89 results match your criteria neuromonitoring guide

Invasive Multimodal Neuromonitoring in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review.

Stroke 2021 Jul 26:STROKEAHA121034633. Epub 2021 Jul 26.

Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany (M.A., W.A., M.W., A.H., H.C., G.A.S.).

Background And Purpose: Aneurysmal subarachnoid hemorrhage is a devastating disease leaving surviving patients often severely disabled. Delayed cerebral ischemia (DCI) has been identified as one of the main contributors to poor clinical outcome after subarachnoid hemorrhage. The objective of this review is to summarize existing clinical evidence assessing the diagnostic value of invasive neuromonitoring (INM) in detecting DCI and provide an update of evidence since the 2014 consensus statement on multimodality monitoring in neurocritical care. Read More

View Article and Full-Text PDF

Applications and Limitations of Neuro-Monitoring in Paediatric Anaesthesia and Intravenous Anaesthesia: A Narrative Review.

J Clin Med 2021 Jun 15;10(12). Epub 2021 Jun 15.

Unit for Research & Innovation, Department of Paediatric Anaesthesia, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy.

Safe management of anaesthesia in children has been one of the top areas of research over the last decade. After the large volume of articles which focused on the putative neurotoxic effect of anaesthetic agents on the developing brain, the attention and research efforts shifted toward prevention and treatment of critical events and the importance of peri-anaesthetic haemodynamic stability to prevent negative neurological outcomes. Safetots. Read More

View Article and Full-Text PDF

Extended neuromonitoring in aortic arch surgery : A case series.

Anaesthesist 2021 Jun 7. Epub 2021 Jun 7.

Department of Cardiothoracic Surgery, University Hospital Bonn, Bonn, Germany.

Background: Aortic arch repair for aortic dissection is still associated with a high mortality rate. Providing adequate means of neuromonitoring to guide cerebral hemodynamics is advantageous, especially during selective anterior cerebral perfusion (SACP).

Objective: We aimed to investigate an easy multimodal neuromonitoring set-up consisting of processed electroencephalography (EEG), near infrared spectroscopy (NIRS), and transcranial doppler sonography (TCD). Read More

View Article and Full-Text PDF

Why do We Use the Concepts of Adult Anesthesia Pharmacology in Developing Brains? Will It Have an Impact on Outcomes? Challenges in Neuromonitoring and Pharmacology in Pediatric Anesthesia.

J Clin Med 2021 May 18;10(10). Epub 2021 May 18.

Hospital Pediatrico Niño Jesús, Service of Anesthesiology, Córdoba 5500, Argentina.

Background: Pediatric sedation and anesthesia techniques have plenty of difficulties and challenges. Data on the pharmacologic, electroencephalographic, and neurologic response to anesthesia at different brain development times are only partially known. New data in neuroscience, pharmacology, and intraoperative neuromonitoring will impact changing concepts and clinical practice. Read More

View Article and Full-Text PDF

The influence of age on EEG-based anaesthesia indices.

J Clin Anesth 2021 Oct 8;73:110325. Epub 2021 May 8.

Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Munich, Germany. Electronic address:

Study Objective: In the upcoming years there will be a growing number of elderly patients requiring general anaesthesia. As age is an independent risk factor for postoperative delirium (POD) the incidence of POD will increase concordantly. One approach to reduce the risk of POD would be to avoid excessively high doses of anaesthetics by using neuromonitoring to guide anaesthesia titration. Read More

View Article and Full-Text PDF
October 2021

Roadmap for Motor Evoked Potential (MEP) Monitoring for Patients Undergoing Lumbar and Lumbosacral Spinal Fusion Procedures.

Neurodiagn J 2021 Mar;61(1):27-36

Medical Department, SpecialtyCare, Brentwood, Tennessee.

MEPs are recommended for patients undergoing lumbar and lumbosacral procedures in which intraoperative neuromonitoring (IONM) is being utilized. While electromyography (EMG) provides critical nerve root proximity information, spontaneous EMG discharges are relatively poor at reliably diagnosing spinal nerve root dysfunction. In contrast, research indicates that MEPs are both sensitive and specific in diagnosing evolving spinal nerve root dysfunction. Read More

View Article and Full-Text PDF

Invasive neuromonitoring and neurological intensive care unit management in life-threatening central nervous system infections.

Curr Opin Neurol 2021 Jun;34(3):447-455

Department of Neurology, Neurocritical Care, Medical University of Innsbruck, Innsbruck, Austria.

Purpose Of Review: Patients with infectious diseases of the central nervous system (CNS) commonly require treatment in the intensive care unit (ICU). In a subset of patients with a life-threatening course, a more aggressive and invasive management is required. Treatment relies on the expertise of the intensivists as most recommendations are currently not based on a high level of evidence. Read More

View Article and Full-Text PDF

Use of postoperative neurophysiological testing to help guide management in a case of delayed neurological injury.

Childs Nerv Syst 2021 Mar 29. Epub 2021 Mar 29.

Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA.

Bimodal intraoperative neuromonitoring (IONM), combining transcranial motor-evoked potentials (tcMEP) and somatosensory-evoked potentials (SSEP), enables real-time detection and prevention of spinal cord injury during pediatric spinal deformity correction. Although rare, false-positive and false-negative signal alerts have been reported. However, no previously published accounts have described the use of postoperative neurophysiological testing to both identify new-onset neurological injury and guide reintervention. Read More

View Article and Full-Text PDF

Traumatic Brain Injury Update.

AACN Adv Crit Care 2021 Mar;32(1):29-50

Karen A. McQuillan is Lead Clinical Nurse Specialist, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland.

Traumatic brain injury is a devastating, life-changing event in most cases. After the primary brain insult, it is helpful to use evidence-based monitoring techniques to guide implementation of essential interventions to minimize secondary injury and thereby improve patient outcomes. An update on multimodal neuromonitoring is provided in this narrative review, with discussion of tools and techniques currently used in the treatment of patients with brain injury. Read More

View Article and Full-Text PDF

Treatment of Delayed Cerebral Ischemia in Good-Grade Subarachnoid Hemorrhage: Any Role for Invasive Neuromonitoring?

Neurocrit Care 2021 Aug 10;35(1):172-183. Epub 2020 Dec 10.

Department of Neurosurgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.

Background: Good-grade aneurysmal subarachnoid hemorrhage (Hunt and Hess 1-2) is generally associated with a favorable prognosis. Nonetheless, patients may still experience secondary deterioration due to delayed cerebral ischemia (DCI), contributing to poor outcome. In those patients, neurological assessment is challenging and invasive neuromonitoring (INM) may help guide DCI treatment. Read More

View Article and Full-Text PDF

Role of Intraoperative Neurophysiologic Monitoring in Internal Carotid Artery Injury During Endoscopic Endonasal Skull Base Surgery.

World Neurosurg 2021 04 7;148:e43-e57. Epub 2020 Dec 7.

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

Objective: In the present study, we investigated the role of intraoperative neuromonitoring (IONM) in internal carotid artery (ICA) injury during endoscopic endonasal skull base surgery (EESBS).

Methods: The study group included all 13 patients who had experienced an ICA injury during EESBS with IONM from 2004 to 2017. The medical records were reviewed for the perioperative data. Read More

View Article and Full-Text PDF

Telemetric intracranial pressure monitoring: our experience with 22 patients investigated for intracranial hypertension.

Br J Neurosurg 2020 Dec 2:1-12. Epub 2020 Dec 2.

1st Department of Neurosurgery, "Evangelismos" General Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Introduction: We present the application of the Raumedic P-tel telemetric device that monitors Intracranial Pressure (ICP) over long periods, in 22 patients, with suspected intracranial hypertension.

Methods: A telemetric device (Raumedic, Neurovent P-tel) was surgically implanted in 22 patients aged between 21 and 65 years. Among the patients, the inconclusive diagnosis of benign intracranial hypertension was set in 10, the possible diagnosis of postoperative hydrocephalus in 3, and the possible diagnosis of aqueduct stenosis in 2. Read More

View Article and Full-Text PDF
December 2020

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on the Role of Neuromonitoring in Perioperative Outcomes: Cerebral Near-Infrared Spectroscopy.

Anesth Analg 2020 11;131(5):1444-1455

Departments of Anesthesiology and Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.

Some neurological complications following surgery have been related to a mismatch in cerebral oxygen supply and demand that may either lead to more subtle changes of brain function or overt complications like stroke or coma. Discovery of a perioperative neurological complication may be outside the treatment window, thereby making prevention an important focus. Early commercial devices used differential spectroscopy to measure relative changes from baseline of 2 chromophores: oxy- and deoxyhemoglobin. Read More

View Article and Full-Text PDF
November 2020

FLAIRectomy in Supramarginal Resection of Glioblastoma Correlates With Clinical Outcome and Survival Analysis: A Prospective, Single Institution, Case Series.

Oper Neurosurg (Hagerstown) 2021 01;20(2):151-163

Department of Medical and Surgical Sciences and Advanced Technologies (G.F. Ingrassia), Neurological Surgery, Policlinico ``G. Rodolico - San Marco'' University Hospital, University of Catania, Italy.

Background: Extent of tumor resection (EOTR) in glioblastoma surgery plays an important role in improving survival.

Objective: To analyze the efficacy, safety and reliability of fluid-attenuated inversion-recovery (FLAIR) magnetic resonance (MR) images used to guide glioblastoma resection (FLAIRectomy) and to volumetrically measure postoperative EOTR, which was correlated with clinical outcome and survival.

Methods: A total of 68 glioblastoma patients (29 males, mean age 65. Read More

View Article and Full-Text PDF
January 2021

Neurophysiologic Intraoperative Monitoring for Spine Surgery: A Practical Guide From Past to Present.

J Intensive Care Med 2020 Sep 28:885066620962453. Epub 2020 Sep 28.

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

Intraoperative neuromonitoring was introduced in the second half of the 20th century with the goal of preventing patient morbidity for patients undergoing complex operations of the central and peripheral nervous system. Since its early use for scoliosis surgery, the growth and utilization of IOM techniques expanded dramatically over the past 50 years to include spinal tumor resection and evaluation of cerebral ischemia. The importance of IOM has been broadly acknowledged, and in 1989, the American Academy of Neurology (AAN) released a statement that the use of SSEPs should be standard-of-care during spine surgery. Read More

View Article and Full-Text PDF
September 2020

Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section.

Acta Neurochir (Wien) 2020 11 29;162(11):2595-2617. Epub 2020 Jul 29.

Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.

Background And Objective: The optimal management of large vestibular schwannomas continues to be debated. We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of this problem from a European perspective.

Material And Methods: A systematic review of MEDLINE database, in compliance with the PRISMA guidelines, was performed. Read More

View Article and Full-Text PDF
November 2020

High Incidence of Burst Suppression during Propofol Sedation for Outpatient Colonoscopy: Lessons Learned from Neuromonitoring.

Anesthesiol Res Pract 2020 19;2020:7246570. Epub 2020 Jun 19.

Department of Anesthesiology, Division of Neurological Anesthesia, Thomas Jefferson University, 111 S. 11 Street, Philadelphia, PA 19107, USA.

Background: Although anesthesia providers may plan for moderate sedation, the depth of sedation is rarely quantified. Using processed electroencephalography (EEG) to assess the depth of sedation, this study investigates the incidence of general anesthesia with variable burst suppression in patients receiving propofol for outpatient colonoscopy. The lessons learned from neuromonitoring can then be used to guide institutional best sedation practice. Read More

View Article and Full-Text PDF

Neuromonitoring Modalities in Pediatric Cardiac Anesthesia: A Review of the Literature.

J Cardiothorac Vasc Anesth 2020 Dec 7;34(12):3420-3428. Epub 2020 Mar 7.

Duke University Medical Center, Durham, NC.

Recent decades have witnessed incredible developments in the care of children with congenital heart disease (CHD), such that survival into adulthood is the expected outcome. Improved survival has shifted the focus from improvements in mortality to improvements in morbidity, with long-term neurologic sequelae among the most important. Children with CHD who undergo corrective procedures in infancy and early childhood have a high rate of neurodevelopmental disability later in childhood. Read More

View Article and Full-Text PDF
December 2020

Strategies for superior thyroid pole dissection in transoral thyroidectomy: a video operative guide.

Surg Endosc 2020 08 7;34(8):3711-3721. Epub 2020 May 7.

Division of Thyroid Surgery, Jilin Provincial Key Laboratory Of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine On Differentiated Thyroid Carcinoma, China-Japan Union Hospital Of Jilin University, 126 Xiantai Blvd, Changchun city, Jilin province, People's Republic of China.

Background: The dissection of the superior thyroid gland pole is challenging when using the in TransOral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) due to (a) the cranio-caudal approach, (b) cranial-caudal view, and (c) the restriction of maneuverability inside the narrow neck air pocket.

Methods: In this paper and operative video guide, a series of TOETVA's tips and tricks are presented with an emphasis on the strategies for a safe approach to the superior thyroid gland pole structures.

Results: Management of the upper thyroid pole structures includes: (a) use of a 5 mm/30°-45° endoscope; (b) retraction ports up to the limit of the lower jaw edge; (c) lateral retraction of 1/3 of the cranial strap muscles; (d) isthmectomy; (e) cutting the sternothyroid muscle cranially for 1 cm; (f) retraction of the thyroid upwards and laterally; (g) monitoring the external branch of the superior laryngeal nerve, and (h) sealing individual vessel branches. Read More

View Article and Full-Text PDF

Modern surgery for advanced thyroid cancer: a tailored approach.

Gland Surg 2020 Feb;9(Suppl 2):S105-S119

Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.

Surgical treatment of advanced thyroid malignancy can be morbid, compromising normal functions of the upper aerodigestive tract. There is a paucity of guidelines dedicated to the management of advanced disease. In fact, there is not even a uniform definition for advanced thyroid cancer currently. Read More

View Article and Full-Text PDF
February 2020

TcMEP threshold change is superior to A-train detection when predicting facial nerve outcome in CPA tumour surgery.

Acta Neurochir (Wien) 2020 05 7;162(5):1197-1203. Epub 2020 Mar 7.

Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.

Object: Surgery of tumours in the cerebellopontine angle (CPA) can lead to loss of facial nerve function. Different methods of intra-operative nerve monitoring (IOM) (including free-running EMG, direct nerve stimulation and transcranial motor evoked potentials (TcMEP)) have been used to predict facial nerve outcome during surgery. Recent research has shown TcMEP threshold increase and the occurrence of A-trains on the EMG to have great potential in doing so. Read More

View Article and Full-Text PDF

Halo-gravity traction for the treatment of pediatric cervical spine disorders.

J Neurosurg Pediatr 2019 Dec 27:1-10. Epub 2019 Dec 27.

1Department of Orthopaedic Surgery, Boston Children's Hospital.

Objective: Halo-gravity traction (HGT) is an effective and safe method for gradual correction of severe cervical deformities in adults. However, the literature is limited on the use of HGT for cervical spine deformities that develop in children. The objective of the present study was to evaluate the safety and efficacy of HGT for pediatric cervical spine deformities. Read More

View Article and Full-Text PDF
December 2019

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on the Role of Neuromonitoring in Perioperative Outcomes: Electroencephalography.

Anesth Analg 2020 05;130(5):1278-1291

Department of Anesthesiology, Stony Brook School of Medicine, Stony Brook, New York.

Electroencephalographic (EEG) monitoring to indicate brain state during anesthesia has become widely available. It remains unclear whether EEG-guided anesthesia influences perioperative outcomes. The sixth Perioperative Quality Initiative (POQI-6) brought together an international team of multidisciplinary experts from anesthesiology, biomedical engineering, neurology, and surgery to review the current literature and to develop consensus recommendations on the utility of EEG monitoring during anesthesia. Read More

View Article and Full-Text PDF

The role of intra-operative neuroelectrophysiological monitoring in single-level approach selective dorsal rhizotomy.

Childs Nerv Syst 2020 09 4;36(9):1925-1933. Epub 2019 Nov 4.

Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.

Objective: Selective dorsal rhizotomy via a single-level approach (SL-SDR) to treat spasticity 100% relies on the interpretation of results from the intra-operative neuroelectrophysiological monitoring. The current study is to investigate the role EMG interpretation plays during SL-SDR procedure with regard to the selection of nerve rootlets for partially sectioning in pediatric cases with spastic cerebral palsy (CP).

Methods: A retrospective study was conducted in pediatric patients with spastic CP undergone our modified rhizotomy protocol-guided SL-SDR from May 2016 to Mar. Read More

View Article and Full-Text PDF
September 2020

Lateral and Oblique Lumbar Interbody Fusion-Current Concepts and a Review of Recent Literature.

Curr Rev Musculoskelet Med 2019 Jun 22:305-310. Epub 2019 Jun 22.

Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo Street, Suite 5400, Los Angeles, CA, 90033, USA.

Purpose: To review the relevant recent literature regarding minimally invasive, lateral, and oblique approaches to the anterior lumbar spine, with a particular focus on the operative and postoperative complications.

Methods: A literature search was performed on Pubmed and Web of Science using combinations of the following keywords and their acronyms: lateral lumbar interbody fusion (LLIF), oblique lateral interbody fusion (OLIF), anterior-to-psoas approach (ATP), direct lateral interbody fusion (DLIF), extreme lateral interbody fusion (XLIF), and minimally invasive surgery (MIS). All results from January 2016 through January 2019 were evaluated and all studies evaluating complications and/or outcomes were included in the review. Read More

View Article and Full-Text PDF

The Safety of Multimodality Monitoring Using a Triple-Lumen Bolt in Severe Acute Brain Injury.

World Neurosurg 2019 Oct 10;130:e62-e67. Epub 2019 Jun 10.

Division of Neurosurgery, Main Line Health, Wynnewood, Pennsylvania, USA; Lankenau Institute of Medical Research, Wynnewood, Pennsylvania, USA. Electronic address:

Background: Multimodality monitoring is used frequently to guide care of patients with severe acute brain injury. The aim of this study was to examine the safety and reliability of multimodality monitoring.

Methods: From a prospective observational database at a Level I trauma center, 501 patients, including 300 men and 201 women (mean age 58 ± 39 years) were identified retrospectively. Read More

View Article and Full-Text PDF
October 2019

Assessment of Regional Perfusion and Organ Function: Less and Non-invasive Techniques.

Front Med (Lausanne) 2019 22;6:50. Epub 2019 Mar 22.

Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany.

Sufficient organ perfusion essentially depends on preserved macro- and micro-circulation. The last two decades brought substantial progress in the development of less and non-invasive monitoring of macro-hemodynamics. However, several recent studies suggest a frequent incoherence of macro- and micro-circulation. Read More

View Article and Full-Text PDF

Review of "Neurotechnologist Reference Guide, 4th Edition," by Quantum Neuromonitoring.

Rebecca Rendahl

Neurodiagn J 2018 2;58(4):260. Epub 2018 Nov 2.

a Duke Raleigh Hospital , Raleigh , North Carolina.

View Article and Full-Text PDF
November 2018

Non-invasive optical neuromonitoring of the temperature-dependence of cerebral oxygen metabolism during deep hypothermic cardiopulmonary bypass in neonatal swine.

J Cereb Blood Flow Metab 2020 01 30;40(1):187-203. Epub 2018 Oct 30.

Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Management of deep hypothermic (DH) cardiopulmonary bypass (CPB), a critical neuroprotective strategy, currently relies on non-invasive temperature to guide cerebral metabolic suppression during complex cardiac surgery in neonates. Considerable inter-subject variability in temperature response and residual metabolism may contribute to the persisting risk for postoperative neurological injury. To characterize and mitigate this variability, we assess the sufficiency of conventional nasopharyngeal temperature (NPT) guidance, and in the process, validate combined non-invasive frequency-domain diffuse optical spectroscopy (FD-DOS) and diffuse correlation spectroscopy (DCS) for direct measurement of cerebral metabolic rate of oxygen (). Read More

View Article and Full-Text PDF
January 2020