An effective intra-operative neurophysiological monitoring scheme for aneurysm clipping and spinal fusion surgeries

Goryawala, Mohammed; Yaylali, Ilker; Cabrerizo, Mercedes; Vedala, Krishnatej; Adjouadi, Malek

doi:10.1088/1741-2560/9/2/026021

Cited by 8 publications

(12 citation statements)

References 34 publications

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“…We chose Chebyshev window as an improvement to our previously presented Gaussian template [15]. A Chebyshev window of the same length was applied to this signal.…”

Section: Methodsmentioning

confidence: 99%

Quasi-Stationarity of EEG for Intraoperative Monitoring during Spinal Surgeries

Vedala¹,

Motahari²,

Goryawala³

et al. 2014

The Scientific World Journal

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We present a study and application of quasi-stationarity of electroencephalogram for intraoperative neurophysiological monitoring (IONM) and an application of Chebyshev time windowing for preconditioning SSEP trials to retain the morphological characteristics of somatosensory evoked potentials (SSEP). This preconditioning was followed by the application of a principal component analysis (PCA)-based algorithm utilizing quasi-stationarity of EEG on 12 preconditioned trials. This method is shown empirically to be more clinically viable than present day approaches. In all twelve cases, the algorithm takes 4 sec to extract an SSEP signal, as compared to conventional methods, which take several minutes. The monitoring process using the algorithm was successful and proved conclusive under the clinical constraints throughout the different surgical procedures with an accuracy of 91.5%. Higher accuracy and faster execution time, observed in the present study, in determining the SSEP signals provide a much improved and effective neurophysiological monitoring process.

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“…We chose Chebyshev window as an improvement to our previously presented Gaussian template [15]. A Chebyshev window of the same length was applied to this signal.…”

Section: Methodsmentioning

confidence: 99%

Quasi-Stationarity of EEG for Intraoperative Monitoring during Spinal Surgeries

Vedala¹,

Motahari²,

Goryawala³

et al. 2014

The Scientific World Journal

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“…3 More recent efforts have focused on the expansion of applications for neuromonitoring and enhancement of algorithms to record SSEPs in speedier, more reliable fashions. 4,5 Herein, we present a case demonstrating the utility of neuromonitoring in detecting neurophysiological changes secondary to peripheral insult caused by an occlusive vascular sheath.…”

Section: Introductionmentioning

confidence: 99%

Detection of acute femoral artery ischemia during neuroembolization by somatosensory and motor evoked potential monitoring

et al. 2015

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Neuromonitoring can be used to map out particular neuroanatomical tracts, define physiologic deficits secondary to specific pathology or intervention, or predict postoperative outcome and proves essential in the detection of central and peripheral ischemic events during neurosurgical intervention. Herein, we describe an instance of elective balloon-assisted coiling of a recurrent basilar tip aneurysm in a 61-year-old woman, where intraoperative somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (TcMEPs) were lost in the right lower extremity intraoperatively. We aim to highlight that targeted use of monitoring proves advantageous in both the open surgical and endovascular setting, even in the avoidance of potential iatrogenic peripheral nerve damage and limb ischemia as documented herein. Consideration of the increased risk for peripheral ischemia in the neurointerventional setting is especially imperative in particular populations where blood vessels might be of diminished size, such as in infants, young children, and severely deconditioned adults.

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“…In terms of the clinical application of EP, intraoperative neurophysiological monitoring (IOM) using EP techniques has grown from an interesting investigational procedure into a widely used method to protect patients from neurological injury during surgery over the last three decades 15) . For IOM, SEPs are nowadays routinely used to monitor whether the sensory tract is intact in procedures in which the brain, spine and peripheral nerves are at risk 6) .…”

Section: Introductionmentioning

confidence: 99%

A New Measure for Monitoring Intraoperative Somatosensory Evoked Potentials

Jin

Chung

Kim

et al. 2014

J Korean Neurosurg Soc

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ObjectiveTo propose a new measure for effective monitoring of intraoperative somatosensory evoked potentials (SEP) and to validate the feasibility of this measure for evoked potentials (EP) and single trials with a retrospective data analysis study.MethodsThe proposed new measure (hereafter, a slope-measure) was defined as the relative slope of the amplitude and latency at each EP peak compared to the baseline value, which is sensitive to the change in the amplitude and latency simultaneously. We used the slope-measure for EP and single trials and compared the significant change detection time with that of the conventional peak-to-peak method. When applied to single trials, each single trial signal was processed with optimal filters before using the slope-measure. In this retrospective data analysis, 7 patients who underwent cerebral aneurysm clipping surgery for unruptured aneurysm middle cerebral artery (MCA) bifurcation were included.ResultsWe found that this simple slope-measure has a detection time that is as early or earlier than that of the conventional method; furthermore, using the slope-measure in optimally filtered single trials provides warning signs earlier than that of the conventional method during MCA clipping surgery.ConclusionOur results have confirmed the feasibility of the slope-measure for intraoperative SEP monitoring. This is a novel study that provides a useful measure for either EP or single trials in intraoperative SEP monitoring.

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An effective intra-operative neurophysiological monitoring scheme for aneurysm clipping and spinal fusion surgeries

Cited by 8 publications

References 34 publications

Quasi-Stationarity of EEG for Intraoperative Monitoring during Spinal Surgeries

Quasi-Stationarity of EEG for Intraoperative Monitoring during Spinal Surgeries

Detection of acute femoral artery ischemia during neuroembolization by somatosensory and motor evoked potential monitoring

A New Measure for Monitoring Intraoperative Somatosensory Evoked Potentials

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