Direct Wave Intraoperative Neuromonitoring for Spinal Tumor Resection: A Focused Review

Olmsted, Zachary T.; Ryu, Brendan; Phayal, Ganesh; Green, Ross; Lo, Sheng-Fu Larry; Sciubba, Daniel M.; Silverstein, Justin W.; D’Amico, Randy S.

doi:10.1016/j.wnsx.2022.100139

Cited by 8 publications

(2 citation statements)

References 27 publications

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“…The electrical potential generated during MEPs can be recorded at different locations, either directly at target muscles or from the epidural space at the spinal cord (d-waves). The latter is the best choice to monitor corticospinal tract integrity during spinal surgery [33,34]. The stability of the d-wave is a predictive indicator for favorable motor outcomes, even when the intraoperative transcranial MEPs are abolished or diminished.…”

Section: Motor Evoked Potentials (Meps) and Direct Cortical Stimulati...mentioning

confidence: 99%

Intraoperative Neurophysiological Monitoring in Neurosurgery

Guzzi,

Ricciuti,

Della Torre

et al. 2024

JCM

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Intraoperative neurophysiological monitoring (IONM) is a crucial advancement in neurosurgery, enhancing procedural safety and precision. This technique involves continuous real-time assessment of neurophysiological signals, aiding surgeons in timely interventions to protect neural structures. In addition to inherent limitations, IONM necessitates a detailed anesthetic plan for accurate signal recording. Given the growing importance of IONM in neurosurgery, we conducted a narrative review including the most relevant studies about the modalities and their application in different fields of neurosurgery. In particular, this review provides insights for all physicians and healthcare professionals unfamiliar with IONM, elucidating commonly used techniques in neurosurgery. In particular, it discusses the roles of IONM in various neurosurgical settings such as tumoral brain resection, neurovascular surgery, epilepsy surgery, spinal surgery, and peripheral nerve surgery. Furthermore, it offers an overview of the anesthesiologic strategies and limitations of techniques essential for the effective implementation of IONM.

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Section: Motor Evoked Potentials (Meps) and Direct Cortical Stimulati...mentioning

confidence: 99%

Intraoperative Neurophysiological Monitoring in Neurosurgery

Guzzi,

Ricciuti,

Della Torre

et al. 2024

JCM

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“…Mapping techniques allow for the identification of neural structures and, therefore, guide the surgeon in establishing a selective and safer entry point into the SC. In addition to neural root mapping, which is widely established, different mapping methods for SC long tracts—dorsal column (DC) [ 9 , 10 , 11 ], and corticospinal tract (CST) [ 12 , 13 , 14 , 15 , 16 ]—have been described in the last few years. Dorsal column mapping (DCM) has become a reliable technique for intraoperative midline localization during posterior myelotomy to minimize DC dysfunction syndrome [ 10 , 11 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Neurophysiological Monitoring in Syringomyelia Surgery: A Multimodal Approach

Sánchez Roldán,

Moncho,

Rahnama

et al. 2023

JCM

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Syringomyelia can be associated with multiple etiologies. The treatment of the underlying causes is first-line therapy; however, a direct approach to the syrinx is accepted as rescue treatment. Any direct intervention on the syrinx requires a myelotomy, posing a significant risk of iatrogenic spinal cord (SC) injury. Intraoperative neurophysiological monitoring (IONM) is crucial to detect and prevent surgically induced damage in neural SC pathways. We retrospectively reviewed the perioperative and intraoperative neurophysiological data and perioperative neurological examinations in ten cases of syringomyelia surgery. All the monitored modalities remained stable throughout the surgery in six cases, correlating with no new postoperative neurological deficits. In two patients, significant transitory attenuation, or loss of motor evoked potentials (MEPs), were observed and recovered after a corrective surgical maneuver, with no new postoperative deficits. In two cases, a significant MEP decrement was noted, which lasted until the end of the surgery and was associated with postoperative weakness. A transitory train of neurotonic electromyography (EMG) discharges was reported in one case. The surgical plan was adjusted, and the patient showed no postoperative deficits. The dorsal nerve roots were stimulated and identified in the seven cases where the myelotomy was performed via the dorsal root entry zone. Dorsal column mapping guided the myelotomy entry zone in four of the cases. In conclusion, multimodal IONM is feasible and reliable and may help prevent iatrogenic SC injury during syringomyelia surgery.

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