American journal of electroneurodiagnostic technology
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Am J Electroneurodiagnostic Technol · Dec 2011
Intraoperative neurophysiological monitoring (IONM): lessons learned from 32 case events in 2069 spine cases.
Intraoperative neurophysiological monitoring (IONM) is becoming the standard of care for many spinal surgeries, especially those with deformity correction and instrumentation. We reviewed 2069 spine cases with multimodality IONM including somatosensory evoked potentials (SSEP), transcranial electrical motor evoked potentials (TCeMEP), and spontaneous and triggered electromyography (s-EMG and t-EMG) in a University setting over a period of four years to examine perioperative clinical findings when an IONM event was noted and to ascertain how IONM has affected our ability to avoid potential neurological injury during spine surgery. We performed a retrospective analysis of cases from 2006 to 2010 to study the frequency and cause of intraoperative events detected via IONM and the clinical outcome of the patient. ⋯ We believe that the use of t-EMGs may have prevented these complications. This review reinforces the importance of multimodality IONM for spinal surgery. The incidence of possible events in our series was 1.5%, and several likely postoperative neurologic deficits were avoided by intraoperative intervention.
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Am J Electroneurodiagnostic Technol · Dec 2011
Case ReportsDetection and prevention of impending brachial plexus injury secondary to arm positioning using ulnar nerve somatosensory evoked potentials during transaxillary approach for thyroid lobectomy.
Robotic assisted surgery is becoming widely used for procedures such as radical prostatectomy. The use of robotic assisted surgery to perform partial and complete thyroidectomies using a transaxillary approach is being investigated in patient populations who wish to avoid a conspicuous cervical scar. ⋯ We report the use of ulnar nerve somatosensory evoked potentials (SSEPs) to detect and prevent positional related neuropathy in the first pediatric patient in the world to undergo this procedure. We conclude that upper extremity SSEPs should be routinely performed during robotic assisted thyroidectomy.
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Am J Electroneurodiagnostic Technol · Sep 2011
Case ReportsPreventing position-related brachial plexus injury with intraoperative somatosensory evoked potentials and transcranial electrical motor evoked potentials during anterior cervical spine surgery.
The use of somatosensory evoked potentials (SSEPs) to monitor upper extremity nerves during surgery is becoming more accepted as a valid and useful technique to minimize intraoperative nerve injuries. We present a case illustrating the benefit of utilizing both SSEPs and transcranial electrical motor evoked potentials (TCeMEPs) for preventing position-related injury during surgery. The patient was a 43-year-old male with a history of neck pain, along with numbness and tingling of the upper extremities. ⋯ At two months follow-up, the patient was well with total pain relief and normal upper extremity function when neurological examination was performed. This report demonstrates a case in which intraoperative neurophysiological monitoring was useful in identifying and reversing impending nerve injury during cervical spine surgery. Significant changes were seen in SSEPs as well as TCeMEPs, so we recommend that TCeMEP monitoring be considered as an adjunct to SSEPs for prevention of injury to the brachial plexus.
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Am J Electroneurodiagnostic Technol · Sep 2010
Effects of anesthetic regimens and other confounding factors affecting the interpretation of motor evoked potentials during pediatric spine surgery.
Children undergoing corrective spine surgery are at risk of serious neurologic injury. Monitoring transcranial electric motor evoked potentials (TCeMEPs) during these procedures may identify and help prevent injury to motor pathways. The difficulty in obtaining consistent motor evoked potential (MEP) responses during pediatric spine surgery can result in part to the suppression of evoked responses caused by volatile inhalational anesthetics, elevated levels of propofol, and/or physiologic variables. ⋯ Additionally, the responses were more variable when inhalational agents were used. These effects were more prominent in younger age patients. The number of alerts of MEP loss or reduction related to anesthetic levels or blood pressure changes was higher under inhalational agents.