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Pediatric Spinal Tumors
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Rajiv R. Iyer, Nir Shimony, Mohammad Hassan A. Noureldine, Eric Bouffet, George I. Jallo
Surgical intervention for IMSCTs is typically performed with the head in three-point fixation, as the most common location for such lesions is the cervical and cervicothoracic spine. Intraoperative neurophysiological monitoring is critical in providing the surgeon with real-time feedback regarding the functionality of longitudinal spinal cord tracts. This typically consists of somatosensory evoked potentials (SSEPs), motor-evoked potentials (MEPs), and epidural D-wave potentials, which are indicative of functioning corticospinal tract units below the level of resection.
Treatment of adjacent segment disease after total disc replacement (TDR)
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Intraoperative neurophysiological monitoring is important in my regimen. I include somatosensory evoked potentials (SSEPs), motor-evoked potentials (MEPs), and free-run electromyographies (EMGs). While not the standard of care, it allows real-time neurological assessment and the potential to take protective steps if spinal cord/nerve root injury is suspected. MEPs require total intravenous anesthesia and obviate the use of muscle relaxants.
Cerebellopontine angle tumor
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Manual of Neuroanesthesia, 2017
Goals of anesthesiaTo prevent increases in intracranial pressure (ICP).To maintain hemodynamic stability and adequate cerebral perfusion pressure (CPP).To facilitate intraoperative neurophysiological monitoring.To facilitate rapid and smooth induction and emergence from anesthesia.
Filum terminale arteriovenous shunt with nidus structure: a report of rare condition and treatment consideration
Published in International Journal of Neuroscience, 2023
Jian-Kun Xu, Ming Ye, Jia-Xing Yu, Hong-Qi Zhang
Although the treatment of spinal cord AVSs is difficult, due to lack of neurological function of the FT, the management of nidus-type FTAVSs should be relatively maneuverable. In this case, we directly excised the FT without any intranidal surgical procedure. Therefore, the critical point of this operation was to confirm that the tissue with nidus involvement did not play a role in normal spinal cord function. Regarding this concern, intraoperative neurophysiological monitoring was critical. In addition, radicular veins may serve to drain the AVS; these veins could significantly expand and prevent the recognition of vascular structures during the operation; therefore, performing surgery in a hybrid operating room should be the primary choice because intraoperative DSA and methylene blue angiography could reveal the angioarchitecture of the AVS in detail.
Postoperative Focal Lower Extremity Supplementary Motor Area Syndrome: Case Report and Review of the Literature
Published in The Neurodiagnostic Journal, 2021
Nicholas B. Dadario, Joanna K. Tabor, Justin Silverstein, Xiaonan R. Sun, Randy S. DAmico
Intraoperative neurophysiological monitoring was used in both stages. TCMEP, as well as DCMEP were conducted. TCMEP and SSEP baselines were established prior to surgical incision as TCEMPs can often be utilized to guide DCEMP measurements (Silverstein et al. 2018). The patient was positioned supine in a semi-seated slouched position. All pressure points were properly padded, and the legs flexed to minimize post-operative positional deficits. A right para-sagittal craniotomy and approach was used to access the cerebral convexity. After durotomy, sensorimotor localization was conducted using the PRT with median nerve stimulation and signal acquisition from a 1 × 6 subdural strip electrode straddled over the central sulcus. Once the Rolandic fissure was identified with PRT, the same 1 × 6 strip electrode was used for direct cortical stimulation. Positive stimulation confirmed motor cortex. During the three-hour procedure we were able to acquire 155 DCMEP trials and 22 TCMEP trials. Systematic motor mapping was not performed to identify primary motor regions beyond the precentral gyrus given the extra-axial nature of the meningioma covering the superior frontal gyrus and the perceived lack of a need to perform a corticectomy to remove the lesion.
Trigeminal schwannoma: a single-center experience with 43 cases and review of literature
Published in British Journal of Neurosurgery, 2021
Mingchu Li, Xu Wang, Ge Chen, Jiantao Liang, Hongchuan Guo, Gang Song, Yuhai Bao
Between January 2008 and January 2018, 43 patients were diagnosed with TS, which included four patients with recurrent tumor after the initial operation in other centers and received surgical treatment in our institution. In addition to the preoperative neurological examination, all patients received brain computerized tomography (CT) and magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) was performed for certain cases, as needed. These operations were performed by three experienced neurosurgeons, and intraoperative neurophysiological monitoring, including motor evoked potential, somatosensory evoked potential, auditory evoked potential, trigeminal nerve, facial nerve, and lower cranial nerves function monitoring, were adopted for certain patients. The total removal was aimed to be achieved for all cases. The brain MRI and neurological examination were routinely rechecked after the operation. Both the imageological and clinical follow up were assigned for all patients at 6 and 12 months after the operation. Then, the annual follow up was arranged. The inpatient data and follow up information were retrospectively analyzed.