Case Studies of Transcranial Electrical Motor Evoked Potentials (TCeMEP) on Patients with Charcot-Marie-Tooth Disease during Posterior Spinal Instrumentation and Fusion.

Neuromuscular disease can present many challenges to monitoring technologists in the operating room. This became evident when we received a request to monitor a patient with Charcot-Marie-Tooth disease during posterior spinal instrumentation and fusion for scoliosis. It has been well documented that the nerve conduction velocity is delayed with Charcot-Marie-Tooth disease (Pareyson et al. 2006). The latencies we normally encounter for somatosensory and motor evoked potentials for the upper extremity responses are between 15 and 20 msec, and for the lower extremity responses, are usually between 25 and 35 msec. Recording with a sweep of 100 msec, we assumed we could record a response with a significant delay. We never imagined we would need to increase the sweep time to 500 msec or more in order to record the responses from the lower extremities.

Practice trends in the utilization of intraoperative neurophysiological monitoring in pediatric neurosurgery as a function of complication rate, and patient-, surgeon-, and procedure-related factors.

OBJECTIVE: Higher benchmarks in safety for patients undergoing neurosurgery have been introduced. With these principles, new tools and techniques were established, including intraoperative neurophysiological monitoring (IONM). Current trends as a function of patient-, surgeon-, and procedure-related factors and complication rates in the utilization of IONM as an adjunct to the practice of pediatric neurosurgery have not been investigated previously. METHODS: Between 2008 and 2011, 4467 neurosurgical procedures were performed on 2352 patients at Texas Children's Hospital. A retrospective chart review was performed in which surgeon, procedure, and patient characteristics, as well as perioperative complications, were recorded for IONM and non-IONM cases. RESULTS: Neurosurgical procedures performed with IONM steadily increased. Surgeon-related factors associated with IONM use included surgeons with <10 years of practice (P < .0001), and subspecialty interest in spine (P < .0001) and oncology (P = .0048). Procedure-related factors associated with IONM use included operations involving the spinal cord (P < .0001). Patient-related factors associated with IONM use included children older than 3 years of age and with increased American Society of Anesthesiologists score (P < .0001). The neurological complication rate in the IONM cohort (range 3.4% to 11.3%; mean 6.4%) was significantly higher compared to the non-IONM cohort (range 1.1% to 1.8%; mean 1.5%) (P < .0001). CONCLUSIONS: The percent of procedures performed with IONM increased. However, these trends do not seem governed by improvement to patient outcomes because the complication rates were higher in the IONM cohort than the non-IONM cohort.