ABSTRACT
The sodium amytal test, or Wada test, named after Juhn Wada, has remained a pillar of presurgical planning and is used to identify the laterality of the dominant language and memory areas in the brain. What is perhaps less well known is that the original intent of the test was to abort seizure activity from an affected hemisphere and also to protect that hemisphere from the effects of electroconvulsive treatment. Some 80 years after Paul Broca described the frontal operculum as an essential area of expressive language and well before the age of MRI, Wada used the test to determine language dominance. The test was later adopted to study hemispheric memory dominance but was met with less consistent success because of the vascular anatomy of the mesial temporal structures. With the advent of functional MRI, the use of the Wada test has narrowed to application in select patients. The concept of selectively inhibiting part of the brain to determine its function, however, remains crucial to understanding brain function. In this review, the authors discuss the rise and fall of the Wada test, an important historical example of the innovation of clinicians in neuroscience.
Subject(s)
Brain Mapping/history , Broca Area , Intraoperative Neurophysiological Monitoring/history , Language/history , Preoperative Care/history , Broca Area/anatomy & histology , Broca Area/physiology , History, 19th Century , History, 20th Century , Humans , Magnetic Resonance Imaging/historyABSTRACT
Intraoperative neurophysiological monitoring (IONM) is nowadays another tool within the operating room that seeks to avoid neurological sequels derived from the surgical act. The Spanish Neurophysiological Intra-Surgical Monitoring Association (AMINE) in collaboration with the Spanish Society of Clinical Neurophysiology (SENFC), and the IONM Working Group of the SENFC has been collecting data in order to know the current situation of the IONM in Spain by hospitals, autonomous communities including the autonomous cities of Ceuta and Melilla, the opinions of the specialists in clinical neurophysiology involved in this topic and further forecasts regarding IONM. The data was gathered from November 2015 to May 2016 through telephone contact and/or email with specialists in clinical neurophysiology of the public National Health System, and through a computerized survey that also includes private healthcare centers. With the data obtained, from the perspective of AMINE and the SENFC we consider that nowadays the field of medicine covered by IONM is considerably large and it is foreseen that it will continue to grow. Therefore, a greater number of specialists in Clinical Neurophysiology will be required, as well as the need for specific training within the specialty that involves increasing the training period of MIRs based on competencies due to the increase in techniques/procedures, as well as its complexity.
TITLE: Monitorizacion neurofisiologica intraoperatoria en España: inicios, situacion actual y perspectivas de futuro.La monitorizacion neurofisiologica intraoperatoria (MNIO) es hoy en dia una herramienta mas dentro del quirofano que busca evitar secuelas neurologicas derivadas del acto quirurgico. Nuestro objetivo, desde la Asociacion de Monitorizacion Intraquirurgica Neurofisiologica Española (AMINE), en colaboracion con la Sociedad Española de Neurofisiologia Clinica (SENFC) y el Grupo de Trabajo de MNIO de la SENFC, ha sido recopilar datos para conocer la situacion actual de la MNIO en España por hospitales, comunidades autonomas y ciudades autonomas de Ceuta y Melilla, las opiniones de los especialistas en neurofisiologia clinica involucrados en este tema y las perspectivas de futuro. La recopilacion de los datos se ha realizado durante el periodo de noviembre de 2015 a mayo de 2016 mediante contacto telefonico o correo electronico con especialistas de neurofisiologia clinica del Sistema Nacional de Salud, y mediante una encuesta via informatica en la que tambien participaron algunos centros sanitarios privados. Con los datos obtenidos consideramos desde la perspectiva de la AMINE y la SENFC que el campo de la medicina que abarca la MNIO en estos momentos es muy amplio y seguira creciendo. Por eso, se precisa un mayor numero de especialistas en neurofisiologia clinica, asi como una mayor formacion especifica dentro de la especialidad, que implica incrementar el periodo formativo actual de los medicos internos residentes en funcion a competencias debido al incremento de las tecnicas/procedimientos, asi como su complejidad.
Subject(s)
Intraoperative Neurophysiological Monitoring/trends , Diagnosis-Related Groups , Forecasting , History, 20th Century , History, 21st Century , Hospitals, Private/statistics & numerical data , Hospitals, Public/statistics & numerical data , Humans , Intraoperative Neurophysiological Monitoring/history , Neurophysiology/education , Practice Guidelines as Topic , Procedures and Techniques Utilization , Societies, Medical , Spain , Surveys and QuestionnairesABSTRACT
X-rays and ventriculograms were the first imaging modalities used to localize intracranial lesions including brain tumors as far back as the 1880s. Subsequent advances in preoperative radiological localization included computed tomography (CT; 1971) and MRI (1977). Since then, other imaging modalities have been developed for clinical application although none as pivotal as CT and MRI. Intraoperative technological advances include the microscope, which has allowed precise surgery under magnification and improved lighting, and the endoscope, which has improved the treatment of hydrocephalus and allowed biopsy and complete resection of intraventricular, pituitary and pineal region tumors through a minimally invasive approach. Neuronavigation, intraoperative MRI, CT and ultrasound have increased the ability of the neurosurgeon to perform safe and maximal tumor resection. This may be facilitated by the use of fluorescing agents, which help define the tumor margin, and intraoperative neurophysiological monitoring, which helps identify and protect eloquent brain.
