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Clin Neurophysiol 2019 Apr 5;130(6):952-959. Epub 2019 Apr 5.

Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland.

Objective: To know whether motor deficits after tumor surgery are transient is reassuring for the patient and crucial for planning rehabilitation and adjuvant treatment. We analyze the value of postoperative MRI navigated transcranial magnetic stimulation (nTMS) compared to intraoperative MEP monitoring in predicting recovery of motor function.

Methods: Retrospective series of nTMS mappings within 14 days after surgery for supratentorial tumors (09/2014-05/2018). Read More

Eur Arch Otorhinolaryngol 2019 Apr 6. Epub 2019 Apr 6.

ENT Service, Hospital Universitario de Canarias, Ctra. Ofra S/N La Cuesta, 38320, La Laguna, Santa Cruz de Tenerife, Spain.

Objectives: To assess the diagnostic capacity of intraoperative neurophysiological monitoring with respect to "gold standard" microscopic findings of facial canal dehiscence in middle ear cholesteatoma surgery.

Study Design, Patients And Setting: We carried out a retrospective cohort study of 57 surgical interventions for cholesteatoma between 2008 and 2013 at Hospital Universitario de Canarias, Spain.

Diagnostic Interventions: Each patient underwent preoperative computed tomography (CT), intraoperative neurophysiological monitoring and intraoperative inspection of the facial nerve during microsurgery. Read More

J Gastric Cancer 2019 Mar 7;19(1):49-61. Epub 2019 Feb 7.

Department of Surgery, Seoul National University Hospital, Seoul, Korea.

Purpose: The perigastric vagus nerve may play an important role in preserving function after gastrectomy, and intraoperative neurophysiologic tests might represent a feasible method of evaluating the vagus nerve. The purpose of this study is to assess the feasibility of neurophysiologic evaluations of the function and viability of perigastric vagus nerve branches during gastrectomy.

Materials And Methods: Thirteen patients (1 open total gastrectomy, 1 laparoscopic total gastrectomy, and 11 laparoscopic distal gastrectomy) were prospectively enrolled. Read More

J Neurosurg Spine 2019 03 29:1-11. Epub 2019 Mar 29.

1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario; and.

OBJECTIVE Intraoperative neurophysiological monitoring (IONM) is a useful adjunct in spine surgery, with proven benefit in scoliosis-correction surgery. However, its utility for anterior cervical discectomy and fusion (ACDF) is unclear, as there are few head-to-head comparisons of ACDF outcomes with and without the use of IONM. The authors sought to evaluate the impact of IONM on the safety and cost of ACDF. Read More

Neurodiagn J 2019 ;59(1):34-44

g Department of Neurosurgery University of Texas Health Science Center , San Antonio , Texas.

Bowel and bladder function are at risk during tumor resection of the conus, cauda equina, and nerve roots. This study demonstrates the ability to acquire transcranial electrical motor evoked potentials (TCeMEPs) from the urethral sphincter muscles (USMEPs) by utilizing a urethral catheter with an embedded electrode. A retrospective analysis of intraoperative neurophysiological monitoring (IONM) data from nine intradural tumors, four tethered cord releases, and two spinal stenosis procedures was performed (n = 15). Read More

Oper Neurosurg (Hagerstown) 2019 Mar 27. Epub 2019 Mar 27.

Department of Neurological Surgery, University of California - San Francisco, San Francisco, California.

Background: Aneurysms of the anterior choroidal artery (AChA) have been associated with high treatment-associated morbidity due to ischemic complications.

Objective: To report a large clinical experience of microsurgically treated AChA aneurysms and describe a systematic approach to reduce ischemic complications.

Methods: One hundred forty-six patients with AChA aneurysms were retrospectively reviewed from a prospectively maintained database. Read More

World Neurosurg 2019 Mar 20. Epub 2019 Mar 20.

Departments of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China. Electronic address:

Background: Hyperhidrosis is caused by sympathetic dysfunction of the central or peripheral nervous system. However, intramedullary spinal cord tumors presenting with hyperhidrosis as an initial symptom had been rarely reported in the literature.

Case Description: This case involves an 18-year-old man who presented with abnormal enhanced sweating and flushing on the bilateral side of his face and neck that had persisted for 6 years. Read More

Acta Orthop Traumatol Turc 2019 Mar 18. Epub 2019 Mar 18.

Department of Orthopedics, Sahlgrenska Academy at University of Gothenburg, Sweden.

Objective: The aim of this study was to evaluate the differences in transcranial electric motor-evoked potentials - TceMEP on upper limbs and the incidences of postoperative brachial plexopathy between patients with kyphotic and scoliotic trunk shapes.

Methods: In the period of January 2011-January 2017, 61 consecutive patients (mean age: 18.4 years ± 4. Read More

J Clin Neurophysiol 2019 Mar 14. Epub 2019 Mar 14.

Surgical Neurophysiology Program, Department of Neurology, University of Southern California, Los Angeles, California, U.S.A.

Purpose: Transcranial motor evoked potentials (TcMEPs) are used to assess the corticospinal tract during surgery. Transcranial motor evoked potentials are elicited by preferentially activating the anode over the target cortex. Crossover occurs when stimulation also induces activation of ipsilateral motor evoked responses. Read More

Oper Neurosurg (Hagerstown) 2019 Mar 19. Epub 2019 Mar 19.

Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania.

Background: Neurophysiological monitoring (NPM) is frequently performed during arteriovenous malformation (AVM) embolization. However, the ability of NPM to predict neurological deficits or improve surgical decision making in this setting has not been studied.

Objective: To review our use of NPM during AVM embolization to better define its utility. Read More

Orthopade 2019 Mar 18. Epub 2019 Mar 18.

Spine Center, Department of Orthopaedic Surgery, Trauma Surgery and Division of Spinal Cord Injury, Ruprecht Karls University Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.

Purpose: Pediatric cervical spine injuries constitute approximately 1-2% of all pediatric trauma cases. Usually pediatric vertebral injuries appear as stable A type fractures, whereas B and C type injuries are relatively uncommon. In contrast to adults, the appropriate treatment strategy in children is still controversial and places spine surgeons in complex situations. Read More

Spine (Phila Pa 1976) 2019 Mar 4. Epub 2019 Mar 4.

Department of Orthopedics, Peking Union Medical College Hospital, Beijing, P. R. China.

Study Design: This is a retrospective cases study from a prospective patient register.

Objective: To clarify the clinical implication regard to the survivals of MEP response.

Summary Of Background Data: Intraoperative neurophysiological monitoring (IONM) has become an essential component for decreasing the incidence of neurological deficits during spine surgeries. Read More

Cureus 2018 Dec 24;10(12):e3771. Epub 2018 Dec 24.

Neurosurgery, Lenox Hill Hospital Northwell Health, New York, USA.

Transcranial motor evoked potential (TCMEP) and direct cortical motor evoked potential (DCMEP) paradigms have historically been used contemporaneously or independently for supratentorial craniotomies. DCMEP provides focal stimulation to the cortical surface, whereas TCMEP stimulation is more variable and may be activating structures deeper than those at risk during a supratentorial craniotomy. We present the case report for a 65-year-old female who underwent a supratentorial craniotomy for the clipping of a right-sided unruptured middle cerebral artery (MCA) aneurysm. Read More

J Clin Monit Comput 2019 04 26;33(2):193-194. Epub 2019 Feb 26.

Stanford University, and Golden Gate Neuromonitoring, San Francisco, CA, USA.

J Neurosurg Pediatr 2019 Feb 22:1-9. Epub 2019 Feb 22.

OBJECTIVEDespite the surge in the intraoperative use of the bulbocavernosus reflex (BCR) during lumbosacral surgeries, there are as yet no widely accepted BCR warning criteria for use with intraoperative neurophysiological monitoring (IONM). The author's aim was to find clinically acceptable warning criteria for use in IONM of the BCR.METHODSRecords of IONM of the BCR in 164 operations in 163 patients (median age 5 months) with a conus spinal lipoma who underwent surgery between August 2002 and May 2016 were retrospectively analyzed. Read More

Clin Exp Emerg Med 2019 Feb 12. Epub 2019 Feb 12.

Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.

A 34-year-old male was brought to the hospital with a chest gunshot wound. Pulseless upon arrival, blood pressure was absent for 10 minutes. A thoracotomy resulted in return of spontaneous circulation. Read More

J Neurol Surg B Skull Base 2019 Feb 3;80(1):40-45. Epub 2018 Jul 3.

Department of Neurosurgery, Brüder Krankenhaus Trier, Trier, Germany.

 Facial nerve (FN) weakness as a presenting feature in vestibular schwannoma (VS) is extremely rare. We are presenting two different cases of VS with significant facial weakness and reviewed the literature for similar cases.  We are presenting two cases of VS with significant facial weakness. Read More

J Clin Monit Comput 2019 04 30;33(2):347-348. Epub 2019 Jan 30.

Evokes LLC, Mason, Cincinnati, OH, 45050, USA.

J Clin Neurophysiol 2019 Mar;36(2):155-160

Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.

Purpose: Intraoperative neurophysiological monitoring using somatosensory evoked potentials has been linked to a reduction in the incidence of neurological deficits during corrective surgery. Nonetheless, quantitative assessments of somatosensory evoked potential waveforms are often difficult to evaluate, because they are affected by anesthesia, injury, and noise. Here, we discuss a novel method that integrates somatosensory evoked potential signals into a single metric by calculating the area under the curve (AUC). Read More

J Neurosurg 2019 Jan 25:1-9. Epub 2019 Jan 25.

1Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland.

OBJECTIVECurrent management of gliomas involves a multidisciplinary approach, including a combination of maximal safe resection, radiotherapy, and chemotherapy. The use of intraoperative MRI (iMRI) helps to maximize extent of resection (EOR), and use of awake functional mapping supports preservation of eloquent areas of the brain. This study reports on the combined use of these surgical adjuncts. Read More

Cochrane Database Syst Rev 2019 Jan 19;1:CD012483. Epub 2019 Jan 19.

Department of General Surgery, University of Perugia, Terni, Italy, 05100.

Background: Injuries to the recurrent inferior laryngeal nerve (RILN) remain one of the major post-operative complications after thyroid and parathyroid surgery. Damage to this nerve can result in a temporary or permanent palsy, which is associated with vocal cord paresis or paralysis. Visual identification of the RILN is a common procedure to prevent nerve injury during thyroid and parathyroid surgery. Read More

World Neurosurg 2019 Jan 11. Epub 2019 Jan 11.

Orthopedic department, University Hospital Jena, Campus Eisenberg, Germany.

Background: Both progression of scoliosis following completion of growth, and the combination of low mental retardationand the conspicuous sagittal clinical and radiographic abnormalities suggest a secondary genesis of the scoliosis according to a genetic aberration.

Case Discription: In the outpatient department, an 18-year-old girl presents with scoliosis and mild mental retardation. Radiography findings demonstrate a sacral agenesis and the consecutively performed MRI a conus depression. Read More

Childs Nerv Syst 2019 Mar 8;35(3):529-533. Epub 2019 Jan 8.

Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.

Purpose: It is well known that the preoperative enlarged sac in occult spinal dysraphism, in which the spinal cord is attached to its dome, can be associated with neurological deficits by aggravation of spinal cord traction. We experienced a similar phenomenon during the early stage of untethering surgery for "lipomyelomeningocele in a strict sense (LMMC)."

Clinical Presentation: We report a case of a 3-month-old girl with LMMC, which showed decreased motor evoked potentials (MEPs) in the lower extremities during the early stage of untethering surgery. Read More

Nan Fang Yi Ke Da Xue Xue Bao 2018 Dec;38(12):1472-1475

Anesthesia and Operation Center, General Hospital of PLA, Beijing 100853, China.

Objective: To determine the maximum dose of continuously infused mivacurium for intraoperative neuromonitoring and observe its adverse effects in thyroid surgery.

Methods: Twenty-eight patients undergoing thyroid surgery with intraoperative neuromonitoring received continuous infusion of mivacurium at the initial rate of 5.43 μg?kg?min, and the infusion rate for the next patient was adjusted based on the response of the previous patient according to the results of neurological monitoring. Read More

J Clin Monit Comput 2019 04 5;33(2):185-190. Epub 2019 Jan 5.

Section of Neurosurgery, University of Manitoba, Winnipeg, MB, Canada.

Acta Neurochir Suppl 2019;125:369-380

Institute of Neurosurgery, University Hospital, Verona, Italy.

Craniovertebral junction (CVJ) surgery encompasses a wide spectrum of neurosurgical procedures ranging from transoral approaches for CVJ bone anomalies to surgery for intramedullary tumours. Intraoperative neurophysiological monitoring (IONM) has been increasingly used in recent years because of its ability to prevent neurological complications during surgery. In CVJ surgery the risk of neurological injuries is related first to the positioning of the patient and then to the surgical procedure. Read More

Clin Spine Surg 2019 Jan 2. Epub 2019 Jan 2.

Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.

Study Design: A retrospective analysis of prospectively collected data of 179 consecutive patients who underwent intraoperative neurophysiological monitoring during posterior cervical spine surgery for compression myelopathy.

Objective: To evaluate preoperative factors in patients with deteriorating spinal cord function due to flexion of the neck during posterior cervical spine surgery by observing changes in waveforms on intraoperative monitoring.

Summary Of Background Data: We encountered several cases of intraoperative monitoring warning alerts because of neck flexion during posterior cervical spine surgery. Read More

Spine Deform 2019 01;7(1):27-32

Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44915, USA.

Background: Intraoperative neuromonitoring (IONM) is used to detect impending neurologic damage during complex spinal surgeries. Although IONM is increasingly used during pediatric scoliosis surgeries in the United States, the effect of IONM on the outcomes of such surgeries at a national level is unclear.

Methods: Using National Inpatient Sample (NIS) from 2009 to 2012, 32,305 spinal fusions performed in children 18 years old or younger of age with scoliosis were identified using ICD-9 procedure and diagnosis codes. Read More

Spine Deform 2019 01;7(1):132-140

Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 〒431-3192 Shizuoka Prefecture, Hamamatsu, Higashi Ward, Handayama, Japan.

Study Design: Retrospective study.

Objectives: To analyze intraoperative neuromonitoring (IONM) alerts in various surgical procedures and clarify incidences and causes of IONM alarms in consecutive adult spinal deformity (ASD) surgeries.

Summary Of Background Data: ASD surgery has a high neurologic complication rate. Read More

Laryngoscope 2018 Dec 25. Epub 2018 Dec 25.

Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea.

Objective: Loss of signal (LOS) during intraoperative neuromonitoring (IONM) of robotic or endoscopic thyroidectomy via a retroauricular approach (RAT) and during conventional open thyroidectomy (COT) was investigated to compare the risk of recurrent laryngeal nerve (RLN) injury between the two groups.

Study Design: Original article.

Methods: This is a retrospective case series study performed between May 2014 and September 2016. Read More

Cir Esp 2019 Feb 20;97(2):103-107. Epub 2018 Dec 20.

Unidad de Neurofisiología, Hospital Universitario General de Albacete, Albacete, España.

In surgical procedures of the supraclavicular and lateral cervical regions, as well as in cardiac and mediastinal surgeries, diaphragm function can be compromised by the risk of injury to the phrenic nerve and/or the C4 root. There are few publications that treat the intraoperative stimulation of these nerve structures to evaluate their functionality and, to our knowledge, until now it has not been hypothesized about whether it is possible to reduce the injury rates, which reach 26% in some cardiac surgery studies. We describe the technique used for the neurophysiological monitoring of the phrenic nerve. Read More

World Neurosurg 2019 Mar 18;123:e646-e651. Epub 2018 Dec 18.

Israel Spine Center, Assuta Medical Center, Tel Aviv, Israel.

Introduction: The purpose of the present study was to examine the effect of various extra- and intraoperative factors on the ability of neuromonitoring to predict neurological complications.

Methods: We reviewed the data from 592 patients who had undergone cervical spine surgery with neuromonitoring at Assuta Medical Center from 2006 to 2013. We compared the somatosensory evoked potentials, transcranial electric motor evoked potentials, and electromyographic signals collected throughout surgery with the patient surgical outcome measures, demographic data, pre-existing pathological features found on neurological examination, and radiographic findings. Read More

Medicine (Baltimore) 2018 Dec;97(51):e13816

Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital of Inje University.

Background: Medical researchers have been reluctant to use neuromuscular blocking drugs (NMBD) during the use of intraoperative motor evoked potential (MEP) monitoring despite the possibility of patient movement. In this study, we compared the effects of no NMBD and continuous rocuronium infusion on the incidence of patient involuntary movement and MEP monitoring.

Methods: In this study, 80 patients who underwent neuro intervention with MEP monitoring were randomly assigned into 2 groups. Read More

Eur Spine J 2019 Mar 17;28(3):599-610. Epub 2018 Dec 17.

Spine Unit, Department of Neurology, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland.

Purpose: We compared the value of different uni- and multimodal intraoperative neurophysiological monitoring (IONM) methods on the detection of neurological complications during spine surgery.

Methods: IONM data derived from sensory spinal and cortical evoked potentials combined with continuous electromyography monitoring, motor evoked potentials and spinal recording were evaluated in relation to subsequent post-operative neurological changes. Patients were categorised based on their true-positive or true-negative post-operative neurological status. Read More

Clin Exp Otorhinolaryngol 2019 May 11;12(2):217-223. Epub 2018 Dec 11.

Department of Otolaryngology, Head and Neck Surgery and Medical Research Institute, Pusan National University College of Medicine, Busan, Korea.

Objectives: False-negative or false-positive responses in intraoperative neuromonitoring (IONM) using electromyography (EMG) in thyroid surgery pose a challenge. Therefore, we developed a novel IONM system that uses a surface pressure sensor instead of EMG to detect muscle twitching. This study aimed to investigate the feasibility and safety of a new IONM system using a piezo-electric surface pressure sensor in an experimental animal model. Read More

J Clin Neurosci 2019 Mar 4;61:78-83. Epub 2018 Dec 4.

Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address:

Background: Lumbar interbody spinal fusion (LIF) surgeries are performed to treat or prevent back pain in patients with degenerated intervertebral discs and a variety of spinal diseases. However, post-operative neurological complications may ensue. Intraoperative monitoring techniques have been used to predict and potentially reduce the risk of complications. Read More

Curr Opin Anaesthesiol 2019 Feb;32(1):101-107

Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.

Purpose Of Review: To summarize recent recommendations on intraoperative electroencephalogram (EEG) neuromonitoring in the elderly aimed at the prevention of postoperative delirium and long-term neurocognitive decline. We discuss recent perioperative EEG investigations relating to aging and cognitive dysfunction, and their implications on intraoperative EEG neuromonitoring in elderly patients.

Recent Findings: The incidence of postoperative delirium in elderly can be reduced by monitoring depth of anesthesia, using an index number (0-100) derived from processed frontal EEG readings. Read More

Curr Opin Anaesthesiol 2019 Feb;32(1):72-79

Department of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

Purpose Of Review: Spinal cord ischemia (SCI) is a devastating complication after open or endovascular aortic repair for thoracoabdominal aortic disease. The underlying pathogenesis is not fully understood but appears multifactorial. Multiple spinal cord protection strategies and monitoring techniques are currently utilized with variable results seen. Read More

Eur Arch Otorhinolaryngol 2019 Feb 30;276(2):305-314. Epub 2018 Nov 30.

Otorhinolaryngology Head and Neck Surgery, University of Udine School of Medicine, Udine, Italy.

Background: Intrathoracic goitres (ITG) often present with compressive symptoms and require specialised care by experienced surgical teams. Most ITG can be accessed by a transcervical approach (TCA) and only between 1 and 15% will require an extracervical approach (ECA). Many controversies exist regarding the clinical presentation, evaluation, selection of cases for ECA, surgical technique and outcomes. Read More

J Neurosurg Spine 2018 Nov;30(2):259-267

4Department of Neurosurgery, Humanitas Research Hospital and University, Milan, Italy.

OBJECTIVEThe purpose of this study was to evaluate the technical feasibility, accuracy, and relevance on surgical outcome of D-wave monitoring combined with somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) during resection of intradural extramedullary (IDEM) spinal tumors.METHODSClinical and intraoperative neurophysiological monitoring (IONM) data obtained in 108 consecutive patients who underwent surgery for IDEM tumors at the Institute for Scientific and Care Research "ASMN" of Reggio Emilia, Italy, were prospectively entered into a database and retrospectively analyzed. The IONM included SSEPs, MEPs, and-whenever possible-D-waves. Read More

World Neurosurg 2019 Mar 26;123:e280-e287. Epub 2018 Nov 26.

Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address:

Background: Dexmedetomidine (DEX) is used as an adjunct to total intravenous anesthesia. However, its effect on intraoperative neurophysiologic monitoring (IOM) during brain tumor surgery remains controversial. The aim of this study was to explore the effect of DEX on IOM during brain tumor surgery. Read More

Acta Neurochir (Wien) 2019 Jan 27;161(1):69-78. Epub 2018 Nov 27.

Department of Surgical Specialties, Division of Neurosurgery and Unit of Neurophysiopathology, San Filippo Neri Hospital/ASLRoma1, Via Reno 14, 00198, Rome, Italy.

Background And Objective: Goals of small vestibular schwannoma (VS) microneurosurgery are as follows: radical resection, facial nerve (FN) preservation, and hearing preservation (HP). Microsurgical advances make HP possible in many patients with preoperative socially useful hearing (SUH). We evaluated postoperative HP in VS with maximum diameter < 2 cm monitored with two different auditory brainstem response (ABR) techniques. Read More

Cureus 2018 Sep 22;10(9):e3346. Epub 2018 Sep 22.

Neurophysiology, Axis Neuromonitoring, Richardson, USA.

Arthroscopic hip surgery is performed routinely for the treatment of various hip disorders. Leg traction during labral tear repair, femoroplasty, and acetabuloplasty for hip stabilization can stretch the peripheral nerves. This may cause temporary or permanent nerve injury. Read More

Front Pediatr 2018 1;6:309. Epub 2018 Nov 1.

Department of Neurosurgery, Alder Hey NHS Foundation Trust, Liverpool, United Kingdom.

Pediatric neuro-oncology surgery continues to progress in sophistication, largely driven by advances in technology used to aid the following aspects of surgery: operative planning (advanced MRI techniques including fMRI and DTI), intraoperative navigation [preoperative MRI, intra-operative MRI (ioMRI) and intra-operative ultrasound (ioUS)], tumor visualization (microscopy, endoscopy, fluorescence), tumor resection techniques (ultrasonic aspirator, micro-instruments, micro-endoscopic instruments), delineation of the resection extent (ioMRI, ioUS, and fluorescence), and intraoperative safety (neurophysiological monitoring, ioMRI). This article discusses the aforementioned technological advances, and their multimodal use to optimize safe pediatric neuro-oncology surgery. Read More

Conf Proc IEEE Eng Med Biol Soc 2018 Jul;2018:3894-3897

The purpose of this study was to develop a user-friendly presentation of surface-EMG data in near-time for intraoperative nerve-monitoring. We have built a novel surface-EMG probe as a diagnostic device to investigate innervation patterns of sphincter muscles in further clinical diagnostic studies. S-EMG data were recorded from 20 healthy volunteers from the orbicularis oris muscles. Read More

Anasthesiol Intensivmed Notfallmed Schmerzther 2018 Oct 13;53(10):682-695. Epub 2018 Nov 13.

Patients with acute cerebral injuries for various reasons (traumatic, ischemic, hemorrhagic) are at risc for developing secondary brain damage and further neurological deterioration. The aim of neuromonitoring is to recognize subtile changes in intracranial physiology as early as possible to initiate adequate diagnostic and therapeutic measures to prevent secondary brain damage. Beside the classic method of clinical neuromonitoring in awake patients, implantation of intracranial probes to monitor intracranial pressure, brain tissue oxygenation and brain metabolism are used in comatose patients. Read More

J Clin Neurophysiol 2019 Jan;36(1):67-73

Departments of Neurosurgery and.

Purpose: Local field potential recordings from deep brain stimulation (DBS) leads provide insight into the pathophysiology of Parkinson disease (PD). We recorded local field potential activity from DBS leads within the subthalamic nucleus in patients with PD undergoing DBS surgery to identify reproducible pathophysiological signatures of the disease.

Methods: Local field potentials were recorded in 11 hemispheres from patients with PD undergoing subthalamic nucleus-DBS. Read More

World Neurosurg 2019 Feb 5;122:e947-e954. Epub 2018 Nov 5.

Department of Neurophysiology, Kashiwaba Neurosurgical Hospital, Sapporo, Japan.

Background: Monitoring of corticocortical evoked potentials (CCEPs) during brain tumor surgery of patients under anesthesia was recently reported to be effective in assisting in preservation of speech function. The aim of this study was to investigate whether CCEPs can be reproducibly measured between the frontal and temporal lobes during standard intracranial vascular surgery under general anesthesia; whether dynamic changes in CCEPs caused by reduced focal cerebral blood flow can be measured; and whether CCEPs can be used to monitor speech function, particularly associated with the left side of the brain.

Methods: We monitored CCEPs during 58 vascular surgeries (42 clipping procedures; 15 bypasses, 1 of which overlapped with clipping; and 2 hematoma removals from the left frontal and temporal lobe) at Kashiwaba Neurosurgical Hospital from October 2016 to January 2018. Read More

BMC Anesthesiol 2018 11 7;18(1):161. Epub 2018 Nov 7.

Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.

Background: The Auditory brainstem implant (ABI) is a new surgical option for hearing impaired children. Intraoperative neurophysiology monitoring includes brainstem mapping of cranial nerve (CN) IX, X, XI, XII and their motor nuclei, and corticobulbar tract motor-evoked potential. These require laryngeal electrodes and intra-oral pins, posing a challenge to airway management especially in the pediatric airway, where specialized electromyogram (EMG) tracheal tubes are not available. Read More

World Neurosurg 2019 Feb 2;122:129-132. Epub 2018 Nov 2.

Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.

Background: There is still a controversy for low-flow extracranial-intracranial or high-flow extracranial-intracranial bypass with proximal occlusion in the treatment of unclippable giant internal carotid artery aneurysms.

Case Description: A 61-year-old woman presented with a 1-month history of double vision. Neuroimages revealed an unclippable giant internal carotid artery aneurysm located from the cavernous sinus to proximal site of the posterior communicating artery. Read More