Objective:To present our classification for peripheral nerve schwannomas as well as explore the surgical strategies and operative management of peripheral nerve schwannomas based on the intraoperative neurophysiologic...Objective:To present our classification for peripheral nerve schwannomas as well as explore the surgical strategies and operative management of peripheral nerve schwannomas based on the intraoperative neurophysiological monitoring(INM)technique and to decrease the risk of postoperative neurological deficits in the management of these schwannomas.Materials and methods:A retrospective study was conducted on 92 cases of peripheral nerve microsurgery performed,using the INM technique.We also made the classification for peripheral nerve schwannomas into two types according to operative findings and proceeded corresponding surgical strategies.Results:All tumors were removed completely under microscopy and INM.Three patients developed residual neurological deficits at final follow-up.There were different results about temporary(18/92,19.6%)and permanent(3/92,3.3%)neurological deficits.The incidence of temporary and permanent neurological deficits in type II group was significantly higher than that in type I group(p<0.01).The incidence of permanent neurological deficits in larger size tumors was significantly higher than that of smaller size(p<0.01).Conclusions:We made the classification for peripheral nerve schwannomas according to operative findings based on INM that is helpful to our surgical strategies.Intracapsular enucleation was the preferred strategy with satisfactory results and low risk of nerve injury.The size and location of tumors seem to be related to the risk of fascicular injury.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
Outpatient electrodiagnostic studies and intraoperative monitoring are essential tools for the surgical management of nerve injury.Decisions are based on the diagnostic certainty afforded by outpatient electrodiagnost...Outpatient electrodiagnostic studies and intraoperative monitoring are essential tools for the surgical management of nerve injury.Decisions are based on the diagnostic certainty afforded by outpatient electrodiagnostic studies,which are more sensitive and specific than clinical examinations regarding the nature and localization of a nerve lesion.Intraoperative neurophysiologic monitoring detects changes in neurologic function during surgery.It provides significantly better information than visual inspection of the operative field,minimizing postoperative neurologic deficits due to surgical manipulation(e.g.,stretching,compression,heating from electrocauterization,constriction,or clamping of local blood vessels).These techniques exploit similar neurophysiologic principles to afford enhanced diagnostic and real-time functional data during surgery.However,an understanding of their limitations is critical for the interpretation of these data.This review discusses these techniques,including their use,advantages,and disadvantages in diagnosing and managing three essential nerve lesions amenable to surgical management-radiculopathy,mononeuropathy,and brachial plexopathy.展开更多
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
基金This work was supported by the Natural Science Foundation of Zhejiang Province of China(LY14H160025)the National Natural Science Foundation of China(81402044)the Natural Science Foundation of Zhejiang Province of China(LY14H160017).
文摘Objective:To present our classification for peripheral nerve schwannomas as well as explore the surgical strategies and operative management of peripheral nerve schwannomas based on the intraoperative neurophysiological monitoring(INM)technique and to decrease the risk of postoperative neurological deficits in the management of these schwannomas.Materials and methods:A retrospective study was conducted on 92 cases of peripheral nerve microsurgery performed,using the INM technique.We also made the classification for peripheral nerve schwannomas into two types according to operative findings and proceeded corresponding surgical strategies.Results:All tumors were removed completely under microscopy and INM.Three patients developed residual neurological deficits at final follow-up.There were different results about temporary(18/92,19.6%)and permanent(3/92,3.3%)neurological deficits.The incidence of temporary and permanent neurological deficits in type II group was significantly higher than that in type I group(p<0.01).The incidence of permanent neurological deficits in larger size tumors was significantly higher than that of smaller size(p<0.01).Conclusions:We made the classification for peripheral nerve schwannomas according to operative findings based on INM that is helpful to our surgical strategies.Intracapsular enucleation was the preferred strategy with satisfactory results and low risk of nerve injury.The size and location of tumors seem to be related to the risk of fascicular injury.
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Outpatient electrodiagnostic studies and intraoperative monitoring are essential tools for the surgical management of nerve injury.Decisions are based on the diagnostic certainty afforded by outpatient electrodiagnostic studies,which are more sensitive and specific than clinical examinations regarding the nature and localization of a nerve lesion.Intraoperative neurophysiologic monitoring detects changes in neurologic function during surgery.It provides significantly better information than visual inspection of the operative field,minimizing postoperative neurologic deficits due to surgical manipulation(e.g.,stretching,compression,heating from electrocauterization,constriction,or clamping of local blood vessels).These techniques exploit similar neurophysiologic principles to afford enhanced diagnostic and real-time functional data during surgery.However,an understanding of their limitations is critical for the interpretation of these data.This review discusses these techniques,including their use,advantages,and disadvantages in diagnosing and managing three essential nerve lesions amenable to surgical management-radiculopathy,mononeuropathy,and brachial plexopathy.
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.
