Intraoperative nerve monitoring(IONM)has evolved into an objective tool not only for the identification but also for the preservation and prognostication of function of the recurrent laryngeal nerve in thyroid surgeri...Intraoperative nerve monitoring(IONM)has evolved into an objective tool not only for the identification but also for the preservation and prognostication of function of the recurrent laryngeal nerve in thyroid surgeries.Technical improvements have resulted in the increasing incorporation of IONM into operating rooms around the world.The importance of adherence to recommended standards is also recognized as being vital in optimizing the efficacy of IONM.The advent of continuous IONM has made real-time nerve monitoring possible,thus providing the surgeon with an ally in difficult surgeries.Additionally,as thyroid surgeries are evolving into remote access and minimally invasive procedures,so also is the applicability of IONM.This review focuses on the use of IONM for nerve monitoring in thyroidectomies for neoplastic conditions while discussing the rationale,technique,and interpretation of findings and their implications.展开更多
Hearing loss is a condition affecting millions of people worldwide. Conductive hearing loss(CHL) is mainly caused by middle ear diseases.The low frequency area is the pivotal part of speech frequencies and most freque...Hearing loss is a condition affecting millions of people worldwide. Conductive hearing loss(CHL) is mainly caused by middle ear diseases.The low frequency area is the pivotal part of speech frequencies and most frequently impaired in patients with CHL. Among various treatments of CHL, middle ear surgery is efficient to improve hearing. However, variable success rates and possible needs for prolonged revision surgery still frustrate both surgeons and patients. Nowadays, increasing numbers of researchers explore various methods to monitor the efficacy of ossicular reconstruction intraoperatively, including electrocochleography(ECoch G), auditory brainstem response(ABR), auditory steady state response(ASSR), distortion product otoacoustic emissions(DPOAE), subjective whisper test, and optical coherence tomography(OCT). Here,we illustrate several methods used clinically by reviewing the literature.展开更多
Patients undergoing intracranial cerebrovascular surgery under general anesthesia are at risk of cerebral ischemia due to the nature of the surgery and/or the underlying cerebrovascular occlusive disease.It is thus im...Patients undergoing intracranial cerebrovascular surgery under general anesthesia are at risk of cerebral ischemia due to the nature of the surgery and/or the underlying cerebrovascular occlusive disease.It is thus imperative to reliably and continuously monitor cerebral perfusion during this type of surgery to timely reverse ischemic processes.The aim of this review is to discuss the techniques currently available for monitoring cerebral ischemia during cerebrovascular surgery with a focus on the advantages and disadvantages of each technique.展开更多
Intramedullary tumors are a class of central nervous system tumors with an incidence of 2 to 4%.As they are located very deep and frequently cause postoperative neurological complications,surgical resection is difficu...Intramedullary tumors are a class of central nervous system tumors with an incidence of 2 to 4%.As they are located very deep and frequently cause postoperative neurological complications,surgical resection is difficult.In recent years,many surgeons have performed electrophysiological monitoring to effectively reduce the occurrence of post-operative neurological complications.Modern electrophysiological monitoring technology has advanced considerably,leading to the development of many monitoring methods,such as SSEPs,MEPs,DCM,and EMG,to monitor intramedullary tumors.However,electrophysiological monitoring in tumor resection is still being studied.In this article,we discussed the different monitoring methods and their role in monitoring intramedullary tumors by reviewing previous studies.Intratumorally tumors need to be monitored for a summary of the condition of the patient.Only by using various monitoring methods flexibly and through clear communication between surgeons and neurophysiological experts can good decisions be made during surgery and positive surgical results be achieved.展开更多
Significant advances in surgical techniques and relevant medium-and long-term outcomes over the past two decades have led to a substantial expansion in the indications for major liver resections.To support these outst...Significant advances in surgical techniques and relevant medium-and long-term outcomes over the past two decades have led to a substantial expansion in the indications for major liver resections.To support these outstanding results and to reduce perioperative complications,anesthesiologists must address and master key perioperative issues(preoperative assessment,proactive intraoperative anesthesia strategies,and implementation of the Enhanced Recovery After Surgery approach).Intensive care unit monitoring immediately following liver surgery remains a subject of active and often unresolved debate.Among postoperative complications,posthepatectomy liver failure(PHLF)occurs in different grades of severity(A-C)and frequency(9%-30%),and it is the main cause of 90-d postoperative mortality.PHLF,recently redefined with pragmatic clinical criteria and perioperative scores,can be predicted,prevented,or anticipated.This review highlights:(1)The systemic consequences of surgical manipulations anesthesiologistsmust respond to or prevent,to positively impact PHLF(a proactive approach);and(2)the maximal intensivetreatment of PHLF,including artificial options,mainly based,so far,on Acute Liver Failure treatment(s),to buytime waiting for the recovery of the native liver or,when appropriate and in very selected cases,toward livertransplant.Such a clinical context requires a strong commitment to surgeons,anesthesiologists,and intensivists towork together,for a fruitful collaboration in a mandatory clinical continuum.展开更多
Near zero stroke rates can be achieved in carotid endarterectomy (CEA) surgery with selective shunting and electrophysiological neuromonitoring.though false negative rates as high as 40% have been reported.We sought...Near zero stroke rates can be achieved in carotid endarterectomy (CEA) surgery with selective shunting and electrophysiological neuromonitoring.though false negative rates as high as 40% have been reported.We sought to determine if improved training for interpretation of the monitoring signals can advance the efficacy of selective shunting with electrophysiological monitoring across multiple centers,and determine if other factors could contribute to the differences in reports.Processed and raw beta band (12.5-30 Hz) electroencephalogram (EEG) and median and tibial nerve somatosensory evoked potentials (SSEP) were monitored in 668 CEA cases at six surgical centers.A decrease in amplitude of 50% or more in any EEG or SSEP channel was the criteria for shunting or initiating a neuroprotective protocol.A reduction of 50% or greater in the beta band of the EEG or amplitude of the SSEP was observed in 150 cases.No patient showed signs of a cerebral infarct after surgery.Selective shunting based on EEG and SSEP monitoring can reduce CEA intraoperative stroke rate to a near zero level if trained personnel adopted standardized protocols.We also found that the rapid administration of a protective stroke protocol by attending anesthesiologists was an important aspect of this success rate.展开更多
Objective To study the application value of cortical somatosensory evoked potential (CSEP) monitoring in child scoliosis surgery. Methods In surgeries of fifty one children with scoliosis, the CSEP changes were con...Objective To study the application value of cortical somatosensory evoked potential (CSEP) monitoring in child scoliosis surgery. Methods In surgeries of fifty one children with scoliosis, the CSEP changes were continuously recorded by evoked potential instrument. The operations were performed under the guidance of CSEP monitoring. Results Before propping and reshaping, the latencies and amplitudes in all cases had no change. During propping and reshaping, the latencies of all cases were slowly elongated, but all less than 10 percent. The amplitudes in 15 cases dropped to 55 percent, but returned to 80 percent 3-8 minutes after stopping the operations or partially loosening the propped rods at once. The amplitude in one case suddenly dropped to 37 percent and returned to 54 percent half an hour after loosening the propped rods at once and recovered to the normal range one day after operation. All cases got ideal orthopedic results and no one had neurological complications post operation. Conclusion CSEP can accurately monitor the spinal injury and has a great value in preventing the spinal injury in child scoliosis surgery.展开更多
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 pe...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.展开更多
BACKGROUND Parathyroid adenoma(PA) sometimes recurs after surgery,how to improve the surgical success rate of PA is the key to the treatment of this disease.AIM To investigate the clinical features,diagnosis,and surgi...BACKGROUND Parathyroid adenoma(PA) sometimes recurs after surgery,how to improve the surgical success rate of PA is the key to the treatment of this disease.AIM To investigate the clinical features,diagnosis,and surgical treatment of patients with PA.METHODS Patients who were pathologically confirmed with PA and had undergone surgery for the first time between January 2010 and December 2017 at the Beijing Shijitan Hospital affiliated to Capital Medical University were included in the study.The clinical features,localization diagnosis,and surgical treatment of these patients were analyzed.RESULTS Of the 140 patients,32 were male and 108 were female;132 cases had one adenoma,and 8 had two adenomas.In addition,114 cases had clinical symptoms,among which 51,28,23,8,and 4 had urinary system,skeletal system,digestive system,neuromuscular system,and neuropsychiatric symptoms,respectively,while 26 cases had no obvious symptoms.The median level of preoperative parathyroid hormone(PTH) was 201.0 pg/m L.The positive detection rate of technetium-99m sestamibi(Tc-99m MIBI) single-photon emission computed tomography/computed tomography(SPECT/CT),ultrasound examination,and the combined use of Tc-99m MIBI SPECT/CT and ultrasound examination was 92.9%,85.5%,and 96.4%,respectively.Open surgery was performed in all patients,and PTH was monitored during surgery.The success rate of surgery was 98.6%.After surgery,21 cases developed hypocalcemia,1 case developed temporary hoarseness,and 19 cases had transient hypoparathyroidism but there was no permanent hypoparathyroidism,postoperative hemorrhage,or hematoma in the surgical area.CONCLUSION For patients with clinically unexplained skeletal system,urinary system,and neuropsychiatric symptoms,the possibility of PA should be considered.Imaging examinations such as ultrasound and Tc-99m MIBI SPECT/CT could be integrated before surgery to obtain accurate localization diagnosis.Precise preoperative localization,intraoperative PTH monitoring,and delicate surgery to protect the integrity of the PA capsule ensure a minimally invasive and successful surgery.展开更多
Background:Even though the use of nerve monitoring during parotid gland surgery is not the gold standard to prevent damage to the nerve,it surely offers some advantages over the traditional approach.Different from thy...Background:Even though the use of nerve monitoring during parotid gland surgery is not the gold standard to prevent damage to the nerve,it surely offers some advantages over the traditional approach.Different from thyroid surgery,where a series of steps in intraoperative nerve monitoring have been described to confirm not only the integrity but—most importantly—the function of the recurrent laryngeal nerve,in parotid gland surgery,a formal guideline to follow while dissecting the facial nerve has yet to be described.Methods:A five‐year retrospective study was done reviewing the intraoperative records of patients who underwent parotid gland surgery under neural monitoring.The operative findings regarding the neuromonitoring process,particularly in regard to the amplitude of two main branches,were revised.A literature search was done to search for guidelines to follow when a facial nerve loss of signal is encountered.Results:Fifty‐five patients were operated on using the Nim 3 Nerve Monitoring System(Medtronic);31 were female patients,and 47 patients had benign lesions.Minimum changes were observed in the amplitude records after a comparison was made between the first and the last stimulation.There were only three articles discussing the term loss of signal during parotid gland surgery.Conclusion:Today,no sufficient attention has been given to the facial nerve monitoring process during parotidectomy.This study proposes a formal guideline to follow during this procedure as well as an instruction to consider when a loss of signal is observed to develop a uniform technique of facial nerve stimulation.展开更多
Background The value of somatosensory evoked potentials (SEPs) in the diagnosis and prognosis of cervical spondylotic myelopathy, as well as the usefulness of monitoring intraoperative potentials in terms of safety ...Background The value of somatosensory evoked potentials (SEPs) in the diagnosis and prognosis of cervical spondylotic myelopathy, as well as the usefulness of monitoring intraoperative potentials in terms of safety and predictive factors were investigated. Methods Each of the 76 myelopathic patients underwent surgical intervention. According to the wave configurations of the SEPs, the cases were categorised into four groups: Type Ⅰ, Ⅱ, Ⅲ and Ⅳ. The clinical myelopathy disability was classified and the severity of neurological deficits was scored. Clinical function after surgery was evaluated. Preoperative potentials and intraoperative monitoring were categorized. The correlations between .evoked potentials detection, monitoring, myelopathy disability and surgical outcome in the different groups were discussed. Results According to the configurations of the SEPs, there were 27 patients (36%) of Type Ⅰ, 30 patients (39%) of Type Ⅱ, 8 patients (11%) of Type Ⅲ, and 11 patients (14%) of Type Ⅳ. The categorised evoked potentials were shown to be significantly associated with the clinical representation of myelopathy (P 〈0.01) and the recovery rate from identifiable SEPs waves (groups A, B and C) was significantly higher than unidentifiable waves (group D, P〈0.01). A deterioration of SEPs was detected in 23 cases (30%), whereas there was no change in 40 cases (53%) and improvements in 13 cases (17%). A significant difference in recovery rates could be observed in various monitoring groups within the short-term follow-up period, while there were no obvious differences in the long-term follow-up groups. Conclusions SEP technique is a valuable and practical tool for the diagnosis, monitoring and prognosis of myelopathy. Classified evoked potentials are well correlated with cervical spondylotic myelopathy disability, and unidentifiable SEPs waves in patients are indicative of a relatively poor outcome. In addition, intraoperative monitoring of SEPs plays an important role in protecting neural structures during cervical spine surgery.展开更多
Objective To investigate pre- and postoperative changes of regional cerebral cortical blood flow in patients with cerebral arteriovenous malformation. Method Twenty-two adult patients with arteriovenous malformatio...Objective To investigate pre- and postoperative changes of regional cerebral cortical blood flow in patients with cerebral arteriovenous malformation. Method Twenty-two adult patients with arteriovenous malformation(AVM) were recruited into this study at Beijing Tiantan Hospital from September 2001 to May 2002. Eight patients had giant cerebral AVM and the other 14 had a small one. Cortical cerebral blood flow (CBF) was measured by laser Doppler flowmetry (LDF) before and after AVM resections. After surgery,the probe of LDF was implanted adjacent to the area of AVM and monitored for 24 hours.Results CBF increased significantly after the resection in all patients regardless of AVM size. In patients with small AVM,CBF returned to the baseline level within 4 hours,but in patients with giant AVM,CBF remained high even after 24 hours.Conclusions Monitoring CBF is helpful to understand pre- and postoperative changes of regional cortical CBF in patients with cerebral AVM.展开更多
文摘Intraoperative nerve monitoring(IONM)has evolved into an objective tool not only for the identification but also for the preservation and prognostication of function of the recurrent laryngeal nerve in thyroid surgeries.Technical improvements have resulted in the increasing incorporation of IONM into operating rooms around the world.The importance of adherence to recommended standards is also recognized as being vital in optimizing the efficacy of IONM.The advent of continuous IONM has made real-time nerve monitoring possible,thus providing the surgeon with an ally in difficult surgeries.Additionally,as thyroid surgeries are evolving into remote access and minimally invasive procedures,so also is the applicability of IONM.This review focuses on the use of IONM for nerve monitoring in thyroidectomies for neoplastic conditions while discussing the rationale,technique,and interpretation of findings and their implications.
基金supported by grants from Provincial Natural Science Foundation of Hai Nan (No. 20168349)the Clinical Research Supporting Foundation of PLA General Hospital (2016FC-TSYS-1014)National Basic Research Program of China (973 Program) (No. 2012CB967900) and National Basic Research Program of China (973 Program) (No. 2011CBA01000)
文摘Hearing loss is a condition affecting millions of people worldwide. Conductive hearing loss(CHL) is mainly caused by middle ear diseases.The low frequency area is the pivotal part of speech frequencies and most frequently impaired in patients with CHL. Among various treatments of CHL, middle ear surgery is efficient to improve hearing. However, variable success rates and possible needs for prolonged revision surgery still frustrate both surgeons and patients. Nowadays, increasing numbers of researchers explore various methods to monitor the efficacy of ossicular reconstruction intraoperatively, including electrocochleography(ECoch G), auditory brainstem response(ABR), auditory steady state response(ASSR), distortion product otoacoustic emissions(DPOAE), subjective whisper test, and optical coherence tomography(OCT). Here,we illustrate several methods used clinically by reviewing the literature.
基金supported by the Inaugural Anesthesia Department Awards for Seed Funding for Clinically-Oriented Research Projects from the Department of Anesthesia and Perioperative Care,University of California San Francisco,San Francisco,California (to Dr.Meng)
文摘Patients undergoing intracranial cerebrovascular surgery under general anesthesia are at risk of cerebral ischemia due to the nature of the surgery and/or the underlying cerebrovascular occlusive disease.It is thus imperative to reliably and continuously monitor cerebral perfusion during this type of surgery to timely reverse ischemic processes.The aim of this review is to discuss the techniques currently available for monitoring cerebral ischemia during cerebrovascular surgery with a focus on the advantages and disadvantages of each technique.
文摘Intramedullary tumors are a class of central nervous system tumors with an incidence of 2 to 4%.As they are located very deep and frequently cause postoperative neurological complications,surgical resection is difficult.In recent years,many surgeons have performed electrophysiological monitoring to effectively reduce the occurrence of post-operative neurological complications.Modern electrophysiological monitoring technology has advanced considerably,leading to the development of many monitoring methods,such as SSEPs,MEPs,DCM,and EMG,to monitor intramedullary tumors.However,electrophysiological monitoring in tumor resection is still being studied.In this article,we discussed the different monitoring methods and their role in monitoring intramedullary tumors by reviewing previous studies.Intratumorally tumors need to be monitored for a summary of the condition of the patient.Only by using various monitoring methods flexibly and through clear communication between surgeons and neurophysiological experts can good decisions be made during surgery and positive surgical results be achieved.
文摘Significant advances in surgical techniques and relevant medium-and long-term outcomes over the past two decades have led to a substantial expansion in the indications for major liver resections.To support these outstanding results and to reduce perioperative complications,anesthesiologists must address and master key perioperative issues(preoperative assessment,proactive intraoperative anesthesia strategies,and implementation of the Enhanced Recovery After Surgery approach).Intensive care unit monitoring immediately following liver surgery remains a subject of active and often unresolved debate.Among postoperative complications,posthepatectomy liver failure(PHLF)occurs in different grades of severity(A-C)and frequency(9%-30%),and it is the main cause of 90-d postoperative mortality.PHLF,recently redefined with pragmatic clinical criteria and perioperative scores,can be predicted,prevented,or anticipated.This review highlights:(1)The systemic consequences of surgical manipulations anesthesiologistsmust respond to or prevent,to positively impact PHLF(a proactive approach);and(2)the maximal intensivetreatment of PHLF,including artificial options,mainly based,so far,on Acute Liver Failure treatment(s),to buytime waiting for the recovery of the native liver or,when appropriate and in very selected cases,toward livertransplant.Such a clinical context requires a strong commitment to surgeons,anesthesiologists,and intensivists towork together,for a fruitful collaboration in a mandatory clinical continuum.
文摘Near zero stroke rates can be achieved in carotid endarterectomy (CEA) surgery with selective shunting and electrophysiological neuromonitoring.though false negative rates as high as 40% have been reported.We sought to determine if improved training for interpretation of the monitoring signals can advance the efficacy of selective shunting with electrophysiological monitoring across multiple centers,and determine if other factors could contribute to the differences in reports.Processed and raw beta band (12.5-30 Hz) electroencephalogram (EEG) and median and tibial nerve somatosensory evoked potentials (SSEP) were monitored in 668 CEA cases at six surgical centers.A decrease in amplitude of 50% or more in any EEG or SSEP channel was the criteria for shunting or initiating a neuroprotective protocol.A reduction of 50% or greater in the beta band of the EEG or amplitude of the SSEP was observed in 150 cases.No patient showed signs of a cerebral infarct after surgery.Selective shunting based on EEG and SSEP monitoring can reduce CEA intraoperative stroke rate to a near zero level if trained personnel adopted standardized protocols.We also found that the rapid administration of a protective stroke protocol by attending anesthesiologists was an important aspect of this success rate.
文摘Objective To study the application value of cortical somatosensory evoked potential (CSEP) monitoring in child scoliosis surgery. Methods In surgeries of fifty one children with scoliosis, the CSEP changes were continuously recorded by evoked potential instrument. The operations were performed under the guidance of CSEP monitoring. Results Before propping and reshaping, the latencies and amplitudes in all cases had no change. During propping and reshaping, the latencies of all cases were slowly elongated, but all less than 10 percent. The amplitudes in 15 cases dropped to 55 percent, but returned to 80 percent 3-8 minutes after stopping the operations or partially loosening the propped rods at once. The amplitude in one case suddenly dropped to 37 percent and returned to 54 percent half an hour after loosening the propped rods at once and recovered to the normal range one day after operation. All cases got ideal orthopedic results and no one had neurological complications post operation. Conclusion CSEP can accurately monitor the spinal injury and has a great value in preventing the spinal injury in child scoliosis surgery.
基金supported by Jiangsu provincial key R&D plan special fund (Social Development)project in China (No.BE2019606).
文摘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.
文摘BACKGROUND Parathyroid adenoma(PA) sometimes recurs after surgery,how to improve the surgical success rate of PA is the key to the treatment of this disease.AIM To investigate the clinical features,diagnosis,and surgical treatment of patients with PA.METHODS Patients who were pathologically confirmed with PA and had undergone surgery for the first time between January 2010 and December 2017 at the Beijing Shijitan Hospital affiliated to Capital Medical University were included in the study.The clinical features,localization diagnosis,and surgical treatment of these patients were analyzed.RESULTS Of the 140 patients,32 were male and 108 were female;132 cases had one adenoma,and 8 had two adenomas.In addition,114 cases had clinical symptoms,among which 51,28,23,8,and 4 had urinary system,skeletal system,digestive system,neuromuscular system,and neuropsychiatric symptoms,respectively,while 26 cases had no obvious symptoms.The median level of preoperative parathyroid hormone(PTH) was 201.0 pg/m L.The positive detection rate of technetium-99m sestamibi(Tc-99m MIBI) single-photon emission computed tomography/computed tomography(SPECT/CT),ultrasound examination,and the combined use of Tc-99m MIBI SPECT/CT and ultrasound examination was 92.9%,85.5%,and 96.4%,respectively.Open surgery was performed in all patients,and PTH was monitored during surgery.The success rate of surgery was 98.6%.After surgery,21 cases developed hypocalcemia,1 case developed temporary hoarseness,and 19 cases had transient hypoparathyroidism but there was no permanent hypoparathyroidism,postoperative hemorrhage,or hematoma in the surgical area.CONCLUSION For patients with clinically unexplained skeletal system,urinary system,and neuropsychiatric symptoms,the possibility of PA should be considered.Imaging examinations such as ultrasound and Tc-99m MIBI SPECT/CT could be integrated before surgery to obtain accurate localization diagnosis.Precise preoperative localization,intraoperative PTH monitoring,and delicate surgery to protect the integrity of the PA capsule ensure a minimally invasive and successful surgery.
文摘Background:Even though the use of nerve monitoring during parotid gland surgery is not the gold standard to prevent damage to the nerve,it surely offers some advantages over the traditional approach.Different from thyroid surgery,where a series of steps in intraoperative nerve monitoring have been described to confirm not only the integrity but—most importantly—the function of the recurrent laryngeal nerve,in parotid gland surgery,a formal guideline to follow while dissecting the facial nerve has yet to be described.Methods:A five‐year retrospective study was done reviewing the intraoperative records of patients who underwent parotid gland surgery under neural monitoring.The operative findings regarding the neuromonitoring process,particularly in regard to the amplitude of two main branches,were revised.A literature search was done to search for guidelines to follow when a facial nerve loss of signal is encountered.Results:Fifty‐five patients were operated on using the Nim 3 Nerve Monitoring System(Medtronic);31 were female patients,and 47 patients had benign lesions.Minimum changes were observed in the amplitude records after a comparison was made between the first and the last stimulation.There were only three articles discussing the term loss of signal during parotid gland surgery.Conclusion:Today,no sufficient attention has been given to the facial nerve monitoring process during parotidectomy.This study proposes a formal guideline to follow during this procedure as well as an instruction to consider when a loss of signal is observed to develop a uniform technique of facial nerve stimulation.
文摘Background The value of somatosensory evoked potentials (SEPs) in the diagnosis and prognosis of cervical spondylotic myelopathy, as well as the usefulness of monitoring intraoperative potentials in terms of safety and predictive factors were investigated. Methods Each of the 76 myelopathic patients underwent surgical intervention. According to the wave configurations of the SEPs, the cases were categorised into four groups: Type Ⅰ, Ⅱ, Ⅲ and Ⅳ. The clinical myelopathy disability was classified and the severity of neurological deficits was scored. Clinical function after surgery was evaluated. Preoperative potentials and intraoperative monitoring were categorized. The correlations between .evoked potentials detection, monitoring, myelopathy disability and surgical outcome in the different groups were discussed. Results According to the configurations of the SEPs, there were 27 patients (36%) of Type Ⅰ, 30 patients (39%) of Type Ⅱ, 8 patients (11%) of Type Ⅲ, and 11 patients (14%) of Type Ⅳ. The categorised evoked potentials were shown to be significantly associated with the clinical representation of myelopathy (P 〈0.01) and the recovery rate from identifiable SEPs waves (groups A, B and C) was significantly higher than unidentifiable waves (group D, P〈0.01). A deterioration of SEPs was detected in 23 cases (30%), whereas there was no change in 40 cases (53%) and improvements in 13 cases (17%). A significant difference in recovery rates could be observed in various monitoring groups within the short-term follow-up period, while there were no obvious differences in the long-term follow-up groups. Conclusions SEP technique is a valuable and practical tool for the diagnosis, monitoring and prognosis of myelopathy. Classified evoked potentials are well correlated with cervical spondylotic myelopathy disability, and unidentifiable SEPs waves in patients are indicative of a relatively poor outcome. In addition, intraoperative monitoring of SEPs plays an important role in protecting neural structures during cervical spine surgery.
文摘Objective To investigate pre- and postoperative changes of regional cerebral cortical blood flow in patients with cerebral arteriovenous malformation. Method Twenty-two adult patients with arteriovenous malformation(AVM) were recruited into this study at Beijing Tiantan Hospital from September 2001 to May 2002. Eight patients had giant cerebral AVM and the other 14 had a small one. Cortical cerebral blood flow (CBF) was measured by laser Doppler flowmetry (LDF) before and after AVM resections. After surgery,the probe of LDF was implanted adjacent to the area of AVM and monitored for 24 hours.Results CBF increased significantly after the resection in all patients regardless of AVM size. In patients with small AVM,CBF returned to the baseline level within 4 hours,but in patients with giant AVM,CBF remained high even after 24 hours.Conclusions Monitoring CBF is helpful to understand pre- and postoperative changes of regional cortical CBF in patients with cerebral AVM.