Identification of injury type using somatosensory and motor evoked potentials in a rat spinal cord injury model

The spinal cord is at risk of injury during spinal surgery.If intraoperative spinal co rd injury is identified early,irreve rsible impairment or loss of neurological function can be prevented.Different types of spinal cord injury result in damage to diffe rent spinal cord regions,which may cause diffe rent somatosensory and motor evoked potential signal res ponses.In this study,we examined electrophysiological and histopathological changes between contusion,distra ction,and dislocation spinal cord injuries in a rat model.We found that contusion led to the most severe dorsal white matter injury and caused considerable attenuation of both somatosensory and motor evoked potentials.Dislocation resulted in loss of myelinated axons in the lateral region of the injured spinal cord along the rostrocaudal axis.The amplitude of attenuation in motor evoked potential responses caused by dislocation was greater than that caused by contusion.After distraction injury,extracellular spaces were slightly but not significantly enlarged;somatosensory evoked potential res ponses slightly decreased and motor evoked potential responses were lost.Correlation analysis showed that histological and electrophysiological findings we re significantly correlated and related to injury type.Intraope rative monitoring of both somatosensory and motor evoked potentials has the potential to identify iatrogenic spinal cord injury type during surgery.

INTRAOPERATIVE LOCALIZATION OF CORTICAL MOTOR EVOKED POTENTIALS IN CENTRAL SULCUS LESIONS

Objective To study direct cortical electrical stimulation technique for the recording of motor evoked potentials under general anesthesia in central sulcus lesions. Methods The largest N20-P25 response was recorded from postcentral gyrus by intraoperative monitoring of cortical motor evoked potentials in 10 patients with intracranial lesions near or in the central area. The muscles of upper extremity in all patients were activated by delivering stimulus to cortical areas continuously. Moving the cortical electrodes forward, the largest P20-N25 response, SEP phase reversal,was obtained as a motor center stimulus. In this site of cortex, a short train stimulation elicited reproducible muscle action potentials that could be observed from the oscilloscope without averaging.Results MEPs can be recorded, pre-and post-operatively, without motor deficits of upper limbs in all patients.Conclusion This technique seems to be preferable for intraoperative localization of motor evoked potentials in central sulcus lesions under total intravenous anesthesia.

CLINICAL STUDY OF MOTOR EVOKED POTENTIALS BY MAGNETIC STIMULATION IN CERVICAL SPONDYLOTIC MYELOPATHY

The combined use of motor .yoked pot'ntlais (MEPs) with F way, recording was cornpared with somatesemory evoked potentials (SEPs) in order to evaluate the clinical value or MEPs incervical spondylotic myelopathy. Magnetic stimulation of motor cortex with F wave recording was used assess central motor conduction. time, (CMCT). and central somatoseusory conduction time(CSCT)was evaluated by SEPs in 20 pailents surffring from myeloP8thy of cervical spondylosis. Theresults were comapared with 20 control subjects. The results showed that CMCT of Patients was obviously prolonged then that of contral subjects, the sbnormal rate was 80% which was higher than70K of SEPs slid that the prolongation or CMCT had a good correlation with the severe degree ofmyelopathy. The Painless and noninvasive .magnetic stimulation of PEPs could figure out the compressed degree of motor descending pathway and was. useful technique for diagnosis of cervicalspondylotic myelopathy.

Ipsilateral motor evoked potentials in a patient with unihemispheric cortical atrophy due to Rasmussen encephalitis

The role of the ipsilaterally descending motor pathways in the recovery mechanisms after unilateral hemispheric damage is still poorly understood. Motor output reorganization was investigated in a 56-year-old male patient with acquired unilateral hemispheric atrophy due to Rasmussen encephalitis. In particular,the ipsilateral corticospinal pathways were explored using focal transcranial magnetic stimulation. In the first dorsal interosseous and wrist extensors muscles, the median amplitudes of the ipsilateral motor evoked potentials induced by transcranial magnetic stimulation in the patient were higher than those of 10 age-matched healthy control subjects. In the biceps brachii muscle, the median amplitudes of the ipsilateral motor evoked potentials were the second largest in the patient compared to the controls. This study demonstrated a reinforcement of ipsilateral motor projections from the unaffected motor cortex to the hemiparetic hand in a subject with acquired unihemispheric cortical damage.

Studies on the effects of embryonic spinal cord implantation into acutely injured spinal cord on the recovery of motor functions and evoked potentials in rats

Somatosensory and corticomotor evoked potentials (SSEP, CMEP) of the rats with acutely injured spinal cord were determined on the 7th, 15th, 30th, 60th, 120th and 240th day after they received implantation of the embryonic spinal cord from 14-day rat embryo into the injured cord. The motor functions of the hindlimbs were also observed. The rats with acute spinal cord injury and those with cord injury treated with the implantation of a piece of skeletal muscle served as the controls. It was found that the motor functions were recovered on the 30th day after implantation but the latent period of both SSEP and CMEP returned to mormal on the 240th day. At that time,the latent period of SSEP and CMEP of the 2 control groups also recovered gradually. It is believed that embryonic spinal cord implantation can affect the recovery of the motor functions of the rats. But more sophisticated methods are needed to clarify the interrelationship of the host cord with the grafts.

Utility of somatosensory and motor-evoked potentials in reflecting gross and fine motor functions after unilateral cervical spinal cord contusion injury

Fine motor skills are thought to rely on the integrity of ascending sensory pathways in the spinal dorsal column as well as descending motor pathways that have a neocortical origin.However, the neurophysiological processes underlying communication between the somatosensory and motor pathways that regulate fine motor skills during spontaneous recovery after spinal cord contusion injury remain unclear.Here, we established a rat model of cervical hemicontusive injury using C5 laminectomy followed by contusional displacement of 1.2 mm(mild injury) or 2.0 mm(severe injury) to the C5 spinal cord.Electrophysiological recordings were performed on the brachial muscles up to 12 weeks after injury to investigate the mechanisms by which spinal cord pathways participate in motor function.After spinal cord contusion injury, the amplitudes of somatosensory and motor-evoked potentials were reduced, and the latencies were increased.The forelimb open field locomotion test, grooming test, rearing test and Montoya staircase test revealed improvement in functions.With increasing time after injury, the amplitudes of somatosensory and motor-evoked potentials in rats with mild spinal cord injury increased gradually, and the latencies gradually shortened.In comparison, the recovery times of somatosensory and motor-evoked potential amplitudes and latencies were longer, and the recovery of motor function was delayed in rats with severe spinal cord injury.Correlation analysis revealed that somatosensoryevoked potential and motor-evoked potential parameters were correlated with gross and fine motor function in rats with mild spinal cord contusion injury.In contrast, only somatosensory-evoked potential amplitude was correlated with fine motor skills in rats with severe spinal cord injury.Our results show that changes in both somatosensory and motor-evoked potentials can reflect the changes in gross and fine motor functions after mild spinal cord contusion injury, and that the change in somatosensory-evoked potential amplitude can also reflect the change in fine motor function after severe spinal cord contusion injury.This study was approved by the Animal Ethics Committee of Nanfang Hospital, Southern Medical University, China(approval No.NFYY-2017-67) on June 11, 2017.

Median Nerve Somatosensory Evoked Potentials in Patients with Chiari Malformation

Abnormal SEP reflects dysfunction of the medial lemniscus and posterior cervical cord. These structures are likely to be affected in Chiari malformation. Therefore, SEP abnormalities may provide valuable information in patients with CM. However, the consistency of SEP abnormality or normality with the damage is a matter of research. Knowing whether median nerve somatosensory evoked potential (SEP) is useful in revealing subclinical damage in patients with Chiari malformation is important in the treatment and follow-up plan of the disease. The aim of this study was to investigate the relationship between median nerve SEP values and the severity of cerebellar ectopia in patients with Chiari type 1 malformation. Median nerve SEP values were obtained from 30 healthy individuals and 146 individuals with Chiari malformation. The cerebellar ectopia degree and McRae line length were measured. SEP values were not significantly different between groups. The McRae line was found to be significantly shorter in the control group than in the Chiari malformation group (p = 0.031). There was no correlation between the degree of cerebellar ectopia and the length of the McRae line (r = 0.002, p = 0.979). Neither cerebellar ectopy degree nor McRae line length had a relationship with SEP values (r = -0.153, p = 0.066;r = -0.056, p = 0.500, respectively). There was no difference in cerebellar ectopy degree or SEP values between the groups with cerebellar ectopy with and without a syrinx (p = 0.899;p = 0.080, respectively). Likewise, McRae line length was not found to be related to the presence of a syrinx (p = 0.139). Median nerve SEP examination was not beneficial for diagnosing asymptomatic-oligosymptomatic Chiari malformation as a subclinical injury, whether accompanied by syringomyelia or not.

Correlation study between the changes of motor evoked potential and the improvement of spinal canal volume in minimally invasive transforaminal lumbar interbody fusion

Objective:To analyze the correlation between the amplitude changes of motor evoked potential(MEP),the 3D volume changes of spinal canal measuring by postoperative CT and the improvement rate of clinical symptoms after the spinal canal decompression in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF),and to explore the predictive value of the changes of both MEP amplitude and spinal canal volume in the assessment of long-term clinical prognosis in MIS-TLIF.Methods:A retrospective study of 68 patients with L4/5 spinal stenosis treated with MIS-TLIF was performed.The changes of both intraoperative MEP amplitude and 3D spinal canal volume during the spinal canal decompression,as well as the visual analogue scale(VAS)and Oswestry dysfunction index(ODI)scores in the long-term follow-up were all recorded.Results:The values of intraoperative MEP amplitude was 159.04%higher in 68 patients with MIS-TLIF after spinal canal decompression(P<0.01).The 3 postoperative 3D spinal canal volume(4.89±1.27)cm increased by 31.22%in comparison 3 with preoperative date(3.78±1.08)cm(P<0.01).The VAS and ODI scores were improved to 78.55%and 80.60%,respectively at the last follow-up(P<0.01).The improvement rate of MEP amplitude on the decompression side was positively correlated with the improvement rate of postoperative spinal canal volume(r=0.272,P=0.025).The improvement rate of postoperative spinal canal volume was positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.656,r=0.490,P<0.01).Moreover,the improvement rate of MEP amplitude on the decompression side was also positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.322 and 0.235,respectively,P<0.05).Conclusion:The increase of MEP amplitude after spinal canal decompression in patients with lumbar spinal stenosis treated by MIS-TLIF was closely correlated with both of the increase of spinal canal volume and the improvement of clinical symptoms.Therefore,MEP amplitude monitoring was not only the one of the important monitoring methods for predicting the prognosis of MIS-TLIF but also the reliably predictive value in the long-term clinical prognosis in MIS-TLIF.

Monitoring somatosensory evoked potentials in spinal cord ischemia-reperfusion injury

It remains unclear whether spinal cord ischemia-reperfusion injury caused by ischemia and other non-mechanical factors can be monitored by somatosensory evoked potentials. Therefore, we monitored spinal cord ischemia-reperfusion injury in rabbits using somatosensory evoked potential detection technology. The results showed that the somatosensory evoked potential latency was significantly prolonged and the amplitude significantly reduced until it disappeared during the period of spinal cord ischemia. After reperfusion for 30-180 minutes, the amplitude and latency began to gradually recover; at 360 minutes of reperfusion, the latency showed no significant difference compared with the pre-ischemic value, while the somatosensory evoked potential amplitude in- creased, and severe hindlimb motor dysfunctions were detected. Experimental findings suggest that changes in somatosensory evoked potentia~ ~atency can reflect the degree of spinat cord ischemic injury, while the amplitude variations are indicators of the late spinal cord reperfusion injury, which provide evidence for the assessment of limb motor function and avoid iatrogenic spinal cord injury.

Effect of sodium tungstate on visual evoked potentials in diabetic rats

AIM： To evaluate the effect of sodium tungstate on visual evoked potentials（VEPs） in diabetic rats.· METHODS： Wistar rats were randomly divided into three groups as normal control, diabetic control and diabetic rats treated with sodium tungstate. Diabetes was induced by single intraperitoneal injection of streptozotocin（50 mg/kg）. Sodium tungstate [40 mg/（kg·d）]was administered for 12 wk and then VEPs were recorded.Additionally, thiobarbituric acid reactive substance（TBARS） levels were measured in brain tissues.·RESULTS： The latencies of P1, N1, P2, N2 and P3 waves were significantly prolonged in diabetic rats compared with control group. Diabetes mellitus caused an increase in the lipid peroxidation process that was accompanied by changes in VEPs. However, prolonged latencies of VEPs for all components returned to control levels in sodium tungstate-treated group. The treatment of sodium tungstate significantly decreased brain TBARS levels and depleted the prolonged latencies of VEP components compared with diabetic control group.· CONCLUSION： Sodium tungstate shows protective effects on visual pathway in diabetic rats, and it can be worthy of further study for potential use.

Short-duration transient visual evoked potentials and color reflectivity discretization analysis in glaucoma patients and suspects

AIM： To evaluate the use of short-duration transient visual evoked potentials（VEP） and color reflectivity discretization analysis（CORDA） in glaucomatous eyes,eyes suspected of having glaucoma,and healthy eyes.METHODS： The study included 136 eyes from 136 subjects： 49 eyes with glaucoma,45 glaucoma suspect eyes,and 42 healthy eyes.Subjects underwent Humphrey visual field（VF） testing,VEP testing,as well as peripapillary retinal nerve fiber layer optical coherence tomography imaging studies with post-acquisition CORDA applied.Statistical analysis was performed using means and ranges,ANOVA,post-hoc comparisons using Turkey＇s adjustment,Fisher＇s Exact test,area under the curve,and Spearman correlation coefficients.RESULTS： Parameters from VEP and CORDA correlated significantly with VF mean deviation（MD）（P〈0.05）.In distinguishing glaucomatous eyes from controls,VEP demonstrated area under the curve（AUC） values of 0.64-0.75 for amplitude and 0.67-0.81 for latency.The CORDA HR1 parameter was highly discriminative for glaucomatous eyes vs controls（AUC=0.94）.CONCLUSION： Significant correlations are found between MD and parameters of short-duration transient VEP and CORDA,diagnostic modalities which warrant further consideration in identifying glaucoma characteristics.

Benefits of combination of electroencephalography, short latency somatosensory evoked potentials, and transcranial Doppler techniques for confirming brain death

Objective: Optimization of combining electroencephalography (EEG), short latency somatosensory evoked potentials (SLSEP) and transcranial Doppler (TCD) techniques to diagnose brain death. Methods: One hundred and eleven patients (69 males, 42 females) from the major hospitals of Zhejiang Province were examined with portable EEG, SLSEP and TCD devices. Re-examinations occurred ≤12 h later. Results: The first examination revealed that the combination of SLSEP and EEG led to more sensitive diagnoses than the combination of SLSEP and TCD. Re-examination confirmed this and also revealed that the combination of TCD and EEG was the most sensitive. Conclusion: The results show that using multiple techniques to diagnose brain death is superior to using single method, and that the combination of SLSEP and EEG is better than other combinations.

Changes in the latencies of visual-evoked potentials in people undergoing tennis training Dynamic comparison before and after 8 weeks training

BACKGROUND： Some previous studies have shown that exercise is an important factor that affects the latencies of visual-evoked potentials （VEPs）. OBJECTIVE： To investigate the effects of spending a period of time undergoing tennis training on the latencies of VEPs by comparing the latencies of VEPs before tennis training with those after 8 weeks of tennis training. DESIGN, TIME AND SETTING： The non-randomly concurrent controlled experiment was performed in the Department of Human Movement Sciences, Physical Education College, Shandong Normal University from April to June 2007. PARTICIPANTS： In total, 45 healthy volunteers from Shandong Normal University were selected as subjects, including 31 students majoring in physical education （11 males and 5 females participated in the tennis training plan for 8 weeks）, and 14 students from other subjects. Informed consent was obtained. According to whether they were majoring in physical education or not, and whether or not they took part in tennis training, the students were divided into 3 groups： a tennis group of physical education students （n = 16） a non-tennis group of physical education students （n =15） and a non-tennis group of non-physical education students （n = 14）. METHODS： The subjects in the tennis group took part in a regular tennis training plan of 2 hours a day and 3 days per week, for 8 weeks, while the subjects in two non-tennis groups were not in the tennis training plan The NDI-200 neural electricity tester （Shanghai Haishen Medical Electronic Instrument Co., Ltd.） was used to measure VEPs before and after the experiment in all three groups, and to compare the latencies of VEPs recorded before training with those recorded after training. MAIN OUTCOME MEASURES： Comparison of the changes in latencies of VEPs before and after 8 weeks of tennis training. RESULTS： All 45 subjects finished the test and datas from all were included in the statistical analysis. There were no significant differences among all the three groups before tennis training, but the female subjects in each group showed significantly shorter N75 latencies than male subjects of the same group （P 〈 0.05）. Comparing the latencies of VEPs after training with those recorded before training, the N75, P100 and N145 latencies were all found to be significantly shorter than before training in the tennis group （P 〈 0.05）, but the N75, P100 and N145 latencies were unaffected in the two non-tennis groups （P 〉 0.05）; some latencies were even significantly longer than the before-training values. CONCLUSION： Special tennis training for 8 weeks can make the subjects＇ VEP latencies significantly shorter. Thus, VEP latencies can change with tennis training.

CORRELATION OF THE MAGNETIC MOTOR EVOKED POTENTIAL TECHNIQUE WITH PATHOLOGICAL CHANGES ASSOCIATED WITH SPINAL CORD INJURY IN ADULT CATS

To determine whether the pathological changes caused by injury to the spinal cord can be correlated with values obtained by the Magnetic Motor Evoked Potential (MEPs) technique, we studied spinal cords from 41 adult cats who were divided into 4 groups. The groups ranged from normal cats whose spinal cords were not compressed, to slightly, moderately and severely injured. MEPs were recorded before compression and in 30 minutes, 6 hours, 1 week, 2 week and 4 week after the compression unit was installed. Pathological changes with increased pressure were seen in blood vessels, nerve cells and fibers, Nissl substance and the central canal. A reversal of pathological changes was observed in slight or moderate injury during the 4 weeks of the experiment. Extensive injury, however, caused irreversible changes in the nerve cells with loss of motor function. The latency of MEPs at 30 minutes and 6 hours in the slightly injured group was 037 and 038 times greater than the baseline and returned to normal levels in 4 weeks. In the moderately injured group, the latency was increased 077 and 081 times and in the severely injured 132 and 136 times over the baseline. Recovery in the second group was partial and not at all in the severely injured. Thus, there appears to be good correlation between observed pathological changes, motor functions and MEPs.

Determination of Median Nerve Somatosensory Evoked Potentials in 27 Patients with Hemiplegia

Summary: Twenty-seven in-patients with hemiplegia following brain injury were studied by using upper extremity median nerve somatosensory evoked patentials (SVEP), Brunnstrom assessment in hemiplegic hand and assessment of the patients' activities of daily lioing (ADL) (Barthel index). The upper extremity median nerve SEP on the affected and normal sides was determined. By using Kovindha standard, upper extremity median nerve SEP was graded in accordance with N20. The correlation between the differences of SEP N20 amplitude and the latencies on the both sides and the Barthel index scores was analyzed. A Spearman correlation analysis was made between the median nerve SEP N20 grades and Brunnstrom stages in hand or ADL on the affected side. The results showed that upper extremity median nerve SEP grades were positively correlated with those of the Brunnstrom stages in hand (r 1=0.6925, P 1<0.01). The correlation coefficient between SEP N20 grades and patients' ADL grades was r 2=0.5015, P 2<0 01. It was concluded that upper extremity median nerve SEP could be used as a sensitive electrophysiological predictor to clinically assess hemiplegic hand function. SEP N20 might play a role in predicting the ADL of the patients with hemiplegia to some extent, but could not be used as a sensitive predictor to directly observe and predict the ADL of the patients.

Test-Retest Reliability of Sensory Evoked Potentials in Low-Functioning Autism: A Case Report

Sensory abnormalities are common in individuals with autism spectrum disorders (ASD) but are often difficult to assess using standard behavioral methods. Evoked potentials provide objective, non-invasive electrophysiological measures of neural sensory processing that could be useful for clinical and investigative studies of individuals with low-functioning autism who are unable to perform behavioral testing. Despite increased use, the reliability of sensory evoked potentials has not been established for individuals with low-functioning autism. Establishing reliability is important for validating the utility of sensory evoked potentials. In this study, we explored the feasibility of assessing the test-retest reliability of sensory evoked potentials using repeat recordings, acquired over 2.5- and 6-month intervals, from a minimally verbal adult with low-functioning autism. Repeat auditory and visual evoked potential recordings showed high test-retest reliability, with cross-correlation coefficients ≥ 0.80. This case demonstrates the feasibility of establishing test-retest reliability for individuals with low-functioning autism and supports the utility of sensory evoked potentials in clinical and investigative ASD studies.

Multimodality evoked potentials in patients with delayed encephalopathy after acute carbon monoxide poisoning

Objective： To evaluate the diagnostic and prognostic values in patients with delayed encephalopathy after acute carbon monoxide poisoning. Methods： The tibial nerve somatosensory evoked potentials （SEPs）, vision evoked potentials （VEPs）, and brain stem audition evoked potentials（BAEPs） were performed in 32 healthy adults and 43 patients with delayed encephalopathy after acute carbon monoxide poisoning. Results： This paper indicated abnormalities of tibial nerve SEPs in 31 patients （31/43, 72.1%）, VEPs in 17 patients （17/28, 60.7%）, and BAEPs in 14, patients （14/43, 32.6%）. These results showed that the greatest diagnostic value was SEPs, followed by VEPs and, BAEPs with the lowest sensitivity. Conclusion： Multimodality evoked potentials （EPs） can be used for evaluating the diagnostic and prognostic values in cases of delayed encephalopathy after acute carbon monoxide poisoning.

Normal values of flash visual evoked potentials in rabbits: Differences between the sexes and the eyes

BACKGROUND: The wave form, latency and wave amplitude of visual evoked potentials (VEP) are obviously affected by the stimulative parameters, physiological status of the subjects and anesthetics, thus there are greater normal variations and individual differences. The features of flash VEP (F-VEP) are to be observed. OBJECTIVE: To observe and compare the differences of F-VEP latencies and wave amplitudes between eyes in rabbits, and investigate the correlation with sex and the side of eyes. DESIGN: A comparative animal experiment. SETTING: Department of Neurosurgery, General Hospital of Chinese PLA. MATERIALS: The experiment was carried out in the neurophysiological laboratory of the Institute of Neurosciences, General Hospital of Chinese PLA from September 2004 to February 2005. Thirty big-ear rabbits of clean degree, 15 males and 15 females, weighing 2.0-2.5 kg, were provided by the animal center of the General Hospital of Chinese PLA. METHODS: Viking-IV perioperative monitor and flash stimulator for special use were applied. The rabbits were anesthetized with intramuscular injection of compound ketamine. The recording electrode was placed at 3 mm anterior to exoccipital tuberosity (onion, Oz), and the reference electrode was placed at the ear edge of the same side. The stimulative frequency was 1.9 Hz, and the amplifier was 50 μV; The range of wave filter was 5 Hz for high pass and 100 Hz for low pass; The average overlapping was 200 times, and the analytical time was 250 ms. MAIN OUTCOME MEASURES: Comparison of F-VEP wave forms; F-VEP latencies and wave amplitudes. RESULTS: All the 30 rabbits were involved in the analysis of results. ① Comparison of F-VEP wave forms in rabbits: The F-VEP waves mainly manifested as positive-negative-positive (PNP). The F-VEP manifestations to light stimulations were extremely similar between left and right eyes, and the wave amplitudes of both eyes were obviously increased. ② Determinations of F-VEP latencies and wave amplitudes: There were no significant differences in the latencies and wave amplitudes of F-VEP between the two groups (P > 0.05), the latencies of P1, N1 and P2 waves of left eye were (32.59±2.01), (43.85±4.35) and (66.20±8.13) ms, respectively, and the wave amplitudes of P1, N1 and P2 waves of left eye were (16.45±10.22), (7.93±3.56) and (17.62±8.18) μV. F-VEP latencies were stable with small changes, whereas amplitudes had greater changes. CONCLUSION: ① The latency and wave amplitudes F-VEP were stable with good repetition. ② The latencies and wave amplitudes had no significant differences between males and females, as well as between left and right eyes. Further investigation should be undertaken on the animal and clinical field.

Intraoperative facial motor evoked potentials monitoring with transcranial electrical stimulation for preservation of facial nerve function in patients with large acoustic neuroma

Background Although various monitoring techniques have been used routinely in the treatment of the lesions in the skull base, iatrogenic facial paresis or paralysis remains a significant clinical problem. The aim of this study was to investigate the effect of intraoperative facial motor evoked potentials monitoring with transcranial electrical stimulation on preservation of facial nerve function. Method From January to November 2005, 19 patients with large acoustic neuroma were treated using intraoperative facial motor evoked potentials monitoring with transcranial electrical stimulation （TCEMEP） for preservation of facial nerve function. The relationship between the decrease of MEP amplitude after tumor removal and the postoperative function of the facial nerve was analyzed. Results MEP amplitude decreased more than 75% in 11 patients, of which 6 presented significant facial paralysis （H-B grade 3）, and 5 had mild facial paralysis （H-B grade 2）. In the other 8 patients, whose MEP amplitude decreased less than 75%, 1 experienced significant facial paralysis, 5 had mild facial paralysis, and 2 were normal. Conclusions Intraoperative TCEMEP can be used to predict postoperative function of the facial nerve. The decreased MEP amplitude above 75 % is an alarm point for possible severe facial paralysis.

Dermatomal Somatosensory Evoked Potentials: An Indicator of Improvement of Breast Sensibility after Reduction Mammaplasty

Introduction: Many women think about reduction mammaplasty for different reasons. The effect of surgery on the beast sensibility is one of the greatest concerns after reconstructive reductive breast surgery through its affect on patient’s social life and psychological health. The dermatomal somatosensory evoked potential (D-SEP) is a new method to quantitatively evaluate breast sensibility. Patients and Methods: Twenty-five women enrolled in this study presenting with breast enlargement, underwent mammary reduction by using the inferior pyramidal breast reduction technique using the same operative technique described by Robbins with some modifications. All D-SEP amplitudes and latencies were calculated preoperatively and then were reassessed six and twelve months post-surgery in each breast. Result: The results revealed that there is a significant difference in the D-SEP latency pre- and post-operatively. The statistically significant decrease in latency and the breast size demonstrated indicates that the sensibility improved after breast reduction surgery both at six and twelve months. There is also a significant increase in the D-SEP amplitude pre- and post-operatively. The negative and statistically significant increase in amplitude with the decrease in breast size demonstrated indicates that the sensibility improved after breast reduction surgery both at six and twelve months. Conclusion: This study concluded that breast sensibility will improve after breast reduction as indicated by significant reduction of D-SEP latencies and increase of its amplitudes. Our results confirm an inverse relationship between breast size and sensibility, with improvement in sensibility after breast reduction.