Effect of intraoperative temperature level on patient outcome in elderly patients with strangulated small bowel obstruction / 中国实用护理杂志

Objective:To investigate the effect of intraoperative body temperature on prognosis of elderly patients with strangulated small bowel obstruction.Methods:The clinical data of 113 elderly patients with strangulated small intestinal obstruction and perform partial resection and anastomosis admitted to the Affiliated Hospital of Southwest Medical University from December 2017 to June 2022 were retrospectively analyzed. The ROC curve was used to analyze the relationship between the intraoperative body temperature(T) and the prognosis of patients, so as to obtain the optimal cutoff point (Ta). According to the relationship between T and Ta, all patients were divided into hypothermia group (33 cases) (T<Ta) and hyperthermia group (80 cases)(T ≥ Ta), and the differences in prognosis between the 2 groups were compared and Logistic regression was applied to analyze the influence of prognostic factors.Results:The optimal cutoff value (Ta ) of ROC curve was 36.45℃. The incidence of postoperative complications in hypothermia group was 60.6% (20/33), higher than 6.3%(5/80) in hyperthermia group ( χ2=40.06, P<0.01). Multivariate analysis by Logistic regression revealed that enteric perforation and lower intraoperative body temperature were risk factors for surgical prognosis ( OR=9.874, 95% CI 1.260-77.400; OR=69 865.637, 95% CI 90.799-53 758 097.700, both P<0.05). Conclusions:Intraoperative body temperature was a factor affecting surgical prognosis in elderly patients with strangulated small bowel obstruction. The temperature lower than 36.45 ℃ during the operation indicated that the patients were more prone to complications and had worse prognosis. Intensive temperature management was required intraoperatively in elderly patients, and nursing interventions such as warming and heating blankets were necessary.

Delayed sampling of intraoperative parathormone may be unnecessary during parathyroidectomy in kidney-transplanted and dialysis patients / A amostragem tardia de paratormônio intraoperatório pode ser desnecessária durante paratireoidectomia em pacientes transplantados renais e em diálise

Abstract Introduction: Some authors advise in favor of delayed sampling of intraoperative parathormone testing (ioPTH) during parathyroidectomy in dialysis and kidney-transplanted patients. The aim of the present study was to evaluate the intensity and the role of delayed sampling in the interpretation of ioPTH during parathyroidectomy in dialysis patients (2HPT) and successful kidney-transplanted patients (3HPT) compared to those in single parathyroid adenoma patients (1HPT). Methods: This was a retrospective study of ioPTH profiles in patients with 1HPT, 2HPT, and 3HPT operated on in a single institution. Samples were taken at baseline ioPTH (sampling at the beginning of the operation), ioPTH-10 min (10 minutes after excision of the parathyroid glands), and ioPTH-15 min (15 minutes after excision of the parathyroid glands). The values were compared to baseline. Results: Median percentage values of ioPTH compared to baseline (100%) were as follows: 1HPT, ioPTH-10 min = 20% and ioPTH-15 min = 16%; 2HPT, ioPTH-10 min = 14% and ioPTH-15 min = 12%; 3HPT, ioPTH-10 min = 18% and ioPTH-15 min = 15%. Discussion: The reduction was equally effective at 10 minutes in all groups. In successful cases, ioPTH decreases satisfactorily 10 minutes after parathyroid glands excision in dialysis and transplanted patients, despite significant differences in kidney function. The postponed sampling of ioPTH appears to be unnecessary.

Resumo Introdução: Alguns autores aconselham a favor de se fazer uma amostragem tardia de teste de paratormônio intraoperatório (PTHIO) durante paratireoidectomia em pacientes transplantados renais e em diálise. O objetivo do presente estudo foi avaliar a intensidade e o papel da amostragem tardia na interpretação do PTHIO durante paratireoidectomia em pacientes em diálise (2HPT) e pacientes com transplante renal bem sucedido (3HPT) em comparação com aqueles em pacientes com adenoma único de paratireoide (1HPT). Métodos: Este foi um estudo retrospectivo dos perfis de PTHIO em pacientes com 1HPT, 2HPT, e 3HPT operados em uma única instituição. Foram coletadas amostras de PTHIO basal (amostragem no início da operação), PTHIO-10 min (10 minutos após a excisão das glândulas paratireoides), e PTHIO-15 min (15 minutos após a excisão das glândulas paratireoides). Os valores foram comparados aos resultados basais. Resultados: Os valores percentuais medianos do PTHIO em comparação aos basais (100%) foram os seguintes: 1HPT, PTHIO-10 min = 20% e PTHIO-15 min = 16%; 2HPT, PTHIO-10 min = 14% e PTHIO-15 min = 12%; 3HPT, PTHIO-10 min = 18% e PTHIO-15 min = 15%. Discussão: A redução foi igualmente eficaz aos 10 minutos em todos os grupos. Em casos de sucesso, o PTHIO diminui satisfatoriamente 10 minutos após a excisão das glândulas paratireoides em pacientes em diálise e transplantados, apesar das diferenças significativas na função renal. A amostragem tardia de PTHIO parece ser desnecessária.

Intraoperative Motor Evoked Potential Improvement in Cervical Spondylotic Myelopathy: Comparison of Cortical Stimulation Parameters

Looking for the reason of hemodynamic instability: a case report of the role of intraoperative ultrasound / Buscando o motivo da instabilidade hemodinâmica: relato de caso sobre o papel do ultrassom intraoperatório

Abstract Background and objectives: A prompt and effective management of trauma patient is necessary. The aim of this case report is to highlight the importance of intraoperative echocardiography as a useful tool in patients suffering from refractory hemodynamic instability no otherwise explained. Case report: A 41 year-old woman suffered a car accident. At the emergency department, no abnormalities were found in ECG or chest X-ray. Abdominal ultrasound revealed the presence of abdominal free liquid and the patient was submitted to urgent exploratory laparotomy. Nevertheless, she persisted suffering arterial hypotension and metabolic acidosis. Looking for the reason of her hemodynamic instability, intraoperative transthoracic echocardiography was performed, finding out the presence of pericardial effusion. Once the cardiac surgeon extracted pericardial clots, patient's situation improved clinically and analytically. Conclusion: Every anesthesiologist should be able to use the intraoperative echocardiography as an effective tool in order to establish the appropriate measures to promote the survival of patients suffering severe trauma.

Resumo Justificativa e objetivos: O atendimento rápido e eficaz do paciente de trauma é necessário. O objetivo deste relato de caso foi destacar a importância do ecocardiograma intraoperatório como uma ferramenta útil em pacientes que sofrem de instabilidade hemodinâmica refratária sem explicação aparente. Relato de caso: Uma mulher de 41 anos sofreu um acidente de automóvel. No departamento de emergência, nenhuma anormalidade foi encontrada no ECG ou na radiografia de tórax. Uma ultrassonografia abdominal revelou a presença de líquido livre no abdome, e a paciente foi submetida à laparotomia exploradora de urgência. No entanto, a paciente continuou apresentando hipotensão arterial e acidose metabólica. Na busca pelo motivo de sua instabilidade hemodinâmica, um ecocardiograma transtorácico foi realizado no período intraoperatório e constatou a presenc¸a de derrame pericárdico. Após a remoção dos coágulos pericárdicos pelo cirurgião cardíaco, a condição da paciente melhorou clínica e analiticamente. Conclusão: Todo anestesiologista deve saber utilizar o ecocardiograma intraoperatório como ferramenta eficaz para estabelecer as medidas adequadas para promover a sobrevida de pacientes com traumatismos graves.

Clinical Usefulness of Intraoperative Motor-Evoked Potential Monitoring during Temporal Lobe Epilepsy Surgery

BACKGROUND AND PURPOSE: We aimed to determine the effectiveness of intraoperative neurophysiological monitoring focused on the transcranial motor-evoked potential (MEP) in patients with medically refractory temporal lobe epilepsy (TLE). METHODS: We compared postoperative neurological deficits in patients who underwent TLE surgery with or without transcranial MEPs combined with somatosensory evoked potential (SSEP) monitoring between January 1995 and June 2018. Transcranial motor stimulation was performed using subdermal electrodes, and MEP responses were recorded in the four extremity muscles. A decrease of more than 50% in the MEP or the SSEP amplitudes compared with baseline was used as a warning criterion. RESULTS: In the TLE surgery group without MEP monitoring, postoperative permanent motor deficits newly developed in 7 of 613 patients. In contrast, no permanent motor deficit occurred in 279 patients who received transcranial MEP and SSEP monitoring. Ten patients who exhibited decreases of more than 50% in the MEP amplitude recovered completely, although two cases showed transient motor deficits that recovered within 3 months postoperatively. CONCLUSIONS: Intraoperative transcranial MEP monitoring during TLE surgery allowed the prompt detection and appropriate correction of injuries to the motor nervous system or ischemic stroke. Intraoperative transcranial MEP monitoring is a reliable modality for minimizing motor deficits in TLE surgery.

Limitation of Intraoperative Transcranial Electrical Stimulation-Motor Evoked Potential Monitoring During Brain Tumor Resection Adjacent to the Primary Motor Cortex

Transcranial electrical stimulation-motor evoked potential (TES-MEP) is a valuable intraoperative monitoring technique during brain tumor surgery. However, TES can stimulate deep subcortical areas located far from the motor cortex. There is a concern about false-negative results from the use of TES-MEP during resection of those tumors adjacent to the primary motor cortex. Our study reports three cases of TES-MEP monitoring with false-negative results due to deep axonal stimulation during brain tumor resection. Although no significant change in TES-MEP was observed during surgery, study subjects experienced muscle weakness after surgery. Deep axonal stimulation of TES could give false-negative results. Therefore, a combined method of TES-MEP and direct cortical stimulation-motor evoked potential (DCS-MEP) or direct subcortical stimulation should be considered to overcome the limitation of TES-MEP.

Effects of SEP and TES-MEP on the operation success rate and safety of patients with spinal surgery / 局解手术学杂志

Objective To investigate the success rate and safety of transcranial electrical stimulation motor evoked potentials (TES-MEP) and somatosensory evoked potential(SEP) in the monitor of the spinal operation.Methods A total of 98 patients with spinal surgery in our hospital from December 2015 to December 2016 were selected and divided into observation group and control group according to the intraoperative monitoring method,49 cases in each group.SEP conbined with TES-MEP were used in the observation group,and SEP monitoring was used in the control group.Intravenous anesthesia was used in all patients to observe and record the amplitude and latency of SEP and TES-MEP.The results of the two groups were compared with those of the postoperative spinal motor and sensory function and the complications.Results The successful detection rate of the observation group and the control group were respectively 100％ and 91.84％,and the difference was statistically significant(P ＜ 0.05).The sensitivity,specificity and Youden index of the spinal cord movement were significantly higher in the observation group than those in the control group,the difference was not significant(P ＞ 0.05).In addition,the sensitivity,specificity and Youden index of the sensory function were higher than those in the control group,and the differences were statistically significant (P ＜ 0.05).There was no significant difference in postoperation complication between the two groups (P ＞ 0.05).Conclusion SEP combined with TES-MEP in monitoring function changes of the spine during spinal surgery on sensitivity and specificity are higher than the SEP monitoring,which can accurately reflect the function of the spine in the operation state,and provide a good reference for surgery.

Intraoperative Monitoring of Hypoglossal Nerve Using Hypoglossal Motor Evoked Potential in Infratentorial Tumor Surgery: A Report of Two Cases

The hypoglossal nerve (CN XII) may be placed at risk during posterior fossa surgeries. The use of intraoperative monitoring (IOM), including the utilization of spontaneous and triggered electromyography (EMG), from tongue muscles innervated by CN XII has been used to reduce these risks. However, there were few reports regarding the intraoperative transcranial motor evoked potential (MEP) of hypoglossal nerve from the tongue muscles. For this reason, we report here two cases of intraoperative hypoglossal MEP monitoring in brain surgery as an indicator of hypoglossal deficits. Although the amplitude of the MEP was reduced in both patients, only in the case 1 whose MEP was disappeared demonstrated the neurological deficits of the hypoglossal nerve. Therefore, the disappearance of the hypoglossal MEP recorded from the tongue, could be considered a predictor of the postoperative hypoglossal nerve deficits.

Utilidad de la ecocardiografía transesofágica en la cirugía de válvula mitral / Usefulness of transesophageal echocardiography in mitral valve surgery / Utilidade do ecocardiograma transesofágico na cirurgia da válvula mitral

El siguiente trabajo detalla un enfoque integral para la evaluación y el manejo intraoperatorio de la cirugía en la válvula mitral. Los avances tecnológicos han hecho de esta técnica un instrumento fundamental en el manejo intraoperatorio de estos pacientes. Las nuevas técnicas quirúrgicas de reparación de la válvula mitocondrial han determinado que el abordaje ecotransesofágico bi-dimensional se ha convertido en un examen de rutina, sin embargo, el advenimiento del ultrasonido tridimensional (3D) nos ha permitido aprender más sobre la anatomía funcional de la regurgitación de la válvula mitral, el mecanismo fisiopatológico predominante, y realizar evaluaciones en tiempo real de los resultados de una reparación o reemplazo quirúrgico. Estas contribuciones han contribuido a la capacidad de toma de decisiones de los equipos quirúrgicos, resultando en una mayor tasa de éxito para la reparación de la válvula mitral y una reducción de las complicaciones quirúrgicas.

The following work details an integral approach to the evaluation and intraoperative management of surgery on the mitral valve. Advances in technology have made this technique a fundamental instrument in the intraoperative management of these patients. The new surgical techniques of mitochondrial valve repair have determined that the bi-dimensional ecotransesophageal approach has become a routine examination, however, the advent of three-dimensional ultrasound (3D) has allowed us to learn more about the functional anatomy of the mitral valve's regurgitation, the predominant pathophysiological mechanism, and to conduct real-time evaluations of the results of a surgical repair or replacement. These contributions have contributed to surgical teams' decision-making capabilities, resulting in a greater success rate for mitral valve repair and a reduction of surgical complications.

O seguinte trabalho, faz uma abordagem integral da avaliação e manipulação intraoperatória da cirurgia na valva mitral. Os avanços na tecnologia tem feito dessa técnica um instrumento fundamental na manipulação intraoperatória desses pacientes. As novas técnicas cirúrgicas de reparação valvar mitral determinaram que a ecocardiografía transesofágica bidimensional tornou se um exame de rotina, no entanto o ultrassom tridimensional (3d) nos permitiu saber mais sobre a anatomia funcional da valva mitral, o mecanismo fisiopatológico predominante, assim como a avaliação em tempo real dos resultados da reparação ou substituição cirúrgica. Essas contribuições tem contribuído para a toma de decisões da equipe cirúrgica resultando numa maior taxa de sucesso de plastias da válvula mitral, assim como uma redução nas complicações cirúrgicas.

Advances in the application of neurophysiological monitoring in spinal cord injury / 天津医药

In recent decades, the development of the neurosurgery has changed from the traditional anatomical model to the modern anatomical-functional model. The nerve functions are maximally protected while lesions are removed as far as possible. Neurophysiological monitoring especially somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) can directly reflect the integrity of the sensory and motor nerve conduction pathways of the nervous system. At present, it has been widely used in the neurosurgery, spinal surgery, vascular surgery and other surgical fields. In recent years, more and more clinical surgeries involved spinal surgery, intraoperative neurophysiological monitoring could timely find any reversible spinal cord damage such as mechanical stretch, ischemia, and anesthetic drugs, which not only improve the quality of surgery, reduce iatrogenic spinal cord injury, but also greatly improve the prognosis of patients and reduce postoperative neurological dysfunction and complications. In this paper, the research progress of neural electrophysiological monitoring techniques in spinal cord surgery is reviewed.

Intraoperative Motor-Evoked Potential Disappearance versus Amplitude-Decrement Alarm Criteria During Cervical Spinal Surgery: A Long-Term Prognosis

BACKGROUND AND PURPOSE: We studied the clinical significance of amplitude-reduction and disappearance alarm criteria for transcranial electric muscle motor-evoked potentials (MEPs) during cervical spinal surgery according to different lesion locations [intramedullary (IM) vs. nonintramedullary (NIM)] by evaluating the long-term postoperative motor status. METHODS: In total, 723 patients were retrospectively dichotomized into the IM and NIM groups. Each limb was analyzed respectively. One hundred and sixteen limbs from 30 patients with IM tumors and 2,761 limbs from 693 patients without IM tumors were enrolled. Postoperative motor deficits were assessed up to 6 months after surgery. RESULTS: At the end of surgery, 61 limbs (2.2%) in the NIM group and 14 limbs (12.1%) in the IM group showed MEP amplitudes that had decreased to below 50% of baseline, with 13 of the NIM limbs (21.3%) and 2 of the IM limbs (14.3%) showing MEP disappearance. Thirteen NIM limbs (0.5%) and 5 IM limbs (4.3%) showed postoperative motor deficits. The criterion for disappearance showed a lower sensitivity for the immediate motor deficit than did the criterion for amplitude decrement in both the IM and NIM groups. However, the disappearance criterion showed the same sensitivity as the 70%-decrement criterion in IM (100%) and NIM (83%) surgeries for the motor deficit at 6 months after surgery. Moreover, it has the highest specificity for the motor deficits among diverse alarm criteria, from 24 hours to 6 months after surgery, in both the IM and NIM groups. CONCLUSIONS: The MEP disappearance alarm criterion had a high specificity in predicting the long-term prognosis after cervical spinal surgery. However, because it can have a low sensitivity in predicting an immediate postoperative deficit, combining different MEP alarm criteria according to the aim of specific instances of cervical spinal surgery is likely to be useful in practical intraoperative monitoring.

Intraoperative Recurrent Laryngeal Nerve Monitoring in a Patient with Contralateral Vocal Fold Palsy

Recurrent laryngeal nerve injury can develop following cervical or thoracic surgery; however, few reports have described intraoperative recurrent laryngeal nerve monitoring. Consensus regarding the use of this technique during thoracic surgery is lacking. We used intraoperative recurrent laryngeal nerve monitoring in a patient with contralateral vocal cord paralysis who was scheduled for completion pneumonectomy. This case serves as an example of intraoperative recurrent laryngeal nerve monitoring during thoracic surgery and supports this indication for its use.

Intraoperative Recurrent Laryngeal Nerve Monitoring in a Patient with Contralateral Vocal Fold Palsy

Recurrent laryngeal nerve injury can develop following cervical or thoracic surgery; however, few reports have described intraoperative recurrent laryngeal nerve monitoring. Consensus regarding the use of this technique during thoracic surgery is lacking. We used intraoperative recurrent laryngeal nerve monitoring in a patient with contralateral vocal cord paralysis who was scheduled for completion pneumonectomy. This case serves as an example of intraoperative recurrent laryngeal nerve monitoring during thoracic surgery and supports this indication for its use.

Intraoperative monitoring of flash visual evoked potential under general anesthesia / 대한마취과학회지

In neurosurgical procedures that may cause visual impairment in the intraoperative period, the monitoring of flash visual evoked potential (VEP) is clinically used to evaluate visual function. Patients are unconscious during surgery under general anesthesia, making flash VEP monitoring useful as it can objectively evaluate visual function. The flash stimulus input to the retina is transmitted to the optic nerve, optic chiasm, optic tract, lateral geniculate body, optic radiation (geniculocalcarine tract), and visual cortical area, and the VEP waveform is recorded from the occipital region. Intraoperative flash VEP monitoring allows detection of dysfunction arising anywhere in the optic pathway, from the retina to the visual cortex. Particularly important steps to obtain reproducible intraoperative flash VEP waveforms under general anesthesia are total intravenous anesthesia with propofol, use of retinal flash stimulation devices using high-intensity light-emitting diodes, and a combination of electroretinography to confirm that the flash stimulus has reached the retina. Relatively major postoperative visual impairment can be detected by intraoperative decreases in the flash VEP amplitude.

Individualized microsurgical treatment of intracranial anterior circulation giant aneurysms: A report of 22 cases / 第二军医大学学报

Objective To investigate the individualized microsurgical treatment regimens for intracranial anterior circulation giant aneurysms and to assess their effectiveness. Methods We retrospectively analyzed the clinical data of 22 patients with anterior circulation giant aneurysms who were treated with microsurgery from May 2006 to May 2016. There were 9 ruptured aneurysms and 13 unruptured aneurysms. The surgical methods included direct clipping of the aneurysmal neck in 5 cases, thrombectomy-aneurysm clip reconstruction in 12 cases, aneurysm excision combined with vessels reconstruction in 2 cases, trapping of the aneurysm in 2 cases, and cervical internal carotid artery ligation in 1 case. Prognoses of patients were evaluated by Glasgow Outcome Scale (GOS). Results At discharge, 14 of the 22 patients recovered well and regained normal life (GOS 5), 5 patients had mild disability (GOS 4), 2 had severe disability (GOS 3), and one died (GOS 1). The mean follow-up time was (39±30) months (ranging from 3 to 118 months). Post-operative three-dimensional CT angiography (3D-CTA) or three-dimensional digital subtraction angiography (3D-DSA) showed that complete angiographic obliteration was achieved in all the 21 survivors; there were 17 survivors with GOS 5, 2 with GOS 4, 1 with GOS 3, and 1 with GOS 1. The mortality and morbidity of patients were 9. 1% (2/22) and 13. 6% (3/22), respectively. Analysis of factors influencing of prognosis showed that there was no significant difference in patients outcomes between groups of age (P=1. 324), sex (P=2. 346), aneurysm size (P=0. 856), Hunt-Hess grade (P=0. 196), or aneurysmal rupture (P=0. 172), and there was significant difference in patients outcomes between microvascular Doppler (MVD) group and none MVD group (P=0. 036). Conclusion Detailed pre-operative evaluation and individualized surgical plan are necessary for patients with intracranial anterior circulation giant aneurysms. Surgeon’s microsurgical experiences and skills together with intra-operative monitoring is the guarantee for satisfactory effectiveness of microsurgery treatment.

Application of motor evoked potential monitoring under threshold-level electrical stimulation using cranial peg- screw electrode during cerebral aneurysm keyhole approach surgery / 第二军医大学学报

Objective To explore the advantage of motor evoked potentials (MEPs) monitoring for postoperativemotor deficit evaluation under threshold-level electrical stimulation using cranial peg-screw electrode (CPSE) during cerebral aneurysm keyhole approach microsurgery. Methods A total of 31 patients who underwent anterior circulation aneurysm microsurgery through keyhole approach were selected in this study. MEPs monitoring of the operation side was conducted with threshold-level electrical stimulation using CPSE, and that of the non-operation side was conducted with transcranial electric stimulation using the same stimulation threshold. The change of minimum voltage required for MEPs monitoring was observed and recorded. The intraoperative MEPs monitoring results and postoperative neurological functions were analyzed by prospective observational study. Results MEPs of the operation side was successfully induced in 28 cases. No complications related to MEPs monitoring were observed. Intraoperative MEPs abnormalities were monitored in3 cases, and2 of them had postoperative transient hemiplegia, showing a sensitivity of 100% (2/2). No motor dysfunction was observed in the other 26 cases who were not presented with intraoperative MEPs abnormalities in 25 cases, showing a specificity of 96. 30% (26/27). Conclusion MEPs monitoring with threshold-level electrical stimulation using CPSE is a feasible and reliable method and t has satisfactory sensitivity and specificity for predicting motor dysfunction induced by cerebral ischemia, indicating that this method can be an alternative for routine MEPs monitoring with conventional transcranial electrical stimulation in cerebral aneurysm microsurgery.

Anesthesia and sedation outside of the operating room / 대한마취과학회지

Due to rapid evolution and technological advancements, medical personnel now require special training outside of their safe zones. Anesthesiologists face challenges in practicing in locations beyond the operating room. New locations, inadequate monitoring devices, poor assisting staff, unfamiliarity of procedures, insufficient knowledge of basic standards, and lack of experience compromise the quality of patient care. Therefore, anesthesiologists must recognize possible risk factors during anesthesia in nonoperating rooms and familiarize themselves with standards to improve safe practice. This review article emphasizes the need for standardizing hospitals and facilities requiring nonoperating room anesthesia, and encourages anesthesiologists to take the lead in applying these practice guidelines to improve patient outcomes and reduce adverse events.

Preservation of Facial Nerve Function Repaired by Using Fibrin Glue-Coated Collagen Fleece for a Totally Transected Facial Nerve during Vestibular Schwannoma Surgery

Recently, the increasing rates of facial nerve preservation after vestibular schwannoma (VS) surgery have been achieved. However, the management of a partially or completely damaged facial nerve remains an important issue. The authors report a patient who was had a good recovery after a facial nerve reconstruction using fibrin glue-coated collagen fleece for a totally transected facial nerve during VS surgery. And, we verifed the anatomical preservation and functional outcome of the facial nerve with postoperative diffusion tensor (DT) imaging facial nerve tractography, electroneurography (ENoG) and House-Brackmann (HB) grade. DT imaging tractography at the 3rd postoperative day revealed preservation of facial nerve. And facial nerve degeneration ratio was 94.1% at 7th postoperative day ENoG. At postoperative 3 months and 1 year follow-up examination with DT imaging facial nerve tractography and ENoG, good results for facial nerve function were observed.

Combined Muscle Motor and Somatosensory Evoked Potentials for Intramedullary Spinal Cord Tumour Surgery

PURPOSE: To evaluate whether intraoperative neurophysiologic monitoring (IONM) with combined muscle motor evoked potentials (mMEPs) and somatosensory evoked potentials is useful for more aggressive and safe resection in intramedullary spinal cord tumour (IMSCT) surgery. MATERIALS AND METHODS: We reviewed data from consecutive patients who underwent surgery for IMSCT between 1998 and April 2012. The patients were divided into two groups based on whether or not IONM was applied. In the monitored group, the procedures were performed under IONM using 75% muscle amplitude decline weaning criteria. The control group was comprised of patients who underwent IMSCT surgery without IONM. The primary outcome was the rate of gross total excision of the tumour on magnetic resonance imaging at one week after surgery. The secondary outcome was the neurologic outcome based on the McCormick Grade scale. RESULTS: The two groups had similar demographics. The total gross removal tended to increase when intraoperative neurophysiologic monitoring was used, but this tendency did not reach statistical significance (76% versus 58%; univariate analysis, p=0.049; multivariate regression model, p=0.119). The serial McCormick scale score was similar between the two groups (based on repeated measure ANOVA). CONCLUSION: Our study evaluated combined IONM of trans-cranial electrical (Tce)-mMEPs and SEPs for IMSCT. During IMSCT surgery, combined Tce-mMEPs and SEPs using 75% muscle amplitude weaning criteria did not result in significant improvement in the rate of gross total excision of the tumour or neurologic outcome.

Usefulness of Intraoperative Monitoring during Microsurgical Decompression of Cervicomedullary Compression Caused by an Anomalous Vertebral Artery

We report a case of cervicomedullary compression by an anomalous vertebral artery treated using microsurgical decompression with intraoperative monitoring. A 68-year-old woman presented with posterior neck pain and gait disturbance. MRI revealed multiple abnormalities, including an anomalous vertebral artery that compressed the spinal cord at the cervicomedullary junction. Suboccipital craniectomy with C1 laminectomy was performed. The spinal cord was found to be compressed by the vertebral arteries, which were retracted dorsolaterally. At that time, the somatosensory evoked potential (SSEP) changed. After release of the vertebral artery, the SSEP signal normalized instantly. The vertebral artery was then lifted gently and anchored to the dura. There was no other procedural complication. The patient's symptoms improved. This case demonstrates that intraoperative monitoring may be useful for preventing procedural complications during spinal cord microsurgical decompression.