Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
-
J Clin Neurophysiol · Dec 2014
Comparative StudyTrain-of-four test in intraoperative neurophysiologic monitoring: differences between hand and foot train-of-four.
Comparison of T1-T4 decrement between upper and lower extremity muscles can indicate differences between recovery time from neuromuscular blockade, which may have repercussions for neurophysiologic intraoperative monitoring. We investigated decrement between T1 and T4 hand and foot muscle responses on quantitative train-of-four (TOF) test. ⋯ The observed difference between recovery of hand and foot muscles suggests that quantitative TOF test should be performed on extremities for which accurate data about the level of neuromuscular blockade is sought. During lumbar spine surgery monitoring, in addition to hand TOF, foot TOF should be included.
-
J Clin Neurophysiol · Dec 2014
Case ReportsRecovery of TES-MEPs during surgical decompression of the spine: a case series of eight patients.
This study aimed to illustrate the recovery of transcranial electrical stimulation motor evoked potentials during surgical decompression of the spinal cord in patients with impaired motor function preoperatively. Specific attention was paid to the duration of neurologic symptoms before surgery and the postoperative clinical recovery. ⋯ In patients with a short onset of neurologic impairment because of compression of the spinal cord or caudal fibers, an intraoperative recovery of transcranial electrical stimulation motor evoked potentials can indicate an improvement of motor function postoperatively. Therefore, transcranial electrical stimulation motor evoked potentials can be considered as a useful tool to the surgeon to monitor the quality of decompression of the spinal cord.
-
J Clin Neurophysiol · Dec 2014
Intraoperative monitoring for intracranial aneurysms: the Michigan experience.
Intraoperative neurophysiological monitoring is routinely used during the repair (endovascular or microsurgical) of intracranial aneurysms at major centers. There is a continued need of data sets from institutions with dedicated intraoperative neurophysiological monitoring services to further define the predictive factors of postoperative neurological deficits. We retrospectively reviewed and analyzed our database of all patients who underwent repair of intracranial aneurysms (endovascular or microsurgical). ⋯ The association between intraoperative neurophysiological monitoring changes and Glasgow outcome scale was significant for reversible changes compared against irreversible and partly reversible changes. Presence of any intraoperative neurophysiological monitoring modality change during repair of intracranial aneurysm may suggest a higher risk for postoperative neurological deficits. Reversibility of the changes is a favorable marker, whereas irreversible changes are predictive of postoperative neurological deficits with deterioration of Glasgow outcome scale on a longer follow-up.