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JBJS Case Connect 2021 06 23;11(2). Epub 2021 Jun 23.

Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, New York, New York.

Case: A 68-year-old woman who underwent a C5 to C6 anterior cervical discectomy and fusion (ACDF) surgery presented with new-onset postoperative quadriplegia. During discectomy, intraoperative neurophysiological monitoring alerted of a spinal cord (SC) dysfunction. The surgery was halted, and measures to ensure adequate SC perfusion were initiated. Read More

World Neurosurg 2021 Jun 14. Epub 2021 Jun 14.

Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, Japan.

Background: We describe a continuous monitoring method aimed at preserving nerve function during biopsy of lesions on the oculomotor nerve using stimulation of the oculomotor nerve proximal to the lesion.

Case Description: A 5-year-old girl with a recurrent left oculomotor nerve palsy and contrast-enhancing left oculomotor nerve mass on magnetic resonance imaging (MRI), underwent a biopsy of the lesion to aid in its diagnosis. At the time of surgery, needle electrodes were inserted into the superior and inferior rectus muscles percutaneously, and cotton covered electrodes were implanted into the oculomotor nerve proximal to the lesion. Read More

Cureus 2021 May 11;13(5):e14960. Epub 2021 May 11.

Neurosurgery, Neuroscience Institute, Hamad Medical Corporation, Doha, QAT.

Awake craniotomy with intraoperative neurophysiological language mapping (INLM) is an established procedure for patients undergoing surgery to resection tumors in the language cortex area. INLM and continuous neurophysiological monitoring allow assessment of the language function, which is not possible under general anesthesia. INLM of the brain areas provides a helpful tool to the operating surgeon in reducing the risks associated with tumor resection in the motor and language cortex. Read More

Clin Neurophysiol 2021 May 1. Epub 2021 May 1.

Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy. Electronic address:

Objective: We examined the feasibility of using cortico-cortical evoked potentials (CCEPs) to monitor the major cortical white matter tract involved in language, the arcuate fasciculus (AF), during surgery under general anaesthesia.

Methods: We prospectively recruited nine patients undergoing surgery for lesions in the left peri-sylvian cortex, for whom awake surgery was not indicated. High angular resolution diffusion imaging (HARDI) tractography was used to localise frontal and temporal AF terminations, which guided intraoperative cortical strip placement. Read More

Front Oncol 2021 21;11:676626. Epub 2021 May 21.

Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.

Background: The resection of a motor-eloquent glioma should be guided by intraoperative neurophysiological monitoring (IOM) but its interpretation is often difficult and may (unnecessarily) lead to subtotal resection. Navigated transcranial magnetic stimulation (nTMS) combined with diffusion-tensor-imaging (DTI) is able to stratify patients with motor-eloquent lesion preoperatively into high- and low-risk cases with respect to a new motor deficit.

Objective: To analyze to what extent preoperative nTMS motor risk stratification can improve the interpretation of IOM phenomena. Read More

Neurosurg Rev 2021 May 27. Epub 2021 May 27.

Department of Neurosurgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.

Intraoperative neurophysiological monitoring of transcranial motor-evoked potentials (tcMEPs) may fail to produce a serviceable signal due to displacements by mass lesions. We hypothesize that navigated placement of stimulation electrodes yields superior potential quality for tcMEPs compared to the conventional 10-20 placement. We prospectively included patients undergoing elective cranial surgery with intraoperative monitoring of tcMEPs. Read More

Stud Health Technol Inform 2021 May;278:211-216

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

Intraoperative neurophysiological monitoring (IOM) enables a function-preserving surgical strategy for surgeries of brain or spinal cord pathologies by neurophysiological measurements. However, the IOM data management at neurosurgical institutions are often either not digitized or inefficient in terms of collecting, storing and processing of IOM data. Here, we describe the development of a web application, called IOM-Manager, as a first step towards the complete digitization of the IOM workflow. Read More

Best Pract Res Clin Anaesthesiol 2021 Jul 23;35(2):255-266. Epub 2020 Oct 23.

Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy. Electronic address:

Cerebral complications are common in perioperative settings even in non-neurosurgical procedures. These include postoperative cognitive dysfunction or delirium as well as cerebrovascular accidents. During surgery, it is essential to ensure an adequate degree of sedation and analgesia, and at the same time, to provide hemodynamic and respiratory stability in order to minimize neurological complications. Read More

Best Pract Res Clin Anaesthesiol 2021 Jul 30;35(2):191-206. Epub 2020 Sep 30.

Division of Anesthesiology, Intensive Care, and Emergency Medicine, University of Brescia at Spedali Civili Hospital, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Division of Anesthesiology, Intensive Care and Emergency Medicine, University of Brescia at Spedali Civili Hospital, Brescia, Italy. Electronic address:

Delirium is a frequent and serious complication after surgery. It has a variable incidence between 20% and 40% with the highest incidence in elderly people undergoing major or cardiac surgery. The development of postoperative delirium (POD) is associated with increased hospital stay lengths, morbidity, the need for home care, and mortality. Read More

Best Pract Res Clin Anaesthesiol 2021 Jul 31;35(2):159-169. Epub 2020 Oct 31.

Hopital Érasme, Université Libre de Bruxelles, Department of Intensive Care Medicine, Route de Lennik, 808 1070, Brussels, Belgium. Electronic address:

With the widespread use of electroencephalogram [EEG] monitoring during surgery or in the Intensive Care Unit [ICU], clinicians can sometimes face the pattern of burst suppression [BS]. The BS pattern corresponds to the continuous quasi-periodic alternation between high-voltage slow waves [the bursts] and periods of low voltage or even isoelectricity of the EEG signal [the suppression] and is extremely rare outside ICU and the operative room. BS can be secondary to increased anesthetic depth or a marker of cerebral damage, as a therapeutic endpoint [i. Read More

IEEE Trans Med Robot Bionics 2021 Feb 30;3(1):44-52. Epub 2020 Dec 30.

Carnegie Mellon University, Pittsburgh, PA, USA.

Objective: Intraoperative neurophysiological monitoring (IONM) is the use of electrophysiological methods during certain high-risk surgeries to assess the functional integrity of nerves in real time and alert the surgeon to prevent damage. However, the efficiency of IONM in current practice is limited by latency of verbal communications, inter-rater variability, and the subjective manner in which electrophysiological signals are described.

Methods: In an attempt to address these shortcomings, we investigate automated classification of free-running electromyogram (EMG) waveforms during IONM. Read More

Anaesthesist 2021 Jun 10;70(6):531-547. Epub 2021 May 10.

Universitätsklinik für Anästhesiologie und Schmerztherapie, Inselspital, Universitätsspital Bern, Freiburgstr., 3010, Bern, Schweiz.

The electroencephalogram (EEG) is increasingly being used in the clinical routine of anesthesia in German-speaking countries. In over 90% of patients the frontal EEG changes somewhat predictably in response to administration of the normally used anesthetic agents (propofol and volatile gasses). An adequate depth of anesthesia and appropriate concentrations of anesthetics in the brain generate mostly frontal oscillations between 8 and 12 Hz as well as slow delta waves between 0. Read More

Spine (Phila Pa 1976) 2021 May 6. Epub 2021 May 6.

Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA.

Study Design: This study is a meta-analysis of prospective and retrospective studies identified in PubMed, Web of Science, and Embase with outcomes of patients who received intraoperative SSEP monitoring during lumbar spine surgery.

Objective: The objective of this study is to determine the diagnostic accuracy of intraoperative lower extremity (LE) SSEP changes for predicting postoperative neurological deficit. As a secondary analysis, we evaluated three subtypes of intraoperative SSEP changes: reversible, irreversible, and total signal loss. Read More

Neurodiagn J 2021 May 5:1-14. Epub 2021 May 5.

Axis Neuromonitoring, Richardson, Texas.

Lateral lumbar interbody fusion procedures are performed with multimodality neuromonitoring of the femoral nerve to prevent lumbosacral plexus and peripheral nerve injury from positioning, dilation, retraction, and hardware implantation. The integrity of the femoral nerve can be continuously assessed during these procedures by Somatosensory Evoked Potentials of the Saphenous nerve (Sn-SSEPs). Sn-SSEPs are technically challenging to acquire and necessitate advanced troubleshooting skills with a more rigid anesthetic regimen and physiological parameters. Read More

Clin Neurophysiol Pract 2021 26;6:115-122. Epub 2021 Mar 26.

Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.

Introduction: As the prevalence of obesity continues to rise, there is a growing need to identify practices that protect overweight patients from injury during spine surgery. Intraoperative neurophysiological monitoring (IONM) has been recommended for complex spine surgery, but its use in obese and morbidly obese patients is understudied.

Case Report: This case report describes a patient with morbid obesity and ankylosing spondylitis who was treated for a T9-T10 3-column fracture with a planned, minimally invasive approach. Read More

Neurodiagn J 2021 Mar;61(1):37-45

Department of Anesthesia, Cincinnati Children's Hospital, Cincinnati, Ohio.

Many algorithms, checklists, and escalation pathways have been created to encourage perioperative teams to share a mental model and approach patient care as a team. Respecting and empowering the many voices involved in patient care is crucial to avoid errors and improve patient safety. None of the concepts described herein are novel; however, sustained improvements in operating room culture remain elusive in many organizations. Read More

J Surg Res 2021 Apr 29;265:131-138. Epub 2021 Apr 29.

Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy. Electronic address:

Background: Intraoperative Neurophysiological Monitoring (IONM) reduces the incidence of Recurrent Laryngeal Nerve (RLN) injuries during thyroid surgery. To preserve nerve function, long acting neuromuscular blocking agents (NMBA) should be avoided. However, NMBA are necessary for laryngoscopy and endotracheal intubation. Read More

Int J Comput Assist Radiol Surg 2021 May 3. Epub 2021 May 3.

School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.

Purpose: Image-guided surgery (IGS) is an integral part of modern neuro-oncology surgery. Navigated ultrasound provides the surgeon with reconstructed views of ultrasound data, but no commercial system presently permits its integration with other essential non-imaging-based intraoperative monitoring modalities such as intraoperative neuromonitoring. Such a system would be particularly useful in skull base neurosurgery. Read More

Epileptic Disord 2021 Apr;23(2):376-384

Pediatric Epilepsy Center, Peking University First Hospital, No. 1 Xi'an Men Street, Xicheng District, Beijing 100034, China, Department of Pediatrics, Peking University First Hospital, No. 1 Xi'an Men Street, Xicheng District, Beijing 100034, China.

We retrospectively analysed the clinical features and prognostic factors of surgery in children with drug-resistant epilepsy involving the Rolandic area, and the relationship between the stable compound muscle action potentials (CMAPs) of intraoperative neurophysiological monitoring (IONM) and good motor function outcomes postoperatively. A study was conducted on the clinical data of 91 patients with epilepsy who underwent epilepsy surgery involving the Rolandic area and IONM from November 2015 to February 2019. In total, 91 patients were included in this study. Read More

Int J Neurosci 2021 Apr 30:1-5. Epub 2021 Apr 30.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing;

Background: In the literature, filum terminale arteriovenous shunts (FTAVSs) always feature a single shunt point. Nidus-type FTAVSs have rarely been reported, and the best treatment strategy is unclear. This is a report of 1 exceptional case of a nidus-type FTAVS and surgical treatment of the lesion. Read More

Acta Anaesthesiol Scand 2021 Apr 21. Epub 2021 Apr 21.

Neurology Unit, Neurophysiologic Section, Parc de Salut MAR, Barcelona, Spain.

Background: Dexmedetomidine is used as adjuvant in total intravenous anaesthesia (TIVA), but there have been few studies concerning its effect on intraoperative neurophysiological monitoring (IONM) during cranial surgery. Our aim was to study the effect of dexmedetomidine on IONM in patients undergoing brain stem and supratentorial cranial surgery.

Methods: Two prospective, randomized, double-blind substudies were conducted. Read More

Surg Neurol Int 2021 24;12:112. Epub 2021 Mar 24.

Department of Neurosurgery, Kyushu University, Saga, Japan.

Background: Retained medullary cord (RMC) is a newly defined entity believed to originate from the late arrest of secondary neurulation. Some RMCs contain varying amounts of lipomatous tissues, which need to be differentiated from spinal lipomas, such as filar and caudal lipomas (terminal lipomas).

Case Description: We surgically treated two patients with a nonfunctional cord-like structure (C-LS) that was continuous from the cord and extended to the dural cul-de-sac, and ran parallel to the terminal lipoma. Read More

Arch Orthop Trauma Surg 2021 Apr 20. Epub 2021 Apr 20.

Israel Center for Disaster Medicine and Humanitarian Response, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.

Background: A reliable, real-time method for the detection of pedicle wall breaching during funnelling in spine deformity surgery could be accessible to any surgeon assisted with neuromonitoring.

Methods: Fifty-six consecutive patients (1066 pedicles), who were submitted to spinal deformity surgery from December 2013 to July 2015 were included in the study group. A control group of 13 consecutive patients (226 pedicles) with spinal deformity surgery were operated on from January to December 2013 and were excluded from finder stimulation. Read More

Oper Neurosurg (Hagerstown) 2021 Apr;20(5):E346-E347

Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Surgical resection is the primary treatment of pilocytic astrocytomas and total removal can be curative. However, these lesions occur in critical areas, such as the thalamus, being surrounded by critical life neurovascular structures, which imposes a surgical challenge.1-5 Exhaustive acquisition and meticulous interpretation of preoperative radiological exams; reliable surgical orientation based on profound microneurosurgical anatomic knowledge and judicious discernment of the neuroanatomic distortions on the surface and deep-seated structures inflicted by the neuropathological entity; embracing and comprehensive application of the vast scope of available intraoperative guidance imaging and neurophysiological monitoring; in alliance with the mastered carefully microsurgical technique supported by endoscopic visualization are the keystones to the pursed duet "cure with quality of life" in the treatment of these lesions. Read More

J Craniovertebr Junction Spine 2021 Jan-Mar;12(1):26-32. Epub 2021 Mar 4.

Department of Neuroanaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Background: Presence of preoperative motor deficits in patients poses a distinct challenge in monitoring the integrity of corticospinal tracts during spinal surgeries. The inconsistency of the motor-evoked potentials is such patients, limits its clinical utility. D-wave is a robust but less utilized technique for corticospinal tract monitoring. Read More

Neurochirurgie 2021 Apr 15. Epub 2021 Apr 15.

Department of Neurosurgery, Meshalkin National Medical Research Centre, Rechkunovskaya street, 15, 630055 Novosibirsk, Russian Federation. Electronic address:

Background: Intraoperative control of optic nerve function conservation during neurosurgical operations currently relies mainly on visual evoked potential monitoring. Unfortunately, this detects peril only when the visual pathways are already compromised, sometimes irreversibly. In contrast, electrophysiological stimulation mapping of the nerves can be a fully preventive measure. Read More

J Neural Eng 2021 04 29;18(4). Epub 2021 Apr 29.

Department of Biomedical Engineering, University of Houston, Houston, TX, United States of America.

Somatosensory evoked potentials (SSEPs) recorded with electrocorticography (ECoG) for central sulcus (CS) identification is a widely accepted procedure in routine intraoperative neurophysiological monitoring. Clinical practices test the short-latency SSEPs for the phase reversal over strip electrodes. However, assessments based on waveform morphology are susceptible to variations in interpretations due to the hand area's localized nature and usually require multiple electrode placements or electrode relocation. Read More

Childs Nerv Syst 2021 05 9;37(5):1505-1514. Epub 2021 Apr 9.

Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurosurgery, University Hospital, Piazzale Stefani 1, 37124, Verona, Italy.

Background: Cerebellar mutism can occur in a third of children undergoing cerebellar resections. Recent evidence proposes it may arise from uni- or bilateral damage of cerebellar efferents to the cortex along the cerebello-dento-thalamo-cortical pathway. At present, no neurophysiological procedure is available to monitor this pathway intraoperatively. Read More

Front Oncol 2021 22;11:629166. Epub 2021 Mar 22.

Neurosurgical Oncological Unit, Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milano, Italy.

Objective: Giant insular tumors are commonly not amenable to complete resection and are associated with a high postoperative morbidity rate. Transcortical approach and brain mapping techniques allow to identify peri-insular functional networks and, with neurophysiological monitoring, to reduce vascular-associated insults. Cognitive functions to be mapped are still under debate, and the analysis of the functional risk of surgery is currently limited to neurological examination. Read More

World Neurosurg 2021 Jun 2;150:147-152. Epub 2021 Apr 2.

Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany; Centre of Neurooncology, University Hospital Düsseldorf, Düsseldorf, Germany.

Background: Intraoperative neuromonitoring (IONM) is widely used for elective resection of eloquently located brain tumors to increase safety and extent of resection. Owing to the need for specially trained personnel for IONM and the sophisticated, time-consuming technical setup, standard IONM is usually not suitable for emergency situations. We report the use of a device that can be operated by the neurosurgeon autonomously for monopolar brain mapping in 2 emergency cases. Read More