Intraoperative Monitoring and Mapping of the Functional Integrity of the Brainstem

Deletis, Vedran; Fernández-Conejero, Isabel

doi:10.3988/jcn.2016.12.3.262

Cited by 82 publications

(72 citation statements)

References 23 publications

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“…The detailed methods and pa-rameters have been described previously. 6 Over the 8-year period of the study the above-described protocol was never changed, and we meticulously followed conventional MEP guidelines. 15 Seizures were detected through clinical observation of movement.…”

Section: Methodsmentioning

confidence: 99%

Incidence of intraoperative seizures during motor evoked potential monitoring in a large cohort of patients undergoing different surgical procedures

Ulkatan¹,

Jaramillo²,

Téllez³

et al. 2017

JNS

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OBJECTIVE The purpose of this study was to investigate the incidence of seizures during the intraoperative monitoring of motor evoked potentials (MEPs) elicited by electrical brain stimulation in a wide spectrum of surgeries such as those of the orthopedic spine, spinal cord, and peripheral nerves, interventional radiology procedures, and craniotomies for supra- and infratentorial tumors and vascular lesions. METHODS The authors retrospectively analyzed data from 4179 consecutive patients who underwent surgery or an interventional radiology procedure with MEP monitoring. RESULTS Of 4179 patients, only 32 (0.8%) had 1 or more intraoperative seizures. The incidence of seizures in cranial procedures, including craniotomies and interventional neuroradiology, was 1.8%. In craniotomies in which transcranial electrical stimulation (TES) was applied to elicit MEPs, the incidence of seizures was 0.7% (6/850). When direct cortical stimulation was additionally applied, the incidence of seizures increased to 5.4% (23/422). Patients undergoing craniotomies for the excision of extraaxial brain tumors, particularly meningiomas (15 patients), exhibited the highest risk of developing an intraoperative seizure (16 patients). The incidence of seizures in orthopedic spine surgeries was 0.2% (3/1664). None of the patients who underwent surgery for conditions of the spinal cord, neck, or peripheral nerves or who underwent cranial or noncranial interventional radiology procedures had intraoperative seizures elicited by TES during MEP monitoring. CONCLUSIONS In this largest such study to date, the authors report the incidence of intraoperative seizures in patients who underwent MEP monitoring during a wide spectrum of surgeries such as those of the orthopedic spine, spinal cord, and peripheral nerves, interventional radiology procedures, and craniotomies for supra- and infratentorial tumors and vascular lesions. The low incidence of seizures induced by electrical brain stimulation, particularly short-train TES, demonstrates that MEP monitoring is a safe technique that should not be avoided due to the risk of inducing seizures.

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Section: Methodsmentioning

confidence: 99%

Incidence of intraoperative seizures during motor evoked potential monitoring in a large cohort of patients undergoing different surgical procedures

Ulkatan¹,

Jaramillo²,

Téllez³

et al. 2017

JNS

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“…More details about our neurophysiologic set-up and the total intravenous anesthesia protocol were published elsewhere. [20][21][22]…”

Section: Neurophysiological Set-upmentioning

confidence: 99%

Continuous Dynamic Mapping to Identify the Corticospinal Tract in Motor Eloquent Brain Tumors: An Update

Seidel

Schucht

Beck

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Objective We recently developed a new subcortical mapping technique based on the concept of stimulating the tissue at the site of and synchronously with resection. Our hypothesis was that instead of performing resection and mapping sequentially, a synchronized resection and mapping could potentially improve deficit rates. Methods We report our 5-year series of patients who prospectively underwent tumor surgery adjacent to the corticospinal tract (CST) (defined as < 1 cm using diffusion tension imaging and fiber tracking) with simultaneous subcortical short train cathodal monopolar mapping, equipped with a new acoustic motor evoked potential (MEP) alarm. Continuous (temporal coverage) and dynamic (spatial coverage) mapping was realized technically by integrating the mapping probe at the tip of a new suction device. Motor function was assessed using the Medical Research Council scale (from M1 to M5) 1 day after surgery, at discharge, and at 3 months. Results Technically, the method was successful in all 182 cases. The lowest individual motor thresholds reached during resection were > 10 mA, n = 56; 6–10 mA, n = 31; 4–5 mA, n = 37; and 1–3 mA, n = 58. At 3 months, six patients (3%) had a persisting postoperative motor deficit that was caused by direct mechanical injury in three of these patients (1.7%). Conclusions Continuous dynamic mapping was found to be a feasible and ergonomic technique for localizing the exact site of the CST and distance to the motor fibers. This new technique may improve the safety of motor eloquent tumor surgery.

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“…Filter ranges were set to 30/500-1000 Hz. A 50% reduction in the amplitude of SEP, a 10% increase in latency period, total loss of muscle MEP or doubling of the stimulation threshold, which were used as critical criteria in previously published studies, were also used in this study (5,6,7,8).…”

Section: Somatosensory-evoked Potential Monitoringmentioning

confidence: 99%

Intraoperative Neurophysiologic Examination in Central Nervous System Tumor Surgery: Four-year Single-institution Experience

Yıldız¹,

Tezer²,

Mut³

et al. 2017

tnd

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Amaç: İntraoperatif nörofizyolojik monitörizasyon (İONM), beyin cerrahisi operasyonlarında nörolojik kaybı en aza indirmek için günümüzde oldukça yaygın şekilde kullanılmaktadır. Amacımız, merkezimizde kullanılan standart İONM tekniklerini tanımlamak ve çoklu modalite yaklaşımına sahip kendi klinik tecrübemizi tartışmaktır. Gereç ve Yöntem:Tüm beyin cerrahisi operasyonları için danışılan ve en az bir modaliteli İONM (beyin sapı uyarılmış potansiyel, motor uyarılmış potansiyel, somatosensoriyel uyarılmış potansiyel ve/veya elektromiyografi) yapılan erişkin hastalar geriye dönük olarak gözden geçirildi. Bulgular: 2012-2016 yılları arasında merkezi sinir sistemi kitle cerrahisi olan 28 hastaya İONM uygulandı. İONM cerrahinin nörolojik morbiditesini en aza indirgemektedir ve fonksiyonel nöral dokuların tanınması ve ayrımını sağlamaktadır.Sonuç: Çoklu modaliteli İONM karmaşık merkezi sinir sistemi cerrahisinde sonucun en iyi şekilde olmasını sağlayan değerli bir araçtır.Anahtar Kelimeler: Merkezi sinir sistemi kitle cerrahisi, intraoperatif nörofizyolojik izleme, somatosensoriyel uyarılmış potansiyel, beyin sapı uyarılmış potansiyel, motor uyarılmış potansiyel Objective: Intraoperative neurophysiologic monitoring (IONM) is widely used nowadays to minimize neurologic morbidity in neurosurgical operations. Our goal was to describe the standard IONM techniques used in our center and to discuss our own clinical experience with a multimodality approach. Materials and Methods:All consecutive adult patients consulted for neurosurgical operations who underwent at least one modality of IONM (brainstemevoked potential, motor-evoked potential, somatosensory-evoked potential, and/or electromyography) were retrospectively reviewed. Results:Twenty-eight patients who underwent central nervous system tumor surgery between 2012 and 2016 received IONM. IONM minimizes the neurologic morbidity of surgery and allows identification and differentiation of functional neural tissues. Conclusion:Multimodal IONM is a valuable tool for optimization of outcomes in complex central nervous system surgery. Keywords

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Intraoperative Monitoring and Mapping of the Functional Integrity of the Brainstem

Cited by 82 publications

References 23 publications

Incidence of intraoperative seizures during motor evoked potential monitoring in a large cohort of patients undergoing different surgical procedures

Incidence of intraoperative seizures during motor evoked potential monitoring in a large cohort of patients undergoing different surgical procedures

Continuous Dynamic Mapping to Identify the Corticospinal Tract in Motor Eloquent Brain Tumors: An Update

Intraoperative Neurophysiologic Examination in Central Nervous System Tumor Surgery: Four-year Single-institution Experience

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