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
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
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
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
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
目的探讨经颅电刺激运动诱发电位(transcranial electric motor evoked potentials,TCeMEP)和体感诱发电位(somatosensory evoked potentials,SSEP)监测在脊柱侧凸翻修截骨手术中的应用价值。方法回顾性分析2011年3月至2016年3月于我科...目的探讨经颅电刺激运动诱发电位(transcranial electric motor evoked potentials,TCeMEP)和体感诱发电位(somatosensory evoked potentials,SSEP)监测在脊柱侧凸翻修截骨手术中的应用价值。方法回顾性分析2011年3月至2016年3月于我科全麻下行脊柱侧凸翻修截骨术的患者176例,均行SSEP监测,其中134例同时应用TCeMEP监测。分别统计单独SSEP、单独TCeMEP及TCeMEP联合SSEP监测的真阳性率、假阳性率、真阴性率、假阴性率、阳性预测值、阴性预测值、敏感性及特异性。结果单独SSEP成功监测162例(92.0%),TCeMEP成功监测109例(81.3%)。134例应用TCeMEP联合SSEP监测患者,有124例(92.5%)采用任意一种监测方式成功监测。162例成功监测的患者中共有14例报警,报警率为8.6%(14/162)。最终残留神经损伤患者3例,占1.9%(3/162)。统计单独SSEP监测组的敏感性和特异性分别为72.7%和98.7%,单独TcMEP组为90.9%和98.0%,而联合TcMEP及SSEP监测组的敏感性为最高100%,特异性为98.2%。联合TcMEP及SSEP监测组阳性及阴性预测值为85.7%和100%,高于单独SSEP组(80.0%和98.0%)及单独TcMEP组(83.3%和99.0%)。结论脊柱侧凸翻修截骨术手术操作复杂,联合TcMEP及SSEP监测较单一监测能更早地发现神经损害,降低手术风险。我们建议对于脊柱侧凸翻修截骨患者应常规应用TcMEP及SSEP进行联合监测。展开更多
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.
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.
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.
文摘目的探讨经颅电刺激运动诱发电位(transcranial electric motor evoked potentials,TCeMEP)和体感诱发电位(somatosensory evoked potentials,SSEP)监测在脊柱侧凸翻修截骨手术中的应用价值。方法回顾性分析2011年3月至2016年3月于我科全麻下行脊柱侧凸翻修截骨术的患者176例,均行SSEP监测,其中134例同时应用TCeMEP监测。分别统计单独SSEP、单独TCeMEP及TCeMEP联合SSEP监测的真阳性率、假阳性率、真阴性率、假阴性率、阳性预测值、阴性预测值、敏感性及特异性。结果单独SSEP成功监测162例(92.0%),TCeMEP成功监测109例(81.3%)。134例应用TCeMEP联合SSEP监测患者,有124例(92.5%)采用任意一种监测方式成功监测。162例成功监测的患者中共有14例报警,报警率为8.6%(14/162)。最终残留神经损伤患者3例,占1.9%(3/162)。统计单独SSEP监测组的敏感性和特异性分别为72.7%和98.7%,单独TcMEP组为90.9%和98.0%,而联合TcMEP及SSEP监测组的敏感性为最高100%,特异性为98.2%。联合TcMEP及SSEP监测组阳性及阴性预测值为85.7%和100%,高于单独SSEP组(80.0%和98.0%)及单独TcMEP组(83.3%和99.0%)。结论脊柱侧凸翻修截骨术手术操作复杂,联合TcMEP及SSEP监测较单一监测能更早地发现神经损害,降低手术风险。我们建议对于脊柱侧凸翻修截骨患者应常规应用TcMEP及SSEP进行联合监测。
