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
Thoracic spinal stenosis (TSS) is a group of clinical syndromes caused by thoracic spinal cord compression, which always results in severe clinical complications. The incidence of TSS is relatively low compared with l...Thoracic spinal stenosis (TSS) is a group of clinical syndromes caused by thoracic spinal cord compression, which always results in severe clinical complications. The incidence of TSS is relatively low compared with lumbar spinal stenosis, while the incidence of spinal cord injury during thoracic decompression is relatively high. The reported incidence of neurological deficits after thoracic decompression reached 13.9%.Intraoperative neurophysiological monitoring (IONM) can timely provide information regarding the function status of the spinal cord, and help surgeons with appropriate performance during operation. This article illustrates the theoretical basis of applying IONM in thoracic decompression surgery, and elaborates on the relationship between signal changes in IONM and postoperative neurological function recovery of the spinal cord. It also introduces updated information in multimodality IONM, the factors influencing evoked potentials,and remedial measures to improve the prognosis.展开更多
Recently, many surgeons have been using intraoperative neurophysiological monitoring(IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, caud...Recently, many surgeons have been using intraoperative neurophysiological monitoring(IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, cauda equina and nerve root. Several established technologies are available and combined motor and somatosensory evoked potentials are considered mandatory for practical and successful IOM. Spinal cord evoked potentials are elicited compound potentials recorded over the spinal cord. Electrical stimulation is provoked on the dorsal spinal cord from an epidural electrode. Somatosensory evoked potentials assess the functional integrity of sensory pathways from the peripheral nerve through the dorsal column and to the sensory cortex. For identification of the physiological midline, the dorsal column mapping technique can be used. It is helpful for reducing the postoperative morbidity associated with dorsal column dysfunction when distortion of the normal spinal cord anatomy caused by an intramedullary cord lesion results in confusion in localizing the midline for the myelotomy. Motor evoked potentials(MEPs) consist of spinal, neurogenic and muscle MEPs. MEPs allow selective and specific assessment of the functional integrity of descending motor pathways, from the motor cortex to peripheral muscles. Spinal surgeons should understand the concept of the monitoring techniques and interpret monitoring records adequately to use IOM for the decision making during the surgery for safe surgery and a favorable surgical outcome.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
目的比较不同肌松水平[4个成串刺激(train of four stimulation,TOF)的T1分别为5%~15%基础值和45%~55%基础值水平]对脊柱手术中脊髓神经电生理监测结果的影响,探讨安全有效的电生理监测麻醉方案。方法选择行术中脊髓神经电生理监测的择...目的比较不同肌松水平[4个成串刺激(train of four stimulation,TOF)的T1分别为5%~15%基础值和45%~55%基础值水平]对脊柱手术中脊髓神经电生理监测结果的影响,探讨安全有效的电生理监测麻醉方案。方法选择行术中脊髓神经电生理监测的择期脊柱手术病人23例。采用丙泊酚和瑞芬太尼全凭静脉麻醉,阿曲库铵维持肌松,监测拇内收肌TOF指示肌松水平,监测体感诱发电位(somatosensory evoked potentials,SEP)和运动诱发电位(motor evoked potentials,MEP)评判脊髓功能。分别记录神经肌肉阻滞水平1(neuromuscular blockade level 1,NMB_1)(T1为5%~15%基础值)和NMB_2水平(T1为45%~55%基础值)时SEP和MEP的波幅和潜伏期,同时记录经颅电刺激时病人是否出现剧烈体动和自主呼吸。结果不同肌松水平的SEP波幅和潜伏期之间差异均无统计学意义(P>0.05)。同一监测部位不同肌松水平的MEP潜伏期差异无统计学意义(P>0.05),左上肢和右下肢不同肌松水平的MEP波幅则差异有统计学意义(P<0.05)。NMB2水平时的经颅电刺激时剧烈体动发生率明显高于NMB1水平时(P<0.05)。两个肌松水平经颅电刺激时均无自主呼吸产生。结论肌松剂的使用在行神经电生理监测的脊柱手术中并非完全禁忌,TOF的T1在45%~55%基础值的肌松水平可能是高风险脊髓手术较理想的肌松水平。展开更多
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Thoracic spinal stenosis (TSS) is a group of clinical syndromes caused by thoracic spinal cord compression, which always results in severe clinical complications. The incidence of TSS is relatively low compared with lumbar spinal stenosis, while the incidence of spinal cord injury during thoracic decompression is relatively high. The reported incidence of neurological deficits after thoracic decompression reached 13.9%.Intraoperative neurophysiological monitoring (IONM) can timely provide information regarding the function status of the spinal cord, and help surgeons with appropriate performance during operation. This article illustrates the theoretical basis of applying IONM in thoracic decompression surgery, and elaborates on the relationship between signal changes in IONM and postoperative neurological function recovery of the spinal cord. It also introduces updated information in multimodality IONM, the factors influencing evoked potentials,and remedial measures to improve the prognosis.
文摘Recently, many surgeons have been using intraoperative neurophysiological monitoring(IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, cauda equina and nerve root. Several established technologies are available and combined motor and somatosensory evoked potentials are considered mandatory for practical and successful IOM. Spinal cord evoked potentials are elicited compound potentials recorded over the spinal cord. Electrical stimulation is provoked on the dorsal spinal cord from an epidural electrode. Somatosensory evoked potentials assess the functional integrity of sensory pathways from the peripheral nerve through the dorsal column and to the sensory cortex. For identification of the physiological midline, the dorsal column mapping technique can be used. It is helpful for reducing the postoperative morbidity associated with dorsal column dysfunction when distortion of the normal spinal cord anatomy caused by an intramedullary cord lesion results in confusion in localizing the midline for the myelotomy. Motor evoked potentials(MEPs) consist of spinal, neurogenic and muscle MEPs. MEPs allow selective and specific assessment of the functional integrity of descending motor pathways, from the motor cortex to peripheral muscles. Spinal surgeons should understand the concept of the monitoring techniques and interpret monitoring records adequately to use IOM for the decision making during the surgery for safe surgery and a favorable surgical outcome.
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.
