Spinal cord monitoring

Nuwer, Marc R.

doi:10.1002/(sici)1097-4598(199912)22:12<1620::aid-mus2>3.0.co;2-1

Cited by 64 publications

(25 citation statements)

References 90 publications

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“…In line with previous studies, we observed a robust negative predictive value with expected specificity and sensitivity 2,13,21,31,32. However, our positive predictive value was lower than expected.…”

Section: Discussionsupporting

confidence: 92%

“…Causes of FNs are of paramount importance as they represent lost opportunities to potentially intervene prior to development of the neurologic deficit. 'Delayed onset' neurologic deficits have been recognized in spinal surgeries32 as well as skull base procedures 2. These delayed onset cases may be attributed to latent vascular or mechanical compression 32.…”

Section: Discussionmentioning

confidence: 99%

“…'Delayed onset' neurologic deficits have been recognized in spinal surgeries32 as well as skull base procedures 2. These delayed onset cases may be attributed to latent vascular or mechanical compression 32. More likely in our case, the affected parenchyma was the supplementary motor area which was distant from the pathway which SSEPs monitor.…”

Section: Discussionmentioning

confidence: 99%

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Predictive Value of Somatosensory Evoked Potential Monitoring during Resection of Intraparenchymal and Intraventricular Tumors Using an Endoscopic Port

et al. 2013

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Background and PurposeIntraoperative neurophysiological monitoring (IONM) using upper and lower somatosensory evoked potentials (SSEPs) is an established technique used to predict and prevent neurologic injury during intracranial tumor resections. Endoscopic port surgery (EPS) is a minimally-invasive approach to deep intraparenchymal and intraventricular brain tumors. The authors intended to evaluate the predictive value of SSEP monitoring during resection of intracranial brain tumors using a parallel endoscopic technique.MethodsA retrospective review was conducted of patients operated on from 2007-2010 utilizing IONM in whom endoscopic ports were used to remove either intraparenchymal or intraventricular tumors. Cases were eligible for review if an endoscopic port was used to resect an intracranial tumor and the electronic chart included all intraoperative monitoring data as well as pre- and post-operative neurologic exams.Results139 EPS cases met criteria for inclusion. Eighty five patients (61%) had intraparenchymal and fifty four (39%) had intraventricular tumors or colloid cysts. SSEP changes were seen in eleven cases (7.9%), being irreversible in three (2.2%) and reversible in eight cases (5.8%). Seven patients (5.0%) with intraparenchymal tumors had SSEP changes which met our criterea for significant changes while there were four (2.9%) with intraventricular (p-value=0.25). Five patients suffered post operative deficits, two reversible and two irreversible SSEP changes. Only one case exhibited post operative hemiparesis with no SSEP changes. The positive predictive value of SSEP was 45.4% and the negative predictive value was 99.2%.ConclusionsBased on the high negative and low positive predictive values, the utility of SSEP monitoring for cylindrical port resections may be limited. However, the use of SSEP monitoring can be helpful in reducing the impact of endoscopic port manipulation when the tumor is closer to the somatosensory pathway.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predictive Value of Somatosensory Evoked Potential Monitoring during Resection of Intraparenchymal and Intraventricular Tumors Using an Endoscopic Port

et al. 2013

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confidence: 99%

“…5,8,16 It has been suggested that monitoring of motor pathway function may provide distinct advantages beyond those attributable to SSEP monitoring alone. 5,7,16,17 Monitoring of function in spinal motor pathways-often referred to as motor evoked potential monitoring-can be accomplished in a variety of ways. 1,7 For our purposes, a successful method must: 1) be suitable for all levels of the spinal cord and brainstem; 2) be reliable within the limits of the patient's preoperative neurological status; 3) reflect the function of the corticospinal tract; 4) provide immediate feedback to the surgical team; 5) be compatible with real-time EMG monitoring of muscle; 6) be practicable with respect to the requirements of instrumentation and anesthesia; and 7) be safe.…”

mentioning

confidence: 99%

Threshold-level repetitive transcranial electrical stimulation for intraoperative monitoring of central motor conduction

Calancie

Harris²,

Brindle³

et al. 2001

Journal of Neurosurgery: Spine

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Object. The authors conducted a study to evaluate repetitive transcranial electrical stimulation (TES) to assess spinal cord motor tract function in individuals undergoing spine surgery, with emphasis on safety and efficacy. Methods. Somatosensory evoked potentials (SSEPs) were elicited using standard technique. Muscle electromyographic values were measured in response to a three- or four-pulse train of stimulation delivered to the motor cortex via subdermal electrodes. They also evaluated whether changes in the minimum stimulus intensity (that is, threshold level) needed to elicit a response from a given muscle predict motor status immediately postoperatively, as well as whether changes in SSEP response amplitude and latency predict sensory status immediately postoperatively. Anesthesia was routinely induced with intravenous propofol and remifentanil, supplemented with inhaled nitrous oxide. Use of neuromuscular block was avoided after intubation. Satisfactory monitoring of muscle response to threshold-level repetitive TES was achieved in all but nine of the 194 patients studied. In contrast, cortical SSEP responses could not be elicited in 42 of 194 individuals. In cases in which responses were present, TES-based evoked responses proved to be extremely accurate for predicting postoperative motor status. Somatosensory evoked potential monitoring was nearly as accurate for predicting postoperative sensory status. There were frequent instances of postoperative motor or sensory deficit that were not predicted by SSEP- and TES-based monitoring, respectively. There were no adverse events attributable to TES-based monitoring, although since this study ended we have had a single adverse event attributable to threshold-level repetitive TES. Conclusions. Intraoperative threshold-level repetitive TES—based monitoring of central motor conduction has proven to be a simple, safe, and highly accurate technique for the prevention or minimization of inadvertent motor deficit during surgery involving the spine or spinal cord.

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Monitoring Somatosensory Evoked Potentials

Møller

2010

Intraoperative Neurophysiological Monitoring

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Spinal cord monitoring

Cited by 64 publications

References 90 publications

Predictive Value of Somatosensory Evoked Potential Monitoring during Resection of Intraparenchymal and Intraventricular Tumors Using an Endoscopic Port

Predictive Value of Somatosensory Evoked Potential Monitoring during Resection of Intraparenchymal and Intraventricular Tumors Using an Endoscopic Port

Threshold-level repetitive transcranial electrical stimulation for intraoperative monitoring of central motor conduction

Monitoring Somatosensory Evoked Potentials

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