Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
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J Clin Neurophysiol · Dec 2011
ReviewNeurophysiologic intraoperative monitoring of the glossopharyngeal and vagus nerves.
Neurophysiologic intraoperative monitoring (NIOM) of the glossopharyngeal and vagus nerves (CN IX and X) is often used during surgeries involving the lower brain stem. Although both of these nerves contain sensory, autonomic, and motor fibers, it is the motor fibers that are most amenable to NIOM. CN IX supplies the stylopharyngeus muscle, and CN X supplies striated muscles in the soft palate, pharynx, and larynx. ⋯ Various surface and needle electrodes can be used to monitor these muscle groups. When CN IX is monitored, CN X should also be monitored, as it is often needed to differentiate when CN IX is selectively activated. Data are accumulating noting the use of monitoring these CN in tumor surgeries involving the lower brain stem.
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J Clin Neurophysiol · Aug 2007
ReviewNeurophysiology of surgical procedures for repair of the aortic arch.
Neurophysiologic monitoring during surgical procedures involving the aortic arch is very complex because of the number of different phases of the procedure, the high mortality rate, and the use of hypothermia. In this paper, the critical goals of neurophysiologic monitoring are discussed in the context of the different surgical events and the surgical options during the different phases of the procedure. ⋯ The role of EEG and evoked potentials in assessing the effect of hypothermia and circulatory arrest is also discussed. As these effects are predictable in large part, the neurophysiologist will be able to determine when changes in the neurophysiologic tests outside the norm occur and provide prompt warnings to the surgeon.
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J Clin Neurophysiol · Aug 2007
ReviewManagement of neurologic complications of thoracic aortic surgery.
Neurologic complications of thoracic aortic surgery are strongly associated with increased morbidity and mortality. Identifying preoperative risk factors for neurologic injury may enable us to refine our perioperative approach, and to lessen or avoid these complications. Methods to identify stroke and spinal ischemia intraoperatively such as neurophysiologic monitoring may enable us to improve outcomes in these patients by immediately instituting measures to improve brain and spine perfusion. The development of both protocols and therapies to treat these complications has allowed us to mitigate and, at times, reverse neurologic injury both intraoperatively and postoperatively.