Transcranial electric motor evoked potential detection of compressional peroneal nerve injury in the lateral decubitus position

Objectives/Hypothesis:Continuous intraoperative neuromonitoring (IONM) of transcranial electric motor evoked potentials (tceMEPs) and somatosensory evoked potentials (SSEPs) has gained universal acceptance as an efficacious method for detecting emerging positional brachial plexopathy or peripheral nerve compression during spinal and shoulder surgery. This has implications for transaxillary thyroid surgery.Study Design:Case report with literature review.Methods:The patient underwent robotic transaxillary thyroid surgery with continuous tceMEP and SSEP monitoring of brachial plexus function. We present detailed IONM data depicting the emergence of positional brachial plexopathy.Results:Significant amplitude loss of both IONM modalities were identified during an evolving positional plexopathy, which resolved upon upper extremity repositioning and conversion to an open procedure. No permanent nerve injury or deficit was noted following surgery.Conclusions:Given the potential for brachial plexus injury during robotic transaxillary thyroid surgery secondary to arm positioning, we recommend that continuous tceMEP and SSEP monitoring be considered during such procedures.

show abstract

“…Oxygen and air were the only inhaled gases. Central temperature was maintained between 35°C and 36°C 3, 5…”

Section: Case Reportmentioning

confidence: 99%

“…Injury to the brachial plexus is among the most frequent complications of surgery and often the primary reason for anesthesia‐related malpractice claims 1, 2. Although such positional‐based nerve injuries have been noted in both spine and cardiothoracic surgery, there are no such reports in head and neck surgery 3–6…”

Section: Introductionmentioning

confidence: 99%

Detection of evolving injury to the brachial plexus during transaxillary robotic thyroidectomy

et al. 2011

Self Cite

View full text Add to dashboard Cite

show abstract

“…One of the prime concerns with this transaxillary approach is the potential for brachial plexus traction and compression injury secondary to arm positioning. 2 , In the early 1990s, somatosensory evoked potential (SSEP) was introduced as a tool for intraoperative neurophysiologic monitoring (IONM) in a number of neurological, orthopedic, and thoracic procedures . SSEP via neurophysiologic monitoring can recognize the changes of nerve conduction that precede permanent injury .…”

Section: Introductionmentioning

confidence: 99%

Somatosensory evoked potential: Preventing brachial plexus injury in transaxillary robotic surgery

Huang¹,

Garstka²,

Murcy³

et al. 2019

The Laryngoscope

View full text Add to dashboard Cite

Objectives/Hypothesis: The potential for brachial plexopathy due to arm positioning is a major concern regarding the robotic transaxillary approach. Intraoperative nerve monitoring via somatosensory evoked potential (SSEP) has been suggested to prevent such injury. In this study, we examined the use of SSEP in detecting imminent brachial plexus traction during robotic transaxillary thyroid and parathyroid surgery.Study Design: Retrospective case series. Methods: A analysis was performed for all patients undergoing robotic transaxillary surgery with continuous intraoperative SSEP monitoring at a North American institution between 2015 and 2017. A significant intraoperative SSEP change was defined as a decrease in signal amplitude of >50% or an increase in latency of >10% from baseline established during preoperative positioning.Results: One hundred thirty-seven robotic transaxillary surgeries using SSEP monitoring were performed on 123 patients. Seven patients (5.1%) developed significant changes, with an average SSEP amplitude reduction of 73% ± 12% recorded at the signals' nadir. Immediate arm repositioning resulted in recovery of signals and complete return to baseline parameters in 14.3 ± 9.2 minutes. There was no difference in age (40.4 ± 9.4 years vs. 44.5 ± 13.4 years; P = .31) or body mass index (27.3 ± 3.7 kg/m 2 vs. 26.9 ± 6.1 kg/m 2 ; P = .79) between cases with and without SSEP change. Operative time was shorter for patients with significant SSEP change (131.6 ± 14.7 minutes vs. 146.5 ± 46.7 minutes; P = .048). There were no postoperative positional brachial plexus injuries.Conclusions: SSEP is a novel, safe, and reliable tool in detection of position-related brachial plexus neuropathy. Intraoperative monitoring using SSEP can play a vital role in early recognition and prevention of injury during robotic transaxillary thyroid and parathyroid surgery.

show abstract

Interventional Neuroradiology

Sestokas¹,

Schwartz²

2011

Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals

View full text Add to dashboard Cite

Transcranial electric motor evoked potential detection of compressional peroneal nerve injury in the lateral decubitus position

Cited by 11 publications

References 27 publications

Detection of evolving injury to the brachial plexus during transaxillary robotic thyroidectomy

Detection of evolving injury to the brachial plexus during transaxillary robotic thyroidectomy

Somatosensory evoked potential: Preventing brachial plexus injury in transaxillary robotic surgery

Interventional Neuroradiology

Contact Info

Product

Resources

About