The application of intraoperative neurophysiological monitoring in selective dorsal neurotomy for primary premature ejaculation: a prospective single-center study / 亚洲男科学杂志(英文版)

Selective dorsal neurotomy (SDN) is a surgical treatment for primary premature ejaculation (PE), but there is still no standard surgical procedure for selecting the branches of the dorsal penile nerves to be removed. We performed this study to explore the value of intraoperative neurophysiological monitoring (IONM) of the penile sensory-evoked potential (PSEP) for standard surgical procedures in SDN. One hundred and twenty primary PE patients undergoing SDN were selected as the PE group and 120 non-PE patients were selected as the normal group. The PSEP was monitored and compared between the two groups under both natural and general anesthesia (GA) states. In addition, patients in the PE group were randomly divided into the IONM group and the non-IONM group. During SDN surgery, PSEP parameters of the IONM group were recorded and analyzed. The differences in PE-related outcome measurements between the perioperative period and 3 months' postoperation were compared for the PE patients, and the differences in effectiveness and complications between the IONM group and the non-IONM group were compared. The results showed that the average latency of the PSEP in the PE group was shorter than that in the normal group under both natural and GA states (P < 0.001). Three months after surgery, the significant effective rates in the IONM and non-IONM groups were 63.6% and 34.0%, respectively (P < 0.01), and the difference in complications between the two groups was significant (P < 0.05). IONM might be useful in improving the short-term therapeutic effectiveness and reducing the complications of SDN.

Comparison of onset of neuromuscular blockade with electromyographic and acceleromyographic monitoring: a prospective clinical trial

Abstract Background Reliable devices that quantitatively monitor the level of neuromuscular blockade after neuromuscular blocking agents' administration are crucial. Electromyography and acceleromyography are two monitoring modalities commonly used in clinical practice. The primary outcome of this study is to compare the onset of neuromuscular blockade, defined as a Train-Of-Four Count (TOFC) equal to 0, as measured by an electromyography-based device (TetraGraph) and an acceleromyography-based device (TOFscan). The secondary outcome was to compare intubating conditions when one of these two devices reached a TOFC equal to 0. Methods One hundred adult patients scheduled for elective surgery requiring neuromuscular blockade were enrolled. Prior to induction of anesthesia, TetraGraph electrodes were placed over the forearm of patients' dominant/non-dominant hand based on randomization and TOFscan electrodes placed on the contralateral forearm. Intraoperative neuromuscular blocking agent dose was standardized to 0.5 mg.kg−1 of rocuronium. After baseline values were obtained, objective measurements were recorded every 20 seconds and intubation was performed using video laryngoscopy once either device displayed a TOFC = 0. The anesthesia provider was then surveyed about intubating conditions. Results Baseline TetraGraph train-of-four ratios were higher than those obtained with TOFscan (Median: 1.02 [0.88, 1.20] vs. 1.00 [0.64, 1.01], respectively, p < 0.001). The time to reach a TOFC = 0 was significantly longer when measured with TetraGraph compared to TOFscan (Median: 160 [40, 900] vs. 120 [60, 300] seconds, respectively, p < 0.001). There was no significant difference in intubating conditions when either device was used to determine the timing of endotracheal intubation. Conclusions The onset of neuromuscular blockade was longer when measured with TetraGraph than TOFscan, and a train-of-four count of zero in either device was a useful indicator for adequate intubating conditions. Clinical trial number and registry URL NCT05120999, https://clinicaltrials.gov/ct2/show/NCT05120999.

Somatosensory evoked potentials in clinical practice: a review / Potenciais evocados somatossensitivos na prática clínica: uma revisão

Abstract The authors present a review of the current use of somatosensory evoked potentials (SSEPs) in neurological practice as a non-invasive neurophysiological technique. For this purpose we have reviewed articles published in English or Portuguese in the PubMed and LILACS databases. In this review, we address the role of SSEPs in neurological diseases that affect the central nervous system and the peripheral nervous system, especially in demyelinating diseases, for monitoring coma, trauma and the functioning of sensory pathways during surgical procedures. The latter, along with new areas of research, has become one of the most important applications of SSEPs.

Resumo Os autores apresentam uma revisão do uso atual do potencial evocado somatossensitivo (PESS) na prática neurológica como uma técnica neurofisiológica não invasiva. Revisamos artigos publicados em Inglês ou Português nas bases de dados PubMed e LILACS. Nesta revisão abordamos o papel do PESS nas doenças neurológicas que atingem o sistema nervoso central e o sistema nervoso periférico, especialmente, nas doenças desmielinizantes, no monitoramento do coma, do trauma e da função das vias sensitivas durante os procedimentos cirúrgicos, que se tornou uma de suas aplicações mais importantes, assim como novas áreas de pesquisa.

Research progress on functional assessment and rehabilitation treatment of vascular cognitive impairment / 中国基层医药

Vascular cognitive impairment is a common type of cognitive impairment. At present, there is no targeted treatment, especially for moderate to severe dementia. This review focuses on the early functional evaluation and rehabilitation treatment in patients with vascular cognitive impairment, in order to obtain optimal curative effects and improve the quality of daily living. Neuropsychological test is helpful for early screening of vascular cognitive impairment. Neuropsychological test, together with the results of neuroelectrophysiology and imaging examination as objective evidence, can further predict the disease progress and can be used to guide rehabilitation treatment and curative effect evaluation. Cognitive training, exercise training, non-invasive nerve regulation technology, acupuncture and moxibustion are currently effective rehabilitation treatments. Combined application of various methods has a better improvement effect than monotherapy. Among them, non-invasive nerve regulation technology shows a good application prospect. At present, more high-quality clinical research evidence is needed.

Cirugía con despertar operatorio para procesos expansivos cerebrales. Reporte de 20 casos

Resumen: Introducción: La cirugía de lesiones expansivas cerebrales con paciente despierto es una técnica que se usa de forma cada vez más frecuente. Esto se debe a que es una técnica costo efectiva para realizar resección de tumores cerebrales de forma amplia y segura. Resultado: Se presentan 20 pacientes operados con dicha técnica. Se trató de 13 hombres y 7 mujeres, rango etario 16 - 67 años, portadores de 17 lesiones tumorales y 3 lesiones vasculares (angiomas cavernosos). Se realizaron 22 cirugías ya que dos pacientes se intervinieron 2 veces. Se logró resección supra-máxima en 3 casos, completa en 9, subtotal en 5 y parcial en 2 pacientes. Un paciente no se pudo operar debido a que presentó un despertar inadecuado y el procedimiento se suspendió. En cuanto a las complicaciones, 18% de los pacientes presentaron crisis intra-operatorias, pero las mismas no impidieron el desarrolló del procedimiento con normalidad luego de yugulada la crisis. Dos pacientes (9% de los procedimientos) presentaron un despertar inadecuado. En un caso la lesión se resecó completamente de todas formas, en el otro se suspendió el procedimiento. 18% de los pacientes presentaron una peoría funcional transitoria y un 4.5% presentó una peoría definitiva (paresia severa). Un solo paciente (4.5%) presentó una infección del colgajo que requirió retiro de la plaqueta ósea y colocación de una placa de acrílico en diferido. Conclusiones: Las cifras presentadas por los autores están en concordancia con las de los centros regionales e internacionales de referencia.

Abstract: Introduction: Expansive brain injury surgery with awake patients is a technique that is being used more and more frequently. This is because it is a cost-effective technique for performing brain tumor resection widely and safely. Outcome: Twenty patients operated with this technique are presented. There were 13 men and 7 women, age range 16 - 67 years, carriers of 17 tumor lesions and 3 vascular lesions (cavernous angiomas). 22 surgeries were performed since two patients underwent surgery twice. Supra-maximal resection was achieved in 3 cases, complete in 9, subtotal in 5, and partial in 2 patients. One patient could not be operated on due to inadequate awakening and the procedure was suspended. Regarding complications, 18% of the patients presented intra-operative seizures, but they did not prevent the normal development of the procedure after the crisis was jugulated. Two patients (9% of the procedures) had inadequate awakening. In one case the lesion was completely resected anyway, in the other the procedure was suspended. 18% of the patients presented a transitory functional deterioration and 4.5% presented a definitive worsening (severe paresis). Only one patient (4.5%) had a flap infection that required removal of the bone plate and placement of a delayed acrylic plate. Conclusions: The figures presented by the authors are in accordance with those of the regional and international reference centers.

Resumo: Introdução: A cirurgia de lesão cerebral extensiva com pacientes acordados é uma técnica cada vez mais utilizada. Isso ocorre porque é uma técnica econômica para realizar a ressecção de tumor cerebral de forma ampla e segura. Resultado: São apresentados 20 pacientes operados com essa técnica. Eram 13 homens e 7 mulheres, com idades entre 16 e 67 anos, portadores de 17 lesões tumorais e 3 lesões vasculares (angiomas cavernosos). Foram realizadas 22 cirurgias, pois dois pacientes foram operados duas vezes. A ressecção supra-máxima foi alcançada em 3 casos, completa em 9, subtotal em 5 e parcial em 2 pacientes. Um paciente não pôde ser operado devido ao despertar inadequado e o procedimento foi suspenso. Em relação às complicações, 18% dos pacientes apresentaram convulsões no intra-operatório, mas não impediram o desenvolvimento normal do procedimento após a jugulação da crise. Dois pacientes (9% dos procedimentos) tiveram despertar inadequado. Em um caso a lesão foi totalmente ressecada de qualquer maneira, no outro o procedimento foi suspenso. 18% dos pacientes apresentaram uma deterioração funcional transitória e 4,5% apresentaram piora definitiva (paresia grave). Apenas um paciente (4,5%) apresentou infecção do retalho que exigiu a retirada da placa óssea e colocação de placa acrílica retardada. Conclusões: Os números apresentados pelos autores estão de acordo com os dos centros de referência regionais e internacionais.

Relationship between intraoperative neurophysiological monitoring alert and postoperative walking ability / 中国组织工程研究

BACKGROUND: Intraoperative neurophysiological monitoring is popular in spinal surgery. However, a severe iatrogenic spinal cord injury cannot be completely eliminated. Is there a relationship between true positive intraoperative neurophysiological monitoring alert during particular surgical steps and postoperative neurological recovery? This topic is to improve the safety of spinal invasive procedures. OBJECTIVE: To determine the relationship between true positive intraoperative neurophysiological monitoring alert during particular surgical steps and postoperative walking ability. METHODS: A retrospective study of 2 249 patients undergoing intraoperative neurophysiological monitoring in Li Ka Shing Faculty of Medicine, the University of Hong Kong was conducted. Standard patient demographics, diagnosis and operative features and intraoperative neurophysiological monitoring data were collected. There were 10 cases of true positive intraoperative neurophysiological monitoring alert (4 males, 6 females, 14-88 years old), and the average follow-up time was 9.8 years. The patients were divided into two groups based on whether surgical steps triggering intraoperative neurophysiological monitoring alert impact the spinal cord or not. The study was performed in accordance with the ethical requirements of Li Ka Shing Faculty of Medicine, the University of Hong Kong, and the patients and their guardians signed the informed consents. RESULTS AND CONCLUSION: These alerts occurred during decompression (n=3), anterior disc release (n=1), finding the entering point of T3 pedicle (n= 1), screw insertion (n=1), reduction of fracture (n=2), insertion of wire (n= 1), and cement injection (n=1). Among these patients, 100% of spinal cord invasive procedure patients developed incompetence of walking, while 80% (4/5) of spine cord non-invasive patients were capable of walking (P < 0.05). After the alert was triggered, four patients continued with primary program, three patients underwent expanding decompression and three patients gave up surgery. If true positive intraoperative neurophysiological monitoring alert is reported during spinal invasive procedures, there should be a very high chance of postoperative walking disability. If any conditions occur, the surgery needs to be stopped, and instead, remedial measures such as surgery suspension, steroids injection, and additional decompression should be performed immediately.

The Role of Neurophysiological Monitoring during Complex Aneurysm Surgery: Report of Two Cases and Review of the Literature

The surgical treatment of intracranial aneurysms is a routine operation in the neurosurgeon practice. Complex aneurysms are those with morphological irregularities, usually large or giant; thrombosed, partially thrombosed or calcified; with aberrant fundus/neck ratio and near eloquent neurological structures. These cases demand special skills by the surgical team. The present article is a report of two cases of complex aneurysms successfully treated, with a discussion on the role of neurophysiological monitoring. In these two cases of supra- and infratentorial complex giant aneurysms, intraoperative monitoring was extremely relevant. Thus, we believe that treating complex and giant aneurysms carries several pitfalls, and the use of multimodal intraoperative monitoring is mandatory to mitigate risks and deliver the best result to the patient.

Neuromonitorización intraoperatoria del nervio facial: a propósito de un caso / Intraoperative neuromonitoring of the facial nerve: a case report

Introdução: A preservação do nervo facial (NF) é uma das principais preocupações do cirurgião durante o tratamento aberto das fraturas mandibulares, uma vez que uma lesão nessa estrutura anatômica pode causar sequelas estéticas e funcionais permanentes. A existência de variações anatômicas (anastomoses e ramificações incomuns) aumenta o risco de danos no NF, mesmo nas mãos de cirurgiões experientes. O neuromonitoramento intraoperatório tem-se mostrado um grande aliado para evitar lesões nos ramos nervosos que podem estar envolvidos na área cirúrgica. Considerando a escassez desse assunto na literatura referente à cirurgia maxilo-facial, objetivamos demonstrar o uso da técnica de neuromonitoração do NF durante o acesso submandibular para o tratamento da fratura bilateral do ângulo mandibular. Relato de caso: No presente relato de caso, as abordagens cirúrgicas de ambos os lados não apresentaram danos permanentes ao NF. Esse resultado assim como a literatura sugerem que o neuromonitoramento intraoperatório proporciona maior segurança durante a realização de abordagens cirúrgicas, nas quais os ramos do nervo facial estão envolvidos, reduzindo, assim, o risco de sequelas nervosas. Considerações Finais: Esse recurso pode ser de grande auxílio no treinamento hospitalar ao longo do processo de formação de cirurgiões bucomaxilofaciais... (AU)

Introduction: Facial nerve (FN) preservation is one of the surgeon's major concerns during the open treatment of mandibular fractures since an injury to this anatomical structure can cause permanent aesthetic and functional sequelae. The existence of anatomical variations (anastomosis and unusual branching) increases the risk of FN damage even in the hands of experienced surgeons. Intraoperative neuromonitoring has proven to be a great ally to avoid injury to the nerve branches that may be involved in the surgical area. Considering the scarcity of this subject in the maxillofacial surgery literature, we aimed to demonstrate the use of the FN neuromonitoring technique during the submandibular approach for the treatment of bilateral mandibular angle fracture. Case report: In the present case report, the surgical approaches of both sides presented no permanent damage to the FN. Results: This result, as well as previous literature, suggests that intraoperative neuromonitoring provides greater safety during the performance of surgical approaches in which the facial nerve branches are involved and thus, reduces the risk of nerve sequelae. Final considerations: This resource can be of special assistance in teaching hospitals throughout the training process of maxillofacial surgeons... (AU)

Application of intraoperative ultrasound and neuromonitoring in microsurgical treatment of intramedullary tumor in the superior cervical spinal cord / 中华显微外科杂志

Objective To analyze the effect of clinical application of ultrasound in microsurgical treatment of intramedullary tumors in the superior cervical spinal cord.Methods Retrospective study the clinical data of 15 patients with intramedullary tumors in the superior cervical spinal cord,which were underwent a laminectomy for microsurgical tumor resection during January,2014 and January,2018.Intraoperative ultrasound and neuromonitoring was accompanied by the whole surgical procedure for each case.The follow-up data was collected by outpatient department visits and telephone interviews.Results All the described patients were performed with microscopic tumor resection by using intraoperative neurophysiological monitoring and ultrasound.The pathological diagnosis was ependymocytoma (n=8) and astrocytoma (n=7).Gross total resections comprised 86.7％ of cases (n=13),and subtotal resections 13.3％ (n=2).The neurological outcome was as follows:Mc-Cormick scale grade Ⅰ,10 patients;grade Ⅱ,3 patients;grade Ⅲ,1 patient;and grade Ⅳ 1 patient;Follow-up was applied for (19.2±7.6) months in 13 cases and 12.0 months in 2 cases.Compared to the preoperative period,66.6％ of patients recovered postoperatively,20.0％ improved,6.7％ remained without deficit and deterioration persisted in 6.7％.Conclusion The microscopic resection of tumors is the effective way to cure this disease.By using intraoperative neurophysiological monitoring and ultrasound,the complete tumor resection and the minimal spinal cord injury were certainly achieved.

Intraoperative Neurophysiological Monitoring during Microvascular Decompression Surgery for Hemifacial Spasm

Hemifacial spasm (HFS) is due to the vascular compression of the facial nerve at its root exit zone (REZ). Microvascular decompression (MVD) of the facial nerve near the REZ is an effective treatment for HFS. In MVD for HFS, intraoperative neurophysiological monitoring (INM) has two purposes. The first purpose is to prevent injury to neural structures such as the vestibulocochlear nerve and facial nerve during MVD surgery, which is possible through INM of brainstem auditory evoked potential and facial nerve electromyography (EMG). The second purpose is the unique feature of MVD for HFS, which is to assess and optimize the effectiveness of the vascular decompression. The purpose is achieved mainly through monitoring of abnormal facial nerve EMG that is called as lateral spread response (LSR) and is also partially possible through Z-L response, facial F-wave, and facial motor evoked potentials. Based on the information regarding INM mentioned above, MVD for HFS can be considered as a more safe and effective treatment.

Development of a Novel Intraoperative Neuromonitoring System Using a Surface Pressure Sensor to Detect Muscle Movement: A Rabbit Model Study

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. METHODS: We developed the surface pressure sensor by modifying a commercial piezo-electric sensor. We evaluated the stimulus thresholds to detect muscle movement, as well as the amplitude and latency of the EMG and surface pressure sensor in six sciatic nerves of three rabbits, according to the stimulus intensity. RESULTS: The surface pressure sensor detected the muscle movements in response to a 0.1 mA stimulation of all six sciatic nerves. There were no differences in the thresholds of stimulus intensity between the surface pressure sensor and EMG recordings to detect muscle movements. CONCLUSION: It is possible to measure the change in surface pressure by using a piezo-electric surface pressure sensor instead of EMG to detect muscle movement induced by nerve stimulation. The application of IONM using a piezo-electric surface pressure sensor during surgery is noninvasive, safe, and feasible. Measuring muscle twitching to identify the state of the nerves using the novel IONM system can be an alternative to recording of EMG responses.

Visual and electrophysiological identification of the external branch of superior laryngeal nerve in redo thyroid surgery compared with primary thyroid surgery

PURPOSE: Thyroid reoperations are surgically challenging because of significant anatomical variance. Visual and functional identification of the external branch of the superior laryngeal nerve (EBSLN) were studied in 2 groups of patients who underwent primary and redo thyroid surgery. METHODS: This study was conducted on 200 patients: 100 patients with redo and 100 patients with primary thyroid surgery. In addition to visual identification, nerve branches were functionally identified by intraoperative nerve monitoring (IONM). Visual, functional, and total identification rates of the EBSLN in both primary and redo surgery were determined and compared between the 2 groups. RESULTS: We attempted to identify 138 and 170 EBSLNs at risk in redo and primary surgery, respectively. Visual identification rates were 65.3% and 30.4% (P < 0.001) in primary and redo surgery groups, respectively. In total, 164 (96.5%) and 97 EBSLNs (70.3%) were identified in primary and redo surgery, respectively (P < 0.001), including the use of IONM. In primary surgery group, 53 nonvisualized EBSLNs of 164 identified nerves (32.3%) were determined by IONM alone. In redo surgery group, 55 of 97 identified nerves (56.7%) were determined by IONM alone (P < 0.001). CONCLUSION: Both visual and total identification rates of the EBSLN are significantly decreased in reoperative thyroidectomy. IONM increases the total identification rate of the EBSLN in primary and redo thyroid surgery. Electrophysiological monitoring makes a substantial contribution to the identification of the EBSLN both in primary and especially in redo thyroid surgery.

Intraoperative Neurophysiologic Testing of the Perigastric Vagus Nerve Branches to Evaluate Viability and Signals along Nerve Pathways during Gastrectomy

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. The hepatic and celiac branches of the vagus nerve were exposed, and grabbing type stimulation electrodes were applied as follows: 10–30 mA intensity, 4 trains, 1,000 µs/train, and 5× frequency. Visible myocontractile movement and electrical signals were monitored via needle probes before and after gastrectomy. Gastrointestinal symptoms were evaluated preoperatively and postoperatively at 3 weeks and 3 months, respectively. RESULTS: Responses were observed after stimulating the celiac branch in 10, 9, 10, and 6 patients in the antrum, pylorus, duodenum, and proximal jejunum, respectively. Ten patients responded to hepatic branch stimulation at the duodenum. After vagus-preserving distal gastrectomy, 2 patients lost responses to the celiac branch at the duodenum and jejunum (1 each), and 1 patient lost response to the hepatic branch at the duodenum. Significant procedure-related complications and meaningful postoperative diarrhea were not observed. CONCLUSIONS: Intraoperative neurophysiologic testing seems to be a feasible methodology for monitoring the perigastric vagus nerves. Innervation of the duodenum via the celiac branch and postoperative preservation of the function of the vagus nerves were confirmed in most patients. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0000823

Comparison of multi-mode and single-mode intraoperative neurophysiological monitoring in the treatment of severe ossification of the cervical posterior longitudinal ligament with anterior cervical corpectomy with fusion / 中国骨伤

OBJECTIVE@#To compare the application of multi-mode and single-mode intraoperative neurophysiological monitoring in the treatment of severe ossification of posterior longitudinal ligament of cervical spine with anterior cervical corpectomy with fusion.@*METHODS@#From April 2015 to June 2018, 32 patients with severe ossification of the posterior longitudinal ligament were treated in the Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. There were 21 males and 11 females, aged 45 to 73 years old, with a mean age of 59 years old. The duration of the disease ranged from 6 to 72 months, with a mean of 39 months. The main manifestations were numbness, numbness and weakness of limbs, cotton feeling of foot stepping on lower limbs, instability of standing and walking. With the gradual aggravation of symptoms, quadriplegia, dysfunction of urine and defecation may occur. Patients with ossification of posterior longitudinal ligament of cervical spine were monitored by somatosensory evoked potentials, motor evoked potentials and electromyogram patterns.@*RESULTS@#During the operation, 8 patients had abnormal amplitude of somatosensory evoked potential(SEP); 5 of them had bleeding during anterior cervical decompression procedure and were placed with too much hemostatic cotton, which caused compression of spinal cord and resulted in abnormal SEP waveform. After removal of the hemostatic cotton, SEP waveform returned ot normal; 3 patients had abnormal SEP waveform due to decreased systolic pressure, which was corrected by increased systolic pressure. Twelve patients had abnormal amplitude of motor evoked potential during monitoring, 9 of which were caused by intraoperative mis-contact with nerve root, and turned to normal after timely adjustment of position, 3 of which were caused by intraoperative inhalation of muscle relaxant during surgery. Among 11 patients with abnormal EMG waveform, 9 patients recovered to normal waveform after adjusting operation, 2 patients recovered to normal waveform after short observation, and all patients recovered to normal waveform of motor evoked potential after operation(<0.05). There were 2 cases of cerebrospinal fluid leakage after operation, which healed spontaneously 7 days after operation, and no complications of spinal cord and nerve occurred in all patients after operation.@*CONCLUSIONS@#In anterior cervical corpectomy with fusion operation for the treatment of severe cervical ossification of posterior longitudinal ligament, various modes of intraoperative neurophysiological monitoring can real-time understand spinal cord and nerve function status, significantly reduce the incidence of spinal cord and nerve injury during operation, and effectively improve the safety of operation.

Establishment of a monitoring model of stellate ganglion discharge in rats / 中华麻醉学杂志

Objective To establish a monitoring model of stellate ganglion discharge in rats.Methods Thirty healthy Sprague-Dawley rats of either sex,aged 6-7 weeks,weighing 230-270 g,were selected.The left stellate ganglion was isolated after anesthesia and hung on the platinum electrode head to observe its electrical signal.Heart rate was recorded immediately after successful anesthesia (T0),immediately after the stellate ganglion was suspended in the electrode head (Tt),at 10,20 and 30 min after the stellate ganglion was suspended in the electrode head (T2-4),the frequency and amplitude of discharge of the stellate ganglion was recorded at T1-4.After recording the nerve electrical signal at T4,the stellate ganglion was locally infiltrated with 0.2％ lidocaine 0.2 ml and then the frequency and amplitude of discharge was recorded 5 min later (Ts).The occurrence of Horner's syndrome was considered as a sign of successful block,and the success of block was recorded.Results There was no significant difference in heart rate at each time point (P＞0.05).Paroxysmal clustered and rhythmically regular neuroelectrical activity of stellate ganglion was found at T1-4,and there was no significant difference in the frequency and amplitude of discharge at each time point (P＞0.05).The frequency and amplitude of discharge of stellate ganglion were significantly decreased at T5 than at T1-4 (P＜0.01).Conclusion The discharge monitoring model of stellate ganglion is successfully established in rats.

Efficacy of bilateral erector spinae plane block in improving intraoperative wake-up quality in patients undergoing thoracolumbar scoliosis correction with general anesthesia / 中华麻醉学杂志

Objective To evaluate the efficacy of bilateral erector spinae plane block (ESPB) in improving intraoperative wake-up quality in the patients undergoing thoracolumbar scoliosis correction with general anesthesia.Methods Forty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes,aged 18-60 yr,scheduled for elective posterior approach thoracolumbar scoliosis correction,were divided into 2 groups (n=20 each) using a random number table method:control group (C group)and bilateral ESPB group (E group).Bilateral ESPB was performed through injecting 0.375％ ropivacaine 15-20 ml to each site in group E.Anesthesia was induced by intravenously injecting propofol,sufentanil and cisatracufium after dexmedetomidine was intravenously infused for 10 min.Anesthesia was maintained by intravenously infusing remifentanil,propofol and dexmedetomidine.Propofol infusion was stopped and the infusion rate of remifentanil and dexmedetomidine was decreased during intraoperative wake-up test.Wake-up test was performed every 30 s starting from 5 min after stopping propofol infusion.The wake-up time,occurrence of agitation and coughing,hemodynamic changes (△ MAP and △ HR,the difference between MAP while stopping administration before wake-up test and maximum MAP during wake-up test,the difference between HR while stopping administration before wake-up test and maximum HR during wake-up test) and blood loss were recorded.The wake-up quality was assessed during operation.Results Compared with C group,the wake-up time was significantly shortened,the incidence of agitation and coughing was decreased,blood loss was reduced,△ MAP and △ HR were decreased,and the wake-up quality was increased in E group (P＜ 0.05).Conclusion Bilateral ESPB can increase the intraoperative wake-up quality in the patients undergoing thoracolumbar scoliosis correction with general anesthesia.

Establishment of a monitoring model of stellate ganglion discharge in rats / 中华麻醉学杂志

Objective@#To establish a monitoring model of stellate ganglion discharge in rats.@*Methods@#Thirty healthy Sprague-Dawley rats of either sex, aged 6-7 weeks, weighing 230-270 g, were selected.The left stellate ganglion was isolated after anesthesia and hung on the platinum electrode head to observe its electrical signal.Heart rate was recorded immediately after successful anesthesia (T0), immediately after the stellate ganglion was suspended in the electrode head (T1), at 10, 20 and 30 min after the stellate ganglion was suspended in the electrode head (T2-4), the frequency and amplitude of discharge of the stellate ganglion was recorded at T1-4.After recording the nerve electrical signal at T4, the stellate ganglion was locally infiltrated with 0.2% lidocaine 0.2 ml and then the frequency and amplitude of discharge was recorded 5 min later (T5). The occurrence of Horner′s syndrome was considered as a sign of successful block, and the success of block was recorded.@*Results@#There was no significant difference in heart rate at each time point (P>0.05). Paroxysmal clustered and rhythmically regular neuroelectrical activity of stellate ganglion was found at T1-4, and there was no significant difference in the frequency and amplitude of discharge at each time point (P>0.05). The frequency and amplitude of discharge of stellate ganglion were significantly decreased at T5 than at T1-4 (P<0.01).@*Conclusion@#The discharge monitoring model of stellate ganglion is successfully established in rats.

Efficacy of bilateral erector spinae plane block in improving intraoperative wake-up quality in patients undergoing thoracolumbar scoliosis correction with general anesthesia / 中华麻醉学杂志

Objective@#To evaluate the efficacy of bilateral erector spinae plane block (ESPB) in improving intraoperative wake-up quality in the patients undergoing thoracolumbar scoliosis correction with general anesthesia.@*Methods@#Forty American Society of Anesthesiologists physical status Ⅱor Ⅲ patients of both sexes, aged 18-60 yr, scheduled for elective posterior approach thoracolumbar scoliosis correction, were divided into 2 groups (n=20 each) using a random number table method: control group (C group) and bilateral ESPB group (E group). Bilateral ESPB was performed through injecting 0.375% ropivacaine 15-20 ml to each site in group E. Anesthesia was induced by intravenously injecting propofol, sufentanil and cisatracurium after dexmedetomidine was intravenously infused for 10 min.Anesthesia was maintained by intravenously infusing remifentanil, propofol and dexmedetomidine.Propofol infusion was stopped and the infusion rate of remifentanil and dexmedetomidine was decreased during intraoperative wake-up test.Wake-up test was performed every 30 s starting from 5 min after stopping propofol infusion.The wake-up time, occurrence of agitation and coughing, hemodynamic changes (△MAP and △HR, the difference between MAP while stopping administration before wake-up test and maximum MAP during wake-up test, the difference between HR while stopping administration before wake-up test and maximum HR during wake-up test) and blood loss were recorded.The wake-up quality was assessed during operation.@*Results@#Compared with C group, the wake-up time was significantly shortened, the incidence of agitation and coughing was decreased, blood loss was reduced, △MAP and △HR were decreased, and the wake-up quality was increased in E group (P<0.05).@*Conclusion@#Bilateral ESPB can increase the intraoperative wake-up quality in the patients undergoing thoracolumbar scoliosis correction with general anesthesia.

Intraoperative Neurophysiological Monitoring during Microvascular Decompression Surgery for Hemifacial Spasm

Hemifacial spasm (HFS) is due to the vascular compression of the facial nerve at its root exit zone (REZ). Microvascular decompression (MVD) of the facial nerve near the REZ is an effective treatment for HFS. In MVD for HFS, intraoperative neurophysiological monitoring (INM) has two purposes. The first purpose is to prevent injury to neural structures such as the vestibulocochlear nerve and facial nerve during MVD surgery, which is possible through INM of brainstem auditory evoked potential and facial nerve electromyography (EMG). The second purpose is the unique feature of MVD for HFS, which is to assess and optimize the effectiveness of the vascular decompression. The purpose is achieved mainly through monitoring of abnormal facial nerve EMG that is called as lateral spread response (LSR) and is also partially possible through Z-L response, facial F-wave, and facial motor evoked potentials. Based on the information regarding INM mentioned above, MVD for HFS can be considered as a more safe and effective treatment.

Surgical Outcomes of Thalamic Tumors in Children: The Importance of Diffusion Tensor Imaging, Neuro-Navigation and Intraoperative Neurophysiological Monitoring

BACKGROUND: Recently, modern technology such as diffusion tensor imaging (DTI), neuro-navigation and intraoperative neurophysiological monitoring (IOM) have been actively adopted for the treatment of thalamic tumors. We evaluated surgical outcomes and efficacy of the aforementioned technologies for the treatment of pediatric thalamic tumors. METHODS: We retrospectively reviewed clinical data from 37 children with thalamic tumors between 2004 and 2017. There were 44 operations (27 tumor resections, 17 biopsies). DTI was employed in 17 cases, neuro-navigation in 23 cases and IOM in 14 cases. All diagnoses were revised according to the 2016 World Health Organization Classification of Tumors of the Central Nervous System. Progression-free survival (PFS) and overall survival (OS) rates were calculated, and relevant prognostic factors were analyzed. The median follow-up duration was 19 months. RESULTS: Fifteen cases were gross total resections (GTR), 6 subtotal resections (STR), and 6 partial resections (PR). Neurological status did not worsen after 22 tumor resections. There were statistically significant differences in terms of the extent of resection between the groups with DTI, neuro-navigation and IOM (n=12, GTR or STR=12) and the group without at least one of the three techniques (n=15, GTR or STR=9, p=0.020). The mean PFS was 87.2±38.0 months, and the mean OS 90.7±36.1 months. The 5-year PFS was 37%, and the 5-year OS 47%. The histological grade (p≤0.001) and adjuvant therapy (done vs. not done, p=0.016) were significantly related to longer PFS. The histological grade (p=0.002) and the extent of removal (GTR/STR vs. PR/biopsy, p=0.047) were significantly related to longer OS. CONCLUSION: Maximal surgical resection was achieved with acceptable morbidity in children with thalamic tumors by employing DTI, neuro-navigation and IOM. Maximal tumor resection was a relevant clinical factor affecting OS; therefore, it should be considered the initial therapeutic option for pediatric thalamic tumors.