68 research outputs found
Intraoperative neurophysiological monitoring during spine surgery: an update
No full textPurpose of review: Intraoperative neurophysiological monitoring (IONM) during spine surgery has dramatically evolved over the past decade. A number of techniques have been recently proposed to monitor motor evoked potentials (MEPs), but contradictory results have been published, questioning their reliability to assess specifically the functional integrity of the motor pathways. The aim of the review is to present the state of the art of spinal cord monitoring and the different, complementary roles played by somatosensory evoked potentials (SEPs) and MEPs. Recent findings: The authors focused on recent publications analyzing the reliability of SEPs and different MEP techniques during surgeries for spine deformities, anterior-posterior stabilization or decompression, vertebrectomy, and discectomy. Finally, publications on nonsurgically induced changes in IONM parameters during spine orthopedic surgery, such as hypotension and hypothermia, are reviewed to emphasize their importance. Summary: The authors suggest that a combination of SEPs and transcranially elicited MEPs should be used during spine surgery because there is no scientific justification to favor either one of the two. Spinal epidural MEP recordings may be added in selective cases. Nonsurgically induced changes in IONM should be recognized and corrected to avoid misleading information on surgery-related evoked potential changes. © 2004 Lippincott Williams & Wilkins
The role of intraoperative neurophysiology in the protection or documentation of surgically induced injury to the spinal cord
No full textPlaying both neuroprotective and educational roles, intraoperative neurophysiology has become an intrinsic part of modern neurosurgery. In this article, we present evidence substantiating the neuroprotective role of intraoperative neurophysiology, specifically its capacity to help prevent injury to the corticospinal tracts and the dorsal columns during spinal cord injury
Comments on: "Intraoperative neurophysiologic monitoring in spine surgery. Developments and state of the art in France in 2011" written by M. Gavaret et al. published in Orthop Traumatol Surg Res 2013;99:s319-27.
No full textLetter to the editor
Refers To
Board members of SFCR (French Society of Spine Surgery)
Response to the letter by Vedran Deletis, David B. Mac Donald, Francesco Sala and Isabel Fernandez Conejero
Revue de Chirurgie Orthopédique et Traumatologique, Volume 100, Issue 3, May 2014, Pages 270-271
M. Gavaret, J.L. Jouve, Y. Péréon, F. Accadbled, N. André-Obadia, E. Azabou, B. Blondel, G. Bollini, J. Delécrin, J.-P. Farcy, J. Fournet-Fayard, C. Garin, P. Henry, V. Manel, V. Mutschler, G. Perrin, J. Sales de Gauzy, the French Society of Spine Surgery (SFCR)
Intraoperative neurophysiologic monitoring in spine surgery. Developments and state of the art in France in 2011
Orthopaedics & Traumatology: Surgery & Research, Volume 99, Issue 6, Supplement, October 2013, Pages S319-S327
Referred to by
Board members of ISIN (International Society of Intraoperative Neurophysiology)
Comments on: “Intraoperative neurophysiologic monitoring in spine surgery. Developments and state of the art in France in 2011” written by M. Gavaret and al. published in Orthop Traumatol Surg Res 2013;99:s319–27
Revue de Chirurgie Orthopédique et Traumatologique, Volume 100, Issue 3, May 2014, Pages 269-27
Intraoperative neurophysiological monitoring of the spinal cord during spinal cord and spine surgery: a review focus on the corticospinal tracts
No full textRecent advances in technology and the refinement of neurophysiological methodologies are significantly changing intraoperative neurophysiological monitoring (IOM) of the spinal cord. This review will summarize the latest achievements in the monitoring of the spinal cord during spine and spinal cord surgeries. This overview is based on an extensive review of the literature and the authors' personal experience. Landmark articles and neurophysiological techniques have been briefly reported to contextualize the development of new techniques. This background is extended to describe the methodological approach to intraoperatively elicit and record spinal D wave and muscle motor evoked potentials (muscle MEPs). The clinical application of spinal D wave and muscle MEP recordings is critically reviewed (especially in the field of Neurosurgery) and new developments such as mapping of the dorsal columns and the corticospinal tracts are presented. In the past decade, motor evoked potential recording following transcranial electrical stimulation has emerged as a reliable technique to intraoperatively assess the functional integrity of the motor pathways. Criteria based on the absence/presence of potentials, their morphology and threshold-related parameters have been proposed for muscle MEPs. While the debate remains open, it appears that different criteria may be applied for different procedures according to the expected surgery-related morbidity and the ultimate goal of the surgeon (e.g. total tumor removal versus complete absence of transitory or permanent neurological deficits). On the other hand, D wave changes - when recordable - have proven to be the strongest predictors of maintained corticospinal tract integrity (and therefore, of motor function/recovery). Combining the use of muscle MEPs with D wave recordings provides the most comprehensive approach for assessing the functional integrity of the spinal cord motor tracts during surgery for intramedullary spinal cord tumors. However, muscle MEPs may suffice to assess motor pathways during other spinal procedures and in cases where the pathophysiology of spinal cord injury is purely ischemic. Finally, while MEPs are now considered the gold standard for monitoring the motor pathways, SEPs continue to retain value as they provide specificity for assessing the integrity of the dorsal column. However, we believe SEPs should not be used exclusively - or as an alternative to motor evoked potentials - during spine surgery, but rather as a complementary method in combination with MEPs. For intramedullary spinal tumor resection, SEPs should not be used exclusively without MEPs
Corticospinal tract monitoring with D- and I-waves from the spinal cord and muscle MEPs from limb muscles
No full textIntraoperative neurophysiology: a tool to prevent and/or document intraoperative injury to the nervous system (Chapter 4)
No full text[no abstract available
Intraoperative neurophysiology: a tool to prevent and document intraoperative injury to the nervous system
No full text[No abstract available
Intraoperative neurophysiological monitoring in pediatric neurosurgery: why, when, how?
No full textINTRODUCTION: This review is primarily based on peer-reviewed scientific publications and on the authors' experience in the field of intraoperative neurophysiology. The purpose is a critical analysis of the role of intraoperative neurophysiological monitoring (INM) during various neurosurgical procedures, emphasizing the aspects that mainly concern the pediatric population. Original papers related to the field of intraoperative neurophysiology were collected using medline. INM consists in monitoring (continuous "on-line" assessment of the functional integrity of neural pathways) and mapping (functional identification and preservation of anatomically ambiguous nervous tissue) techniques. We attempted to delineate indications for intraoperative neurophysiological techniques according to their feasibility and reliability (specificity and sensitivity). DISCUSSION AND CONCLUSIONS: In compiling this review, controversies about indications, methodologies and the usefulness of some INM techniques have surfaced. These discrepancies are often due to lack of familiarity with new techniques in groups from around the globe. Accordingly, internationally accepted guidelines for INM are still far from being established. Nevertheless, the studies reviewed provide sufficient evidence to enable us to make the following recommendations. (1) INM is mandatory whenever neurological complications are expected on the basis of a known pathophysiological mechanism. INM becomes optional when its role is limited to predicting postoperative outcome or it is used for purely research purposes. (2) INM should always be performed when any of the following are involved: supratentorial lesions in the central region and language-related cortex; brain stem tumors; intramedullary spinal cord tumors; conus-cauda equina tumors; rhizotomy for relief of spasticity; spina bifida with tethered cord. (3) Monitoring of motor evoked potentials (MEPs) is now a feasible and reliable technique that can be used under general anesthesia. MEP monitoring is the most appropriate technique to assess the functional integrity of descending motor pathways in the brain, the brain stem and, especially, the spinal cord. (4) Somatosensory evoked potential (SEP) monitoring is of value in assessment of the functional integrity of sensory pathways leading from the peripheral nerve, through the dorsal column and to the sensory cortex. SEPs cannot provide reliable information on the functional integrity of the motor system (for which MEPs should be used). (5) Monitoring of brain stem auditory evoked potentials remains a standard technique during surgery in the brain stem, the cerebellopontine angle, and the posterior fossa. (6) Mapping techniques (such as the phase reversal and the direct cortical/subcortical stimulation techniques) are invaluable and strongly recommended for brain surgery in eloquent cortex or along subcortical motor pathways. (7) Mapping of the motor nuclei of the VIIth, IXth-Xth and XIIth cranial nerves on the floor of the fourth ventricle is of great value in identification of "safe entry zones" into the brain stem. Techniques for mapping cranial nerves in the cerebellopontine angle and cauda equina have also been standardized. Other techniques, although safe and feasible, still lack a strong validation in terms of prognostic value and correlation with the postoperative neurological outcome. These techniques include monitoring of the bulbocavernosus reflex, monitoring of the corticobulbar tracts, and mapping of the dorsal columns. These techniques, however, are expected to open up new perspectives in the near future
Intraoperative neurophysiological monitoring and mapping during brain stem surgery: a modern approach
No full textAlthough magnetic resonance imaging technology has contributed significantly to the surgical treatment of a variety of brain stem pathologies, it remains an inadequate tool in the prevention of intraoperatively induced brain stem neurological injury. We introduce a new approach to brain stem intraoperative neurophysiological monitoring that promises to diminish intraoperative morbidity to the motor system by the proper identification of exposed brain stem structures, before initial incision or during tumor removal. The approach comprises three intraoperative neurophysiological techniques: The first technique localizes the motor cranial nerve nuclei on the surgically exposed floor of the fourth ventricle. The second technique localizes the corticospinal tract within the cerebral peduncle. The third technique tests the functional integrity of the corticospinal tract through continuous monitoring and eliciting of the D waves (descending activity) from the electrically activated corticospinal tracts. Copyright (C) 2000 by W.B. Saunders Company
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