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Ius T, Montemurro N, Lombardi G, Berardinelli J, Romano A, Barresi V, Cerretti G, Guarnera A, Tel A, Cavallo LM, Pasqualetti F, Feletti A. Decoding the puzzle: A multidisciplinary systematic review of adult brainstem glioma. Crit Rev Oncol Hematol 2024; 196:104261. [PMID: 38395241 DOI: 10.1016/j.critrevonc.2024.104261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 02/25/2024] Open
Abstract
Adult brainstem gliomas (BSGs) are a group of rare central nervous system tumors with varying prognoses and controversial standard treatment strategies. To provide an overview of current trends, a systematic review using the PRISMA guidelines, Class of evidence (CE) and strength of recommendation (SR), was conducted. The review identified 27 studies. Surgery was found to have a positive impact on survival, particularly for focal lesions with CE II SR C. Stereotactic image-guided biopsy was recommended when resective surgery was not feasible with CE II and SR B. The role of systemic treatments remains unclear. Eight studies provided molecular biology data. This review gathers crucial literature on diagnosis and management of adult BSGs. It provides evidence-based guidance with updated recommendations for diagnosing and treating, taking into account recent molecular and genetic advancements. The importance of brain biopsy is emphasized to optimize treatment using emerging genetic-molecular findings and explore potential targeted therapies.
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Affiliation(s)
- Tamara Ius
- Neurosurgery Unit, Head-Neck and NeuroScience Department University Hospital of Udine, Italy.
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Jacopo Berardinelli
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Andrea Romano
- Department of Neuroradiology, NESMOS S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Valeria Barresi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giulia Cerretti
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Alessia Guarnera
- Department of Neuroradiology, NESMOS S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Alessandro Tel
- Clinic of Maxillofacial Surgery, Head-Neck and NeuroScience Department University Hospital of Udine, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Francesco Pasqualetti
- Division of Radiation Oncology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Alberto Feletti
- Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Italy
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Lapteva K, Gavrjushin A, Pitskhelauri D, Birg T, Danilov G, Ogurtsova A, Strunina Y, Fomochkina L. Intraoperative Neurophysiologic Monitoring in Predicting Dysphagia After Brainstem and Fourth Ventricle Surgery. World Neurosurg 2023; 180:e334-e340. [PMID: 37757944 DOI: 10.1016/j.wneu.2023.09.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE Dysphagia represents the main complication of posterior fossa neurosurgery. Adequate diagnosis of this complication is warranted to prevent untimely extubation with subsequent aspiration. Intraoperative neurophysiologic monitoring (IONM) modalities may be used for this purpose. However, it is not known which IONM modality may be significant for diagnosis. This study aimed to define the most significant IONM modality for dysphagia prognostication after posterior fossa neurosurgery. METHODS The analysis included 46 patients (34 with tumors of the fourth ventricle and 12 with brainstem localization) who underwent surgical excision of the tumor. Neurologic symptoms before and after neurosurgery were noted and magnetic resonance imaging with the subsequent volume estimation of the removed mass was performed, followed by an IONM findings analysis (mapping of the nucleus of the caudal cranial nerves [CN] and corticobulbar motor-evoked potentials [CoMEP]). RESULTS Aggravation of dysphagia was noted in 24% of the patients, more often in patients with tumor localization in the fourth ventricle (26%) than in those with brainstem mass lesions (16%). Mapping of the caudal cranial nerve nuclei did not correlate with the dysfunction of these structures. CoMEP was significantly associated with the neurologic state of the CN. The decrease in CoMEP is a significant prognostic factor for postoperative bulbar symptoms appearance or aggravation. CONCLUSIONS Mapping the CN is an important identification tool. The CoMEP modality should be used intraoperatively to determine the functional state of the CN and predict postoperative dysphagia.
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Affiliation(s)
- Kristina Lapteva
- Department of Clinical Neurophysiology, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation.
| | - Andrey Gavrjushin
- Department of Neuro-oncology, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - David Pitskhelauri
- Department of Neuro-oncology, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Tatiana Birg
- Department of Intensive Care Unit, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Gleb Danilov
- Laboratory of Biomedical Informatics and Artificial Intelligence, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Anna Ogurtsova
- Department of Clinical Neurophysiology, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Yulia Strunina
- Laboratory of Biomedical Informatics and Artificial Intelligence, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Ludmila Fomochkina
- Department of Otorhinolaryngology, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
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Carrai R, Morone F, Baldanzi F, Martinelli C, Bonaudo C, Tola S, Muscas G, Caramelli R, Spalletti M, Grippo A, Bucciardini L, Amadori A, Della Puppa A. Intraoperative Mapping of the Sensory Root of the Trigeminal Nerve in Patients with Pontocerebellar Angle Pathology. World Neurosurg 2023; 178:e104-e112. [PMID: 37454910 DOI: 10.1016/j.wneu.2023.06.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The aim of the present study was to determine the position of the 3 sensory branches of the trigeminal nerve in the preganglionic tract using intraoperative neurophysiological mapping. METHODS We included consecutive adult patients who underwent neurosurgical treatment of cerebellopontine angle lesions. The trigeminal nerve was antidromically stimulated at 3 sites along its circumference with different stimulus intensities at a distance of ≤1 cm from the brainstem. The sensory nerve action potentials (SNAPs) were recorded from each main trigeminal branch (V1 [ophthalmic branch], V2 [maxillary branch], and V3 [mandibular branch]). RESULTS We analyzed 13 patients. The stimulation points at which we obtained the greatest number of congruous and exclusive SNAPs (SNAPs only on the stimulated branch) was the stimulation point for V3 (20.7%). The stimulation intensity at which we obtained the highest number of congruent and exclusive SNAPs with the stimulated branch was 0.5 mA. CONCLUSIONS Using our recording conditions, trigeminal stimulation is a reliable technique for mapping the V3 and V1 branches using an intensity not exceeding 0.5. However, reliable identification of the fibers of V2 is more difficult. Stimulation of the trigeminal nerve can be a reliable technique to identify the V3 and V1 branches if rhizotomy of these branches is necessary.
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Affiliation(s)
- Riccardo Carrai
- SODc Neurophysiopathology, AOU Careggi, University Hospital, Florence, Italy
| | - Francesca Morone
- Neurosurgery Unit, Head and Neck Department, AORN San G. Moscati Hospital, Avellino, Italy
| | - Fabrizio Baldanzi
- SODc Neurophysiopathology, AOU Careggi, University Hospital, Florence, Italy
| | | | - Camilla Bonaudo
- Neurosurgery Clinic, AOU Careggi University Hospital, Florence, Italy
| | - Serena Tola
- Neurosurgery Clinic, AOU Careggi University Hospital, Florence, Italy
| | - Giovanni Muscas
- Neurosurgery Clinic, AOU Careggi University Hospital, Florence, Italy
| | - Riccardo Caramelli
- SODc Neurophysiopathology, AOU Careggi, University Hospital, Florence, Italy
| | - Maddalena Spalletti
- SODc Neurophysiopathology, AOU Careggi, University Hospital, Florence, Italy
| | - Antonello Grippo
- SODc Neurophysiopathology, AOU Careggi, University Hospital, Florence, Italy.
| | - Luca Bucciardini
- Neuro-Anesthesiology and Intensive Care Unit, AOU Careggi University Hospital, Florence, Italy
| | - Andrea Amadori
- Neuro-Anesthesiology and Intensive Care Unit, AOU Careggi University Hospital, Florence, Italy
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San A, Rahman RK, Sanmugananthan P, Dubé MD, Panico N, Ariwodo O, Shah V, D’Amico RS. Health-Related Quality of Life Outcomes in Meningioma Patients Based upon Tumor Location and Treatment Modality: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:4680. [PMID: 37835374 PMCID: PMC10571784 DOI: 10.3390/cancers15194680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Patients with meningiomas may have reduced health-related quality of life (HRQoL) due to postoperative neurological deficits, cognitive dysfunction, and psychosocial burden. Although advances in surgery and radiotherapy have improved progression-free survival rates, there is limited evidence regarding treatment outcomes on HRQoL. This review examines HRQoL outcomes based on tumor location and treatment modality. A systematic search in PubMed yielded 28 studies with 3167 patients. The mean age was 54.27 years and most patients were female (70.8%). Approximately 78% of meningiomas were located in the skull base (10.8% anterior, 23.3% middle, and 39.7% posterior fossae). Treatment modalities included craniotomy (73.6%), radiotherapy (11.4%), and endoscopic endonasal approach (EEA) (4.0%). The Karnofsky Performance Scale (KPS) was the most commonly utilized HRQoL instrument (27%). Preoperative KPS scores > 80 were associated with increased occurrence of postoperative neurological deficits. A significant difference was found between pre- and post-operative KPS scores for anterior/middle skull base meningiomas (SBMs) in comparison to posterior (SBMs) when treated with craniotomy. Post-craniotomy SF-36 scores were lower for posterior SBMs in comparison to those in the anterior and middle fossae. Risk factors for poor neurological outcomes include a high preoperative KPS score and patients with posterior SBMs may experience a greater burden in HRQoL.
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Affiliation(s)
- Ali San
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO 64106, USA
| | - Raphia K. Rahman
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, CA 92501, USA
| | | | | | - Nicholas Panico
- Lake Erie College of Osteopathic Medicine, Erie, PA 16509, USA
| | - Ogechukwu Ariwodo
- Philadelphia College of Osteopathic Medicine, Moultrie, GA 31768, USA
| | - Vidur Shah
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO 64106, USA
| | - Randy S. D’Amico
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY 11030, USA;
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Morota N, Deletis V. Brainstem Surgery: Functional Surgical Anatomy with the Use of an Advanced Modern Intraoperative Neurophysiological Procedure. Adv Tech Stand Neurosurg 2023; 48:21-55. [PMID: 37770680 DOI: 10.1007/978-3-031-36785-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Intraoperative neurophysiology (ION) in brainstem surgery evolved as brainstem surgery advanced.The original idea of brainstem mapping (BSM) is a neurophysiological procedure to locate cranial nerve motor nuclei (CNMN) on the floor of the fourth ventricle. With the introduction of various skull base approaches to the brainstem, BSM is carried out on any surface of the brainstem to expose the safe entry zone to the intrinsic brainstem lesion. It is the modern concept of BSM, a broader definition of BSM. BSM enables to avoid direct damage to the CNMN when approaching the brainstem through the negative mapping region.The corticobulbar tract (CBT) motor evoked potential (MEP) is another ION procedure in brainstem surgery. It enables monitoring of the functional integrity of the whole cranial motor pathway without interrupting surgical procedures. Combined application of both BSM and CBT-MEP monitoring is indispensable for the functional preservation of the CNMN and their supranuclear innervation during the brainstem surgery.In this paper, the neurophysiological aspect of BSM and the CBT-MEP was fully described. Normal anatomical background of the floor of the fourth ventricle and the detail of the CBT anatomy were demonstrated to better understand their clinical usefulness, limitations, and surgical implications derived from ION procedures. Finally, a future perspective in the role of ION procedures in brainstem surgery was presented. The latest magnetic resonance imaging (MRI) technology can allow surgeons to find an "on the image" safe entry zone to the brainstem. However, the role of BSM and the CBT-MEP monitoring in terms of safe brainstem surgery stays unshakable. Special attention was paid for the recent trend of management in diffuse intrinsic pontine gliomas. A new role of BSM during a stereotactic biopsy was discussed.It is the authors' expectation that the paper enhances the clinical application of a contemporary standard of the ION in brainstem surgery and supports safer brainstem surgery more than ever and in the future.
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Affiliation(s)
- Nobuhito Morota
- Department of Neurosurgery, Kitasato University Hospital, Sagamihara, Japan
| | - Vedran Deletis
- Department of Neurosurgery, University Hospital, Zagreb, Croatia
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Tailored Approach and Multimodal Intraoperative Neuromonitoring in Cerebellopontine Angle Surgery. Brain Sci 2022; 12:brainsci12091167. [PMID: 36138903 PMCID: PMC9497190 DOI: 10.3390/brainsci12091167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/18/2022] [Accepted: 08/29/2022] [Indexed: 11/24/2022] Open
Abstract
The cerebellopontine angle (CPA) is a highly complex anatomical compartment consisting of numerous nervous and vascular structures that present mutual and intricate spatial relationships. CPA surgery represents, therefore, a constant challenge for neurosurgeons. Over the years, neurosurgeons have developed and refined several solutions with the aim of maximizing the surgical treatment effects while minimizing the invasiveness and risks for the patient. In this paper, we present our integrated approach to CPA surgery, describing its advantages in treating pathologies in this anatomical district. Our approach incorporates the use of technology, such as neuronavigation, along with advanced and multimodal intraoperative neuromonitoring (IONM) techniques, with the final goal of making this surgery safe and effective.
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Yang Y, Neidert MC, Velz J, Kälin V, Sarnthein J, Regli L, Bozinov O. Mapping and Monitoring of the Corticospinal Tract by Direct Brainstem Stimulation. Neurosurgery 2022; 91:496-504. [DOI: 10.1227/neu.0000000000002065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/28/2022] [Indexed: 11/19/2022] Open
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Intra-operative neurophysiological mapping to identify distorted functional anatomy of the 4th ventricle in a 5-month-old infant. Childs Nerv Syst 2022; 38:1371-1375. [PMID: 34609612 DOI: 10.1007/s00381-021-05356-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Neurophysiological brainstem mapping techniques facilitate the intra-operative localisation of cranial nerve nuclei amidst distorted anatomy. Neurophysiological recording in young infants can be limited due to immature myelination and synaptogenesis, as well as an increased sensitivity to anaesthetic agents. CASE REPORT A 5-month-old boy was diagnosed with a cystic brainstem lesion located dorsally within the pons and upper medulla. An open surgical biopsy was undertaken via a posterior fossa craniotomy, revealing a grossly distorted fourth ventricular floor. Intra-operative neurophysiological mapping produced oculomotor, facial, glossopharyngeal and vagal muscle responses allowing a deviated functional midline to be identified. Direct stimulation was used to identify an area in the floor of the fourth ventricle eliciting no cranial nerve responses and allow safe entry into the tumour cavity and biopsy. Transcranial motor evoked responses (TcMEPs), short-latency somatosensory evoked potentials (SSEPs) and brainstem auditory evoked potentials (BAEPs) were all successfully recorded throughout the procedure, despite the use of halogenated gaseous anaesthesia. CONCLUSIONS We describe the use of brainstem mapping techniques for identification of a distorted midline on the floor of the 4th ventricle in an infant, with reproducible recordings of intra-operative TcMEPs, SSEPs and BAEPs.
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Kodama K, Kothbauer KF, Deletis V. Mapping and monitoring of brainstem surgery. HANDBOOK OF CLINICAL NEUROLOGY 2022; 186:151-161. [PMID: 35772884 DOI: 10.1016/b978-0-12-819826-1.00021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The surgical morbidity of brainstem lesions is higher than in other areas of the central nervous system because the compact brainstem is highly concentrated with neural structures that are often distorted or even unrecognizable under microscopic view. Intraoperative neurophysiologic mapping helps identify critical neural structures to avoid damaging them. With the trans-fourth ventricular floor approach, identifying the facial colliculi and vagal and hypoglossal triangles enables incising and approaching the brainstem through the safe entry zones, the suprafacial or infrafacial triangle, with minimal injury. Corticospinal tract mapping is adopted in the case of brainstem surgery adjacent to the corticospinal tract. Intraoperative neurophysiologic monitoring techniques include motor evoked potentials (MEPs), corticobulbar MEPs, brainstem auditory evoked potentials, and somatosensory evoked potentials. These provide real-time feedback about the functional integrity of neural pathways, and the surgical team can reconsider and correct the surgical strategy accordingly. With multimodal mapping and monitoring, the brainstem is no longer "no man's land," and brainstem lesions can be treated surgically without formidable morbidity and mortality.
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Affiliation(s)
- Kunihiko Kodama
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Karl F Kothbauer
- Formerly Department of Neurosurgery, University of Basel and Division of Neurosurgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Vedran Deletis
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia; Albert Einstein College of Medicine, New York, NY, United States
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Intraoperative Neuromonitoring of Blink Reflex During Posterior Fossa Surgeries and its Correlation With Clinical Outcome. J Clin Neurophysiol 2020; 39:299-306. [PMID: 33009043 DOI: 10.1097/wnp.0000000000000777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Blink reflex (BR) under general anesthesia as an intraoperative neuromonitoring method was used to monitor facial nerves in few studies. This study aimed to test the utility of intraoperative BR during cerebellopontine angle and skull base surgeries, assess its prognostic value for facial nerve functions, and compare it with facial corticobulbar motor evoked potentials (CoMEPs). METHODS Blink reflex and facial CoMEPs were recorded from 40 patients undergoing skull base surgeries. Subdermal needles were placed in the supraorbital notch for stimulation and in the orbicularis oculi muscle for recording the BR. A double train of 20 to 40 V intensity with an intertrain interval of 40 to 60 milliseconds, an interstimulus interval of 2.5 milliseconds, and a stimulus duration of 0.5 milliseconds were applied. Facial nerve functions were assessed with the House-Brackmann grading system in the postoperative day 1 and third-month period and correlated with intraoperative BR and CoMEPs measurements. RESULTS Of 40 patients, BR was recordable on the affected side in 32 (80%) and contralateral side in 35 (87.5%) patients. According to our statistical results, BR had a slightly better sensitivity than facial CoMEPs in predicting impairment of facial nerve functions for both postoperative and third-month time points. Blink reflex showed better accuracy for predicting postoperative nerve functions, whereas CoMEPs correlated better in predicting third-month outcome. CONCLUSIONS We suggest that BR is a valuable intraoperative neuromonitoring method that can be used in addition to facial CoMEPs during skull base surgeries to assess real-time facial nerve integrity and predict prognosis.
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Roth J, Korn A, Sala F, Benvenisti H, Jubran M, Bitan-Talmor Y, Ekstein M, Constantini S. Intraoperative neurophysiology in pediatric supratentorial surgery: experience with 57 cases. Childs Nerv Syst 2020; 36:315-324. [PMID: 31422426 DOI: 10.1007/s00381-019-04356-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/13/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Utilization of intraoperative neurophysiology (ION) to map and assess various functions during supratentorial brain tumor and epilepsy surgery is well documented and commonplace in the adult setting. The applicability has yet to be established in the pediatric age group. METHODS All pediatric supratentorial surgery utilizing ION of the motor system, completed over a period of 10 years, was analyzed retrospectively for the following variables: preoperative and postoperative motor deficits, extent of resection, sensory-motor mappability and monitorability, location of lesion, patient age, and monitoring alarms. Intraoperative findings were correlated with antecedent symptomatology as well as short- and long-term postoperative clinical outcome. The monitoring impact on surgical course was evaluated on a per-case basis. RESULTS Data were analyzed for 57 patients (ages 3-207 months (93 ± 58)). Deep lesions (in proximity to the pyramidal fibers) constituted 15.7% of the total group, superficial lesions 47.4%, lesions with both deep and superficial components 31.5%, and ventricular 5.2%. Mapping of the motor cortex was significantly more successful using the short-train technique than Penfield's technique (84% vs. 25% of trials, respectively), particularly in younger children. The youngest age at which motor mapping was successfully achieved was 3 vs. 93 months for each method, respectively. Preoperative motor strength was not associated with monitorability. Direct cortial motor evoked potential (dcMEP) was more sensitive than transcranial (tcMEP) in predicting postoperative motor decline. dcMEP decline was not associated with tumor grade or extent of resection (EOR); however, it was associated with lesion location and more prone to decline in deep locations. ION actively affected surgical decisions in several aspects, such as altering the corticectomy location and alarming due to a MEP decline. CONCLUSION ION is applicable in the pediatric population with certain limitations, depending mainly on age. When successful, ION has a positive impact on surgical decision-making, ultimately providing an added element of safety for these patients.
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Affiliation(s)
- Jonathan Roth
- Department of Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
| | - Akiva Korn
- Intraoperative Neurophysiological Monitoring Service, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Francesco Sala
- Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | - Haggai Benvenisti
- Department of Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Muna Jubran
- Intraoperative Neurophysiological Monitoring Service, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Yifat Bitan-Talmor
- Intraoperative Neurophysiological Monitoring Service, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Margaret Ekstein
- Department of Anesthesiology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
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12
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Seidel K, Biner MS, Zubak I, Rychen J, Beck J, Raabe A. Continuous dynamic mapping to avoid accidental injury of the facial nerve during surgery for large vestibular schwannomas. Neurosurg Rev 2018; 43:241-248. [PMID: 30367353 DOI: 10.1007/s10143-018-1044-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/23/2018] [Accepted: 10/16/2018] [Indexed: 11/24/2022]
Abstract
In vestibular schwannoma (VS) surgery postoperative facial nerve (CN VII) palsy is reducing quality of life. Recently, we have introduced a surgical suction device for continuous dynamic mapping to provide feedback during tumor resection without switching to a separate stimulation probe. The objective was to evaluate the reliability of this method to avoid CN VII injury. Continuous mapping for CN VII was performed in large VS (08/2014 to 11/2017) additionally to standard neurophysiological techniques. A surgical suction-and-mapping probe was used for surgical dissection and continuous monopolar stimulation. Stimulation was performed with 0.05-2 mA intensities (0.3 msec pulse duration, 2.0 Hz). Postoperative CNVII outcome was assessed by the House-Brackmann-Score (HBS) after 1 week and 3 months following surgery. Twenty patients with Koos III (n = 2; 10%) and Koos IV (n = 18; 90%) VS were included. Preoperative HBS was 1 in 19 patients and 2 in 1 patient. Dynamic mapping reliably indicated the facial nerve when resection was close to 5-10 mm. One week after surgery, 7 patients presented with worsening in HBS. At 3 months, 4 patients' facial weakness had resolved and 3 patients (15%) had an impairment of CN VII (HBS 3 and 4). Of the 3 patients, near-total removal was attempted in 2. The continuous dynamic mapping method using an electrified surgical suction device might be a valuable additional tool in surgery of large VS. It provides real-time feedback indicating the presence of the facial nerve within 5-10 mm depending on stimulation intensity and may help in avoiding accidental injury to the nerve.
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Affiliation(s)
- Kathleen Seidel
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010, Bern, Switzerland.
| | - Matthias S Biner
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010, Bern, Switzerland
| | - Irena Zubak
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010, Bern, Switzerland
| | - Jonathan Rychen
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010, Bern, Switzerland
| | - Jürgen Beck
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010, Bern, Switzerland
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Li Z, Wang M, Zhang L, Fan X, Tao X, Qi L, Ling M, Xiao X, Wu Y, Guo D, Qiao H. Neuronavigation-Guided Corticospinal Tract Mapping in Brainstem Tumor Surgery: Better Preservation of Motor Function. World Neurosurg 2018; 116:e291-e297. [PMID: 29733992 DOI: 10.1016/j.wneu.2018.04.189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate a new technique in brainstem surgery, neuronavigation (NN)-guided corticospinal tract (CST) mapping, in a retrospective study of patients undergoing brainstem tumor surgery. METHODS We studied 40 patients with a brainstem tumor who were enrolled in this study. Patients whose worst preoperative muscle strength of the 4 limbs was greater than 3 levels from normal on the Lovett scale were divided into 2 groups: a treatment group of 21 patients who underwent NN-guided CST mapping and routine intraoperative neurophysiology monitoring (IONM) and a control group of 19 patients who underwent routine NN and IONM. Preoperative muscle strength and postoperative (day 90 postsurgery) muscle strength were assessed and compared between the 2 groups. RESULTS In the NN-guided CST mapping group, 3 patients (14.3%) had a decrease in muscle strength by 1 level postoperatively, and no patient experienced a decrease of >1 level. In the control group, 4 patients (21.1%) had a 1-level decrease in muscle strength, and 5 (26.3%) had a decrease of >1 level. Patients in the NN-guided CST mapping group had significantly better surgical outcomes compared with those in the control group (P = 0.018, Fisher exact test). CONCLUSIONS Brainstem tumor resection using NN-guided CST mapping achieved better preservation of motor function compared with routine NN and IONM. NN-guided CST mapping not only decreased the difficulty of the surgery, but also significantly improved the efficiency of surgery.
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Affiliation(s)
- Zhibao Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neuroelectrophysiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mingran Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neuroelectrophysiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liwei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing Fan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neuroelectrophysiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaorong Tao
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neuroelectrophysiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lei Qi
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neuroelectrophysiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Miao Ling
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neuroelectrophysiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiong Xiao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuliang Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dongze Guo
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neuroelectrophysiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hui Qiao
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neuroelectrophysiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Shahar T, Korn A, Barkay G, Biron T, Hadanny A, Gazit T, Nossek E, Ekstein M, Kesler A, Ram Z. Elaborate mapping of the posterior visual pathway in awake craniotomy. J Neurosurg 2017; 128:1503-1511. [PMID: 28841121 DOI: 10.3171/2017.2.jns162757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Resection of intraaxial tumors adjacent to the optic radiation (OR) may be associated with postoperative visual field (VF) deficits. Intraoperative navigation using MRI-based tractography and electrophysiological monitoring of the visual pathways may allow maximal resection while preserving visual function. In this study, the authors evaluated the value of visual pathway mapping in a series of patients undergoing awake craniotomy for tumor resection. METHODS A retrospective analysis of prospectively collected data was conducted in 18 patients who underwent an awake craniotomy for resection of intraaxial tumors involving or adjacent to the OR. Preoperative MRI-based tractography was used for intraoperative navigation, and intraoperative acquisition of 3D ultrasonography images was performed for real-time imaging and correction of brain shift. Goggles with light-emitting diodes were used as a standard visual stimulus. Direct cortical visual evoked potential (VEP) recording, subcortical recordings from the OR, and subcortical stimulation of the OR were used intraoperatively to assess visual function and proximity of the lesion to the OR. VFs were assessed pre- and postoperatively. RESULTS Baseline cortical VEP recordings were available for 14 patients (77.7%). No association was found between preoperative VF status and baseline presence of cortical VEPs (p = 0.27). Five of the 14 patients (35.7%) who underwent subcortical stimulation of the OR reported seeing phosphenes in the corresponding contralateral VF. There was a positive correlation (r = 0.899, p = 0.04) between the subcortical threshold stimulation intensity (3-11.5 mA) and the distance from the OR. Subcortical recordings from the OR demonstrated a typical VEP waveform in 10 of the 13 evaluated patients (76.9%). These waveforms were present only when recordings were obtained within 10 mm of the OR (p = 0.04). Seven patients (38.9%) had postoperative VF deterioration, and it was associated with a length of < 8 mm between the tumor and the OR (p = 0.05). CONCLUSIONS Intraoperative electrophysiological monitoring of the visual pathways is feasible but may be of limited value in preserving the functional integrity of the posterior visual pathways. Subcortical stimulation of the OR may identify the location of the OR when done in proximity to the pathways, but such proximity may be associated with increased risk of postoperative worsening of the VF deficit.
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Affiliation(s)
| | | | | | | | | | - Tomer Gazit
- 2Tel-Aviv Center for Brain Functions, Wohl Institute for Advanced Imaging
| | | | | | - Anat Kesler
- 4Department of Ophthalmology, Neuro-Ophthalmology Unit, Tel Aviv Medical Center (affiliated with Sackler Faculty of Medicine, Tel Aviv University), Tel Aviv, Israel
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Abstract
Advances in electrophysiological monitoring have improved the ability of surgeons to make decisions and minimize the risks of complications during surgery and interventional procedures when the central nervous system (CNS) is at risk. Individual techniques have become important for identifying or mapping the location and pathway of critical neural structures. These techniques are also used to monitor the progress of procedures to augment surgical and physiologic management so as to reduce the risk of CNS injury. Advances in motor evoked potentials have facilitated mapping and monitoring of the motor tracts in newer, more complex procedures.
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Affiliation(s)
- Antoun Koht
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, 251 East Huron Street, F5-704, Chicago, IL 60611, USA; Department of Neurology, Northwestern University, 251 East Huron Street, F5-704, Chicago, IL 60611, USA; Department of Neurosurgery, Northwestern University, 251 East Huron Street, F5-704, Chicago, IL 60611, USA.
| | - Tod B Sloan
- Department of Anesthesiology, School of Medicine, University of Colorado, 571 Cambridge Drive, Fairview, TX 75069, USA
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Singh H, Vogel RW, Lober RM, Doan AT, Matsumoto CI, Kenning TJ, Evans JJ. Intraoperative Neurophysiological Monitoring for Endoscopic Endonasal Approaches to the Skull Base: A Technical Guide. SCIENTIFICA 2016; 2016:1751245. [PMID: 27293965 PMCID: PMC4886091 DOI: 10.1155/2016/1751245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 04/04/2016] [Accepted: 04/11/2016] [Indexed: 06/06/2023]
Abstract
Intraoperative neurophysiological monitoring during endoscopic, endonasal approaches to the skull base is both feasible and safe. Numerous reports have recently emerged from the literature evaluating the efficacy of different neuromonitoring tests during endonasal procedures, making them relatively well-studied. The authors report on a comprehensive, multimodality approach to monitoring the functional integrity of at risk nervous system structures, including the cerebral cortex, brainstem, cranial nerves, corticospinal tract, corticobulbar tract, and the thalamocortical somatosensory system during endonasal surgery of the skull base. The modalities employed include electroencephalography, somatosensory evoked potentials, free-running and electrically triggered electromyography, transcranial electric motor evoked potentials, and auditory evoked potentials. Methodological considerations as well as benefits and limitations are discussed. The authors argue that, while individual modalities have their limitations, multimodality neuromonitoring provides a real-time, comprehensive assessment of nervous system function and allows for safer, more aggressive management of skull base tumors via the endonasal route.
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Affiliation(s)
- Harminder Singh
- Stanford Hospitals and Clinics, Department of Neurosurgery, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Richard W. Vogel
- Safe Passage Neuromonitoring, 915 Broadway, Suite 1200, New York, NY 10010, USA
| | - Robert M. Lober
- Stanford Hospitals and Clinics, Department of Neurosurgery, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Adam T. Doan
- Safe Passage Neuromonitoring, 915 Broadway, Suite 1200, New York, NY 10010, USA
| | - Craig I. Matsumoto
- Sentient Medical Systems, 11011 McCormick Road, Suite 200, Hunt Valley, MD 21031, USA
| | - Tyler J. Kenning
- Department of Neurosurgery, Albany Medical Center, Physicians Pavilion, First Floor, 47 New Scotland Avenue, MC 10, Albany, NY 12208, USA
| | - James J. Evans
- Thomas Jefferson University Hospital, Department of Neurosurgery, 909 Walnut Street, Third Floor, Philadelphia, PA 19107, USA
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Abstract
Improved neuronavigation guidance as well as intraoperative imaging and neurophysiologic monitoring technologies have enhanced the ability of neurosurgeons to resect focal brainstem gliomas. In contrast, diffuse brainstem gliomas are considered to be inoperable lesions. This article is a continuation of an article that discussed brainstem glioma diagnostics, imaging, and classification. Here, we address open surgical treatment of and approaches to focal, dorsally exophytic, and cervicomedullary brainstem gliomas. Intraoperative neuronavigation, intraoperative neurophysiologic monitoring, as well as intraoperative imaging are discussed as adjunctive measures to help render these procedures safer, more acute, and closer to achieving surgical goals.
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Affiliation(s)
- Abdulrahman J Sabbagh
- Department of Pediatric Neurosurgery, National Neurosciences Institute, King Fahd Medical City, Riyadh, Kingdom of Saudi Arabia. Tel. +966 (11) 2889999 Ext. 8211, 2305. Fax. +966 (11) 2889999 Ext 1391. E-mail:
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18
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Abstract
The complex neuroanatomy of the brainstem and the additional distortion incurred by intrinsic lesions have previously discouraged aggressive neurosurgical procedures. Safe access to the brainstem and complete lesionectomy has been thwarted by considerable perioperative risk. Brainstem mapping has established itself as one of the means by which modern neurosurgery can improve surgical outcome while decreasing morbidity. It involves the use of neurophysiologic techniques for the identification of critical structures, such as the cranial motor nuclei and their nerves, and the corticobulbar and corticospinal tracts at different stages of the operation. Familiarity with these techniques can map a safe corridor toward a brainstem lesion and guide the surgeon during the resection. By means of reviewing the available literature, we discuss the anatomic, pathophysiologic, technical, and interpretational aspects of brainstem mapping and elaborate on its indications, limitations, and future directions.
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Verst SM, Sucena AC, Maldaun MVC, Aguiar PHP. Effectiveness of C5 or C6-Cz assembly in predicting immediate post operative facial nerve deficit. Acta Neurochir (Wien) 2013; 155:1863-9. [PMID: 23864399 DOI: 10.1007/s00701-013-1806-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 06/21/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Intraoperative neurophysiology monitoring (IOM) is a valuable tool in cerebellopontine angle (CPA) surgeries posing risk to the cranial nerves. Transcranial electrical stimulation (TES) for cranial nerves has been performed in the last 7 years, for obtaining the facial nerve motor evoked potential (MEP), using either C3/C4-Cz or C3-C4 (or inverse) stimulating points, which have been correlated with facial nerve functional outcome. METHOD Intraoperative surgical and electrophysiological findings were documented prospectively. Patient files were reviewed for clinical data. We studied 23 patients undergoing CPA tumor resection using C5 or C6-Cz montage for TES, and were able to determine the correlation between facial nerve functional outcome and the amplitude drop of facial MEP above 50 %. Patients were evaluated for immediate facial nerve outcome and 6 months after the surgery. Follow-up was performed by structured telephone interviews with local physicians. RESULTS The sensibility of the studied parameters was 92.8 % for amplitude drop of facial nerve MEP, with positive predictive value of 81.2 %. The absence of changes during IOM has shown a negative predictive value of 100 %. CONCLUSION In this series, the used montage was effective in predicting new facial deficit.
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Affiliation(s)
- Silvia Mazzali Verst
- Post-Graduation Department, São Paulo Medical School, University of Sao Paulo, São Paulo, Brazil,
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20
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Alternative sites for intraoperative monitoring of cranial nerves X and XII during intracranial surgeries. J Clin Neurophysiol 2013; 30:275-9. [PMID: 23733092 DOI: 10.1097/wnp.0b013e3182933c2a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
During intracranial surgeries, cranial nerve (CN) X is most commonly monitored with electromyographic endotracheal tubes. Electrodes on these endotracheal tubes may be displaced from the vocal folds during positioning, and there is a learning curve for their correct placement. Cranial nerve XII is most commonly monitored with electrodes in the dorsum of the tongue, which are also prone to displacement because of their proximity to the endotracheal tube. A retrospective review was conducted of a consecutive series of 83 skull base surgeries using alternative sites for monitoring CN X and XII. On-going (spontaneous) and evoked electromyography (EMG) were obtained from the cricothyroid muscle for CN X and submental genioglossus for CN XII. Stimulation of CN X or XII evoked specific compound motor action potentials from these muscles, and well-defined on-going EMG was observed during tumor resection in the vicinity of CN X and XII. Volume-conducted responses from the adjacent platysma muscle during CN VII stimulation were identified by concomitant responses from the orbicularis oris and oculi. In conclusion, during skull base surgeries, CN X may be monitored with electrodes in the cricothyroid muscle and CN XII with electrodes in the submental genioglossus. These alternative sites are less prone to displacement of electrodes compared with the more commonly used EMG endotracheal tube and electrodes in the dorsum of the tongue. The cricothyroid muscle should not be used when the recurrent laryngeal nerve is at risk.
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The efficacy of a biopsy of intrinsic brainstem lesions for decision making of the treatments. Childs Nerv Syst 2013; 29:833-7. [PMID: 23377758 DOI: 10.1007/s00381-013-2042-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 01/25/2013] [Indexed: 10/27/2022]
Abstract
OBJECT The diagnosis of diffuse intrinsic pontine gliomas (DIPGs) has been generally made mainly by magnetic resonance imaging (MRI) and clinical course. However, the accuracy of MRI-based diagnosis has not been fully confirmed yet. Our aim was to review efficacy of biopsy for decision making of the treatments. METHODS We retrospectively analyzed pediatric patients undergoing biopsy for intrinsic brainstem lesions which were considered atypical for DIPGs by MRI findings. The lesion was evaluated atypical when it extended beyond the pons or it had a well-margined localized enhancing portion. RESULTS Seven patients underwent biopsy. Preoperative MRI revealed a lesion extending beyond the pons in five patients and a focal enhancing lesion in four. Two patients had both of these. Open biopsy was performed via midline suboccipital approach in six patients and retrosigmoid approach in one. No intraoperative complications were observed. Histopathological examination revealed diffuse brainstem glioma in five patients, primitive neuroectodermal tumor (PNET) in one, and pilocytic astrocytoma in one. In the case with PNET, chemotherapy and radiotherapy were effective and the patient had been stable for 12 months without recurrence. The patient with pilocytic astrocytoma did not undergo radiotherapy and has been stable without regrowth of the tumor for 9 months. CONCLUSIONS Open biopsy of intrinsic brainstem lesions is considered to be safe and effective for selecting an appropriate course of therapy. Patients with intrinsic pontine lesions which extend beyond the pons or with localized enhancing portion seem to be benefited from the biopsy.
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Abstract
This article focuses on the application of neurophysiologic monitoring in uniquely neurosurgical procedures. Neurophysiologic monitoring provides functional testing and mapping to identify neural structures. Once identified, the functionality of the central and peripheral nervous system areas at risk for neurosurgical injury can be monitored. It discusses the use of motor-evoked potentials, sensory evoked potentials, electromyography and electroencephalography to assess neurologic change.
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Affiliation(s)
- Leslie C Jameson
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, 12401 East 17th Avenue, Aurora, CO 80045, USA.
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Comparison between the C5 or C6-Cz electrode assembly and C3 or C4-Cz assembly for transcranial electric motor activation of muscular response of the contralateral facial nerve. Acta Neurochir (Wien) 2012; 154:2229-35. [PMID: 23053280 DOI: 10.1007/s00701-012-1505-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 09/13/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We used an assembly of electrodes C3 and C4-Cz in order to activate the motor cortical area of the corticobulbar tract to elucidate the motor-evoked potential of the contralateral mentalis muscle. METHOD We compared this setup to that of an assembly with electrodes C5 or C6-Cz using a train of electrical pulses and a single electrical pulse. This analysis was made in 23 consecutive patients who underwent several varied surgeries and were prospectively operated on at Santa Paula Hospital between January and June 2011. RESULTS The results showed that the assembly with C5 or C6-Cz produced a multisynaptic motor-evoked potential in the contralateral mentalis muscle in 86.9 % of the patients, whereas 82.6 % of patients stimulated at points C3 or C4-Cz presented the same response. However, both assemblies showed similar behavior with the use of a single electrical pulse for peripheral contralateral nerve stimulation. CONCLUSION We concluded that the C5 or C6-Cz assembly was similar to C3 or C4-Cz in obtaining a multisynaptic response in the contralateral mentalis muscle, although it required less intensive stimulation than the C3 or C4- Cz assembly.
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25
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Neurophysiologic Intraoperative Monitoring of Trigeminal and Facial Nerves. J Clin Neurophysiol 2011; 28:551-65. [DOI: 10.1097/wnp.0b013e318241de1a] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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