex treatment of vertebral LSR. Materials and methods. The first-control group (n=32) who were treated by using ST as a treatment. The second ― treatment group (n=32) included those who were treated by using the IT and ST on the same day. All patients had radicular syndromes. All patients passed the lumbar MRI scan. PS was estimated according to the visual-analogic scale (VAS) and McGills questionnaire. Estimation of life quality of patients was based on Roland-Morris questionnaire. Electromyography registered dynamics of impulse conduction on motor fibres, as well as parametеrs of compound muscle action potential and H-reflex. Results. Positive effect of combined use of interference therapy with spine traction in complex treatment of vertebral radiculopathy patients are proved. It has been established that the therapeutic effect of the complex application of IT and ST lies in the improvement in the afferent and efferent links of the neuromotor apparatus, as well as the functional state of the spinal alpha-motoneurons associated with the acceleration of the regenerative processes. Conclusion. Results of the clinical neurophysiological investigation, carried out before and after rehabilitative treatment allow to recommend combined therapy of IT and ST for treatment of vertebral LSR.

Influence of combined use of gas-liquid peeling and PDT on quality of life of patients with visible signs of involutive skin changes

2021 ◽  
pp. 32-34
Author(s):  
S. I. Surkichin ◽  
L. S. Kholupova
Keyword(s):  
Quality Of Life ◽  
Life Quality ◽  
Depression Scale ◽  
Positive Trend ◽  
Skin Changes ◽  
Age Related ◽  
Combined Use ◽  
Before And After ◽  
And Behavior

Objective of the study. To develop a questionnaire to determine the quality of life of a patient with visible signs of involutive skin changes. To determine the effect of the combined use of gas-liquid peeling and PDT on the quality of life of patients with visible signs of involutive skin changes.Materials and methods. The study involved 50 patients aged 35 to 45 years. The state of the emotional sphere was assessed before and after the course of treatment using the following methods: a scale for assessing discomfort; ‘The Scale of States’ methodology by А. B. Leonova, Hospital Anxiety and Depression Scale (HADS), Dermatological Life Quality Index (DLQI). The condition was assessed before and after treatment (gas-liquid peeling and photodynamic therapy).Results. The use of the questionnaire developed by us made it possible to determine the index for assessing the quality of life in persons with agerelated skin changes and to reveal the influence of the latter on the emotional sphere and behavior of the respondents. A clear positive trend was observed when comparing indicators of discomfort, anxiety, depression, quality of life. The data obtained make it possible to recommend an assessment of the dermatological index of the quality of life in patients with age-related skin changes as a criterion for the effectiveness of the therapy, and also focus on the need for further study and correction of factors that cause deterioration in life in this category of women.

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.

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