Improved neuromonitoring during spinal surgery using double-train transcranial electrical stimulation

Journée, H. L.; Polak, H; Kleuver, Marinus de; Langeloo, Danielle D.; Postma, A A

doi:10.1007/bf02351019

Cited by 75 publications

(31 citation statements)

References 20 publications

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“…28 Because younger children have more immature myelinated fibers, monitoring of motor evoked potentials may require double-train stimulation to obtain useful motor evoked potential amplitudes. 31,32 The difficulty of obtaining free-run electromyograms should be noted when electrocautery is used. 6 Stimulated electromyography, however, allows for identification of functional nerve roots and delineation of nervous tissue from filum and scar elements.…”

Section: Intraoperative Monitoringmentioning

confidence: 99%

Lipomyelomeningocele: pathology, treatment, and outcomes

Sarris

Tomei²,

Carmel³

et al. 2012

FOC

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Lipomyelomeningocele represents a rare but complex neurological disorder that may present with neurological deterioration secondary to an inherent tethered spinal cord. Radiological testing is beneficial in determining the morphology of the malformation. Specialized testing such as urodynamic studies and neurophysiological testing may be beneficial in assessing for neurological dysfunction secondary to the lipomyelomeningocele. Early surgical intervention may be beneficial in preventing further neurological decline.

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Section: Intraoperative Monitoringmentioning

confidence: 99%

Lipomyelomeningocele: pathology, treatment, and outcomes

Sarris

Tomei²,

Carmel³

et al. 2012

FOC

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“…Even so, responses can always be obtained when no halogenated agents are administered and patients do not have severe neurological deficits (8,23). And also, using double train stimulation compensates the relative hyperpolarisation of motor neurons resulting in reliable MEP responses in this situation (5,6). It is only a worthy of notice feature that EEG cup electrode usage is recommended for young children.…”

Section: █ Discussionmentioning

confidence: 99%

Multimodal intraoperative neurophysiologic monitoring in the spinal cord surgery

Taşkıran

Brandmeier²,

Özek³

et al. 2015

Turkish Neurosurgery

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Intraoperative neurophysiological monitoring (IONM) is the use of electrophysiological methods to monitor the functional integrity of critical neural structures during surgery. IONM can predict an increased risk of injury during surgery based on electrophysiological changes. The most commonly used electrophysiological modalities are evoked potentials (Somatosensory Evoked Potentials -SSEP and Motor Evoked Potentials -MEP) and electromyography (EMG) in spinal cord █ INTRODUCTION S pinal surgeries carry a very high risk of injury to the spinal cord, spinal nerves and/or blood vessels. Neurological deficits, such as paralysis, muscle weakness, pain, bladder/bowel disturbances and sexual dysfunction, which emerge after these surgeries can seriously affect basic human functions and increase morbidity (1,3,11,14).AIm: Intraoperative neurophysiological monitoring (IONM) monitors the functional integrity of critical neural structures by electrophysiological methods during surgery. Multimodality combines different neurophysiological methods to maximize diagnostic efficacy and provide a safety margin to improve the outcomes of spinal surgery. Our aim was to share our intraoperative monitoring experiences with patients who underwent surgery because of spinal cord pathologies between September 2013 and January 2015. mATERIAl and mEThODS:We had twenty-six cases. Location of the lesions, surgery, neurological findings, and electrophysiological findings intraoperatively and postoperatively were documented. RESUlTS:The combination of motor evoked potential (MEP), somatosensorial evoked potential (SSEP), free-run and trigger electromyography (EMG) were performed according to lesion localization. MEPs plus SSEPs were run in 23 patients and MEPs with triggered EMG were performed in 4 patients. In only one patient, optimal recording could not be elicited because of technical problems. MEP and SSEP changes were recorded in 12 and 3 patients respectively. Postoperative neurological deficits were observed in 2 patients. Deficits were transient in one case and permanent in the other. While baseline MEP responses were either absent or low amplitude (<50 microvolt) in 7 patients, following resection they were either visible or increased in amplitude. Surgery was ended in one patient with C7-T2 intramedullary tumour after the right distal MEP response disappeared. CONClUSION:Multimodal IONM is an important method to monitor the neural structures under risk in spine surgery and to keep the surgery within safety limits, especially for intramedullary spinal cord lesion surgery.

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“…This often results in failure to elicit muscle MEPs. Conditioning by double-train stimulation compensates the relative hyperpolarisation of motorneurons resulting in stable MEP responses with high amplitudes [15, 16]…”

Section: Discussionmentioning

confidence: 99%

The value of intraoperative neurophysiological monitoring in tethered cord surgery

et al. 2011

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PurposeThe value of intraoperative neurophysiological monitoring (IONM) with surgical detethering in dysraphic patients has been questioned. A retrospective analysis of our series of 65 patients is presented with special focus on technical set-up and outcome.MethodsAll patients were diagnosed with a tethered cord (TC) due to spinal dysraphism. A high-risk group (HRG) was determined consisting of 40 patients with a lipomyelomeningocele and/or a split cord malformation sometimes in combination with a tight filum terminale. The surgical procedure was a detethering operation in all cases performed by a single surgeon during a 9-year period (1999–2008). A standard set-up of IONM was used in all patients consisting of motor-evoked potentials (MEP) evoked by transcranial electrical stimulation (TES) and electrical nerve root stimulation. In young patients, conditioning stimulation was applied in order to improve absent or weak MEPs.ResultsIONM responses could be obtained in all patients. Postoperative deterioration of symptoms was found in two patients of whom one patient belonged to the HRG. Mean maximal follow-up of all 65 patients was 4.6 years (median 4.1 years). Long-term deterioration of symptoms was found in 6 of 65 patients with a mean follow-up of 5 years (median 5.3 years).ConclusionThe use of IONM is feasible in all TC patients. The identification of functional nervous structures and continuous guarding of the integrity of sacral motor roots by IONM may contribute to the safety of surgical detethering.

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Improved neuromonitoring during spinal surgery using double-train transcranial electrical stimulation

Cited by 75 publications

References 20 publications

Lipomyelomeningocele: pathology, treatment, and outcomes

Lipomyelomeningocele: pathology, treatment, and outcomes

Multimodal intraoperative neurophysiologic monitoring in the spinal cord surgery

The value of intraoperative neurophysiological monitoring in tethered cord surgery

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