American Journal of Electroneurodiagnostic Technology最新文献_第3页

American Journal of Electroneurodiagnostic Technology Pub Date : 2011-12-01 DOI: 10.1080/1086508x.2011.11079837

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Kathleen Mears Memorial Lecture: Are we ready for 2014? An overview of healthcare reform for the neurodiagnostic practitioner. 凯瑟琳·米尔斯纪念讲座:我们为2014年做好准备了吗?对神经诊断从业者的医疗改革的概述。

American Journal of Electroneurodiagnostic Technology Pub Date : 2011-12-01

L Elizabeth Mullikin

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Intraoperative neurophysiological monitoring (IONM): lessons learned from 32 case events in 2069 spine cases. 术中神经生理监测(IONM):对2069例脊柱病例32例事件的总结。

American Journal of Electroneurodiagnostic Technology Pub Date : 2011-12-01

Matthew Eager, Adam Shimer, Faisal R Jahangiri, Francis Shen, Vincent Arlet

{"title":"Intraoperative neurophysiological monitoring (IONM): lessons learned from 32 case events in 2069 spine cases.","authors":"Matthew Eager, Adam Shimer, Faisal R Jahangiri, Francis Shen, Vincent Arlet","doi":"","DOIUrl":"","url":null,"abstract":"Intraoperative neurophysiological monitoring (IONM) is becoming the standard of care for many spinal surgeries, especially those with deformity correction and instrumentation. We reviewed 2069 spine cases with multimodality IONM including somatosensory evoked potentials (SSEP), transcranial electrical motor evoked potentials (TCeMEP), and spontaneous and triggered electromyography (s-EMG and t-EMG) in a University setting over a period of four years to examine perioperative clinical findings when an IONM event was noted and to ascertain how IONM has affected our ability to avoid potential neurological injury during spine surgery. We performed a retrospective analysis of cases from 2006 to 2010 to study the frequency and cause of intraoperative events detected via IONM and the clinical outcome of the patient. There were 32 cases (1.5%) with possible intraoperative events. There were 17 (53%) cases where IONM changes affected the course of the surgery and prevented possible postoperative neurological deficits. Seven cases (41%) were due to deformity correction, five (29%) due to hypotension, four (24%) due to patient positioning, and one (6%) due to a screw requiring repositioning. None of the 17 patients had postoperative motor or sensory deficits. There were four cases with false-positive IONM findings due to correctible technical issues. Three cases required surgical revision due to pedicle screw malposition. In each case, s-EMGs failed to exhibit intraoperative changes but the patient presented with postoperative radiculopathy. We believe that the use of t-EMGs may have prevented these complications. This review reinforces the importance of multimodality IONM for spinal surgery. The incidence of possible events in our series was 1.5%, and several likely postoperative neurologic deficits were avoided by intraoperative intervention.","PeriodicalId":7480,"journal":{"name":"American Journal of Electroneurodiagnostic Technology","volume":"51 4","pages":"247-63"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30434834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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The Janet Ghigo Awards Janet Ghigo奖

American Journal of Electroneurodiagnostic Technology Pub Date : 2011-12-01 DOI: 10.1080/1086508x.2011.11079834

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Transcranial motor evoked potential changes induced by provocative testing during embolization of cerebral arteriovenous malformations in patients under total intravenous anesthesia. 全静脉麻醉下脑动静脉畸形栓塞术中刺激试验引起的经颅运动诱发电位变化。

American Journal of Electroneurodiagnostic Technology Pub Date : 2011-12-01

Fenghua Li, Eric Deshaies, Geoffrey Allott, Reza Gorji

{"title":"Transcranial motor evoked potential changes induced by provocative testing during embolization of cerebral arteriovenous malformations in patients under total intravenous anesthesia.","authors":"Fenghua Li, Eric Deshaies, Geoffrey Allott, Reza Gorji","doi":"","DOIUrl":"","url":null,"abstract":"Cerebral motor evoked potential (MEP) monitoring during arteriovenous malformation (AVM) embolization is not well studied (Söderman et al. 2003). Alterations of cerebral blood flow (CBF) during cerebral embolization could cause ischemia/infarction to the cerebral cortex. Permanent loss of MEPs is correlated with a permanent motor deficit. We report a case of a patient undergoing AVM embolization during which transcranial electrical motor evoked potentials (TCeMEP) reliably predicted changes to CBF induced by selective methohexital testing. Our finding demonstrated that MEPs are a useful means of intraoperative monitoring of motor pathway integrity and predicting changes. The loss of MEP predicted and prevented severe postoperative motor deficits. Intraoperative neuromonitoring with SSEP, TCeMEP and continuous EEG revealed no changes until the posterior cerebral artery (PCA), but not the anterior cerebral artery (ACA), was injected. TCeMEP may be superior to somatosensory evoked potential (SSEP) and EEG monitoring in predicting motor impairment during AVM surgery.","PeriodicalId":7480,"journal":{"name":"American Journal of Electroneurodiagnostic Technology","volume":"51 4","pages":"264-73"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30434835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Waveform Window #21: Anomaly during Pedicle Screw Stimulation 波形窗口#21:椎弓根螺钉刺激期间的异常

American Journal of Electroneurodiagnostic Technology Pub Date : 2011-12-01 DOI: 10.1080/1086508X.2011.11079831

Justin W. Silverstein, Sushil K. Basra

{"title":"Waveform Window #21: Anomaly during Pedicle Screw Stimulation","authors":"Justin W. Silverstein, Sushil K. Basra","doi":"10.1080/1086508X.2011.11079831","DOIUrl":"https://doi.org/10.1080/1086508X.2011.11079831","url":null,"abstract":"Empirical data support the stimulation of pedicle screws intraoperatively to reduce the risk of neural damage to exiting nerve roots post-operatively. Lenke and colleagues (1995) published a range of threshold intensities to indicate whether a screw is directly making dural contact ( < 4 rnA), medially breached without dural contact (4 rnA to 8 rnA), or completely within pedicle(> 8 rnA). However, false negatives occur with screw stimulation which include: fluid in the wound (which would cause current shunting, requiring higher stimulus output), something other than the screw head being stimulated (for example, stimulus to wound tissue or screw crown would impede the current, making the threshold value of a distal electromyogram (EMG) response greater than it should be), or the patient is pharmacologically paralyzed (different levels of paralytic agents would cause higher thresholds needed to obtain a response). These false negatives tend to manifest as high impedance threshold values (>50 rnA). We present a case where eight pedicle screws were stimulated via a monopolar intraoperative stimulation probe. The reference was placed in the wound rostral to stimulation, not far from the stimulus. A rep rate of 2. 79 Hz and duration of .2 msec was utilized. Sub-maximal stimulation was utilized to obtain the response. This is the least amount of current needed to elicit a compound muscle action potential (CMAP). Note in the figures presented the morphology and amplitude differences from each CMAP acquired, as screw stimulation elicits variable responses at every level tested. A time base of 5 msec/div and a sensitivity of 100 11 V /div were used. Each screw had a threshold value greater than 50 rnA with the exception of the left S 1 screw which elicited a response at 12 rnA. After deducing there were no indications for a false negative to occur, we decided to remove the screw and manually probe the hole.","PeriodicalId":7480,"journal":{"name":"American Journal of Electroneurodiagnostic Technology","volume":"55 1","pages":"296 - 300"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80485310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Preventing position-related brachial plexus injury with intraoperative somatosensory evoked potentials and transcranial electrical motor evoked potentials during anterior cervical spine surgery. 颈椎前路手术中应用体感诱发电位和经颅运动诱发电位预防体位相关性臂丛神经损伤。

American Journal of Electroneurodiagnostic Technology Pub Date : 2011-09-01

Faisal R Jahangiri, Andrea Holmberg, Francisco Vega-Bermudez, Vincent Arlet

{"title":"Preventing position-related brachial plexus injury with intraoperative somatosensory evoked potentials and transcranial electrical motor evoked potentials during anterior cervical spine surgery.","authors":"Faisal R Jahangiri, Andrea Holmberg, Francisco Vega-Bermudez, Vincent Arlet","doi":"","DOIUrl":"","url":null,"abstract":"The use of somatosensory evoked potentials (SSEPs) to monitor upper extremity nerves during surgery is becoming more accepted as a valid and useful technique to minimize intraoperative nerve injuries. We present a case illustrating the benefit of utilizing both SSEPs and transcranial electrical motor evoked potentials (TCeMEPs) for preventing position-related injury during surgery. The patient was a 43-year-old male with a history of neck pain, along with numbness and tingling of the upper extremities. While the patient was being draped, upper extremity SSEPs diminished significantly TCeMEP responses in the hands (abductor pollicus brevis-abductor digiti minimi; APB-ADM) vanished shortly after that, followed by the biceps and left deltoid. The surgeons were notified, and the tape on the shoulders was loosened. No improvements were noted in SSEPs nor TCeMEPs due to this intervention, so all tape was removed and the patient's arms were allowed to rest naturally upon the arm boards. Upper extremity TCeMEP responses could then be elicited and SSEPs improved shortly afterward. Surgery was completed with the arms on the arm boards. All signals remained stable for the remaining three hours of the procedure. At two months follow-up, the patient was well with total pain relief and normal upper extremity function when neurological examination was performed. This report demonstrates a case in which intraoperative neurophysiological monitoring was useful in identifying and reversing impending nerve injury during cervical spine surgery. Significant changes were seen in SSEPs as well as TCeMEPs, so we recommend that TCeMEP monitoring be considered as an adjunct to SSEPs for prevention of injury to the brachial plexus.","PeriodicalId":7480,"journal":{"name":"American Journal of Electroneurodiagnostic Technology","volume":"51 3","pages":"198-205"},"PeriodicalIF":0.0,"publicationDate":"2011-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30199636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

EEG Monitoring during Therapeutic Hypothermia in Neonates, Children, and Adults 新生儿、儿童和成人治疗性低温期间的脑电图监测

American Journal of Electroneurodiagnostic Technology Pub Date : 2011-09-01 DOI: 10.1080/1086508X.2011.11079816

N. Abend, R. Mani, Tammy N Tschuda, T. Chang, A. Topjian, M. Donnelly, D. LaFalce, Margaret C Krauss, Sarah E. Schmitt, J. Levine

引用次数: 24

EEG monitoring during therapeutic hypothermia in neonates, children, and adults. 新生儿、儿童和成人治疗性低温期间的脑电图监测。

American Journal of Electroneurodiagnostic Technology Pub Date : 2011-09-01

Nicholas S Abend, Ram Mani, Tammy N Tschuda, Tae Chang, Alexis A Topjian, Maureen Donnelly, Denise LaFalce, Margaret C Krauss, Sarah E Schmitt, Joshua M Levine

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Direct cortical stimulation but not transcranial electrical stimulation motor evoked potentials detect brain ischemia during brain tumor resection. 直接皮层刺激而非经颅电刺激运动诱发电位检测脑肿瘤切除过程中的脑缺血。

American Journal of Electroneurodiagnostic Technology Pub Date : 2011-09-01

Fenghua Li, Eric M Deshaies, Geoffrey Allott, Gregory Canute, Reza Gorji

{"title":"Direct cortical stimulation but not transcranial electrical stimulation motor evoked potentials detect brain ischemia during brain tumor resection.","authors":"Fenghua Li, Eric M Deshaies, Geoffrey Allott, Gregory Canute, Reza Gorji","doi":"","DOIUrl":"","url":null,"abstract":"Motor evoked potentials (MEPs) elicited by both direct cortical stimulation (DCS) and transcranial electrical stimulation are used during brain tumor resection. Parallel use of direct cortical stimulation motor evoked potentials (DCS-MEPs) and transcranial electrical stimulation motor evoked potentials (TCeMEPs) has been practiced during brain tumor resection. We report that DCS-MEPs elicited by direct subdural grid stimulation, but not TCeMEPs, detected brain ischemia during brain tumor resection. Following resection of a brainstem high-grade glioma in a 21-year-old, the threshold of cortical motor-evoked-potentials (cMEPs) increased from 13 mA to 20 mA while amplitudes decreased. No changes were noted in transcranial motor evoked potentials (TCMEPs), somatosensory evoked potentials (SSEPs), auditory evoked potentials (AEPs), anesthetics, or hemodynamic parameters. Our case showed the loss of cMEPs and SSEPs, but not TCeMEPs. Permanent loss of DCS-MEPs and SSEPs was correlated with permanent left hemiplegia in our patient even when appropriate action was taken. Parallel use of DCS- and TCeMEPs with SSEPs improves sensitivity of intraoperative detection of motor impairment. DCS may be superior to TCeMEPs during brain tumor resection.","PeriodicalId":7480,"journal":{"name":"American Journal of Electroneurodiagnostic Technology","volume":"51 3","pages":"191-7"},"PeriodicalIF":0.0,"publicationDate":"2011-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30198667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0