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Guzzi G, Ricciuti RA, Della Torre A, Lo Turco E, Lavano A, Longhini F, La Torre D. Intraoperative Neurophysiological Monitoring in Neurosurgery. J Clin Med 2024; 13:2966. [PMID: 38792507 PMCID: PMC11122101 DOI: 10.3390/jcm13102966] [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: 04/16/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Intraoperative neurophysiological monitoring (IONM) is a crucial advancement in neurosurgery, enhancing procedural safety and precision. This technique involves continuous real-time assessment of neurophysiological signals, aiding surgeons in timely interventions to protect neural structures. In addition to inherent limitations, IONM necessitates a detailed anesthetic plan for accurate signal recording. Given the growing importance of IONM in neurosurgery, we conducted a narrative review including the most relevant studies about the modalities and their application in different fields of neurosurgery. In particular, this review provides insights for all physicians and healthcare professionals unfamiliar with IONM, elucidating commonly used techniques in neurosurgery. In particular, it discusses the roles of IONM in various neurosurgical settings such as tumoral brain resection, neurovascular surgery, epilepsy surgery, spinal surgery, and peripheral nerve surgery. Furthermore, it offers an overview of the anesthesiologic strategies and limitations of techniques essential for the effective implementation of IONM.
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Affiliation(s)
- Giusy Guzzi
- Neurosurgery Department, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
| | | | - Attilio Della Torre
- Neurosurgery Department, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
| | - Erica Lo Turco
- Neurosurgery Department, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
| | - Angelo Lavano
- Neurosurgery Department, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
| | - Federico Longhini
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
- Anesthesia and Intensive Care Unit, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
| | - Domenico La Torre
- Neurosurgery Department, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
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Telleman JA, Sneag DB, Visser LH. The role of imaging in focal neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:19-42. [PMID: 38697740 DOI: 10.1016/b978-0-323-90108-6.00001-6] [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: 05/05/2024]
Abstract
Electrodiagnostic testing (EDX) has been the diagnostic tool of choice in peripheral nerve disease for many years, but in recent years, peripheral nerve imaging has been used ever more frequently in daily clinical practice. Nerve ultrasound and magnetic resonance (MR) neurography are able to visualize nerve structures reliably. These techniques can aid in localizing nerve pathology and can reveal significant anatomical abnormalities underlying nerve pathology that may have been otherwise undetected by EDX. As such, nerve ultrasound and MR neurography can significantly improve diagnostic accuracy and can have a significant effect on treatment strategy. In this chapter, the basic principles and recent developments of these techniques will be discussed, as well as their potential application in several types of peripheral nerve disease, such as carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow (UNE), radial neuropathy, brachial and lumbosacral plexopathy, neuralgic amyotrophy (NA), fibular, tibial, sciatic, femoral neuropathy, meralgia paresthetica, peripheral nerve trauma, tumors, and inflammatory neuropathies.
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Affiliation(s)
- Johan A Telleman
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States
| | - Leo H Visser
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
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Yalikun A, Yushan M, Hamiti Y, Lu C, Yusufu A. Intraneural or extraneural ganglion cysts as a cause of cubital tunnel syndrome: A retrospective observational study. Front Neurol 2022; 13:921811. [PMID: 35989915 PMCID: PMC9388826 DOI: 10.3389/fneur.2022.921811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/13/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose Cubital tunnel syndrome caused by ganglion cysts has rarely been reported. The purpose of this study was to evaluate the surgical treatment outcomes of a patient diagnosed with cubital tunnel syndrome caused by intraneural or extraneural cysts and to summarize our experience. Method In total, 34 patients were evaluated retrospectively from January 2011 to January 2020 with a follow-up of more than 24 months. Preoperative data, such as demographic data, clinical symptoms, physical examination findings, and laboratory tests, were all recorded and pre-operative and post-operative data were compared. The function was evaluated by the modified Bishop scoring system and the McGowan grade at the last follow-up. Results Improvement of interosseous muscle strength, the Visual Analog Scale (VAS), 2-point discrimination (2-PD), electromyogram (EMG) result, Wartenberg sign, claw hand, and weakness could be clearly observed in all patients. Extraneural cysts were completely removed and the pedicles of the cysts were ligated. Intraneural cysts were incised and drained, and part of their cyst walls were removed using a microsurgical technique. All patients underwent anterior subcutaneous transposition (AST). At the last follow-up, McGowan's (0-IIa) grade increased from seven patients (20.6%) preoperatively to 27 patients (79.4%); the excellent and good rate according to the modified Bishop scoring system was 82.4% (28 patients), and all patients had no symptoms of recurrence after surgery. Conclusion The treatment of cubital tunnel syndrome caused by intraneural or extraneural cysts achieved good long-term results through extraneural cyst resection or intraneural cyst incision and drainage combined with subcutaneous transposition. Early diagnosis and surgical treatment are essential for the patient's postoperative recovery.
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Affiliation(s)
| | | | | | | | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Jorgensen SP, Cartwright MS, Norbury J. Neuromuscular Ultrasound: Indications in the Electrodiagnostic Laboratory. Am J Phys Med Rehabil 2022; 101:78-88. [PMID: 33990480 DOI: 10.1097/phm.0000000000001790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Accurate assessment of neuromuscular disorders is critical to facilitate timely treatment and achieve the best outcomes. Historically, electrodiagnostic studies have filled this role, but recently, neuromuscular ultrasound is being used in the electrodiagnostic laboratory. This review discusses the uses of neuromuscular ultrasound in the electrodiagnostic laboratory that have strong evidence, emphasizing those that could be adopted in a typical electrodiagnostic laboratory with a reasonable level of equipment and training. The evidence currently supports using neuromuscular ultrasound to diagnose carpal tunnel syndrome and ulnar neuropathies at the elbow and as a supplementary test when electrodiagnostic studies are suspected to be falsely negative or in axonal nonlocalizing lesions. Neuromuscular ultrasound can identify the causes of focal mononeuropathies, which can change treatment in specific cases. It is sensitive at identifying fasciculations and providing complementary evidence of autoimmune demyelinating polyneuropathies. It is particularly helpful in assessing nerves after trauma. Neuromuscular ultrasound is likely to prove even more useful in the electrodiagnostic laboratory as the technology continues to advance.
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Affiliation(s)
- Shawn P Jorgensen
- From the Department of Physical Medicine and Rehabilitation, Albany Medical College, Albany, New York (SPJ); Department of Family Medicine, Larner Medical College at the University of Vermont, Burlington, Vermont (SPJ); Adirondack Rehabilitation Medicine, PLLC, Queensbury, New York (SPJ); Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina (MSC); and Division of Physical Medicine and Rehabilitation, Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas (JN)
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Kim JS, Shah GM, Chae YJ, Hwang JS, Ahn JM, Gong HS. Ulnar nerve morphology on magnetic resonance imaging predicts nerve recovery after surgery for cubital tunnel syndrome. HAND SURGERY & REHABILITATION 2021; 41:90-95. [PMID: 34763114 DOI: 10.1016/j.hansur.2021.10.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
Magnetic resonance imaging (MRI) can evaluate nerve morphology in cubital tunnel syndrome (CuTS), but its value in predicting surgical outcome is unclear. The purpose of this study was to determine whether ulnar nerve morphology on MRI correlated with outcome after CuTS surgery. We reviewed 40 patients who had preoperative MRI and electrodiagnostic (EDX) examinations for CuTS and outcome evaluation 6 months and 2 years postoperatively. Using MRI, ulnar nerve cross-sectional area (UNCSA), changes in signal intensity, and any space-occupying lesion were evaluated. Other factors assessed were age, symptom duration and severity, type-2 diabetes and EDX parameters. Factors associated with unfavorable surgical outcome were identified. At 6 months postoperatively, 12 patients (30%) had excellent, 19 (47.5%) good, 8 (20%) fair and 1 (2.5%) poor results on modified Wilson-Krout criteria. On univariate analysis, unfavorable outcomes were associated with increased UNCSA, space-occupying lesion, and decreased motor nerve conduction velocity (mNCV), and on multivariate analysis with increased UNCSA 1 cm distal from the epicondyle only (model 1) or increased UNCSA 1 cm proximal from the epicondyle and decreased mNCV (model 2). At 2 years, 15 patients (37.5%) had excellent, 21 (52.5%) good, 3 (7.5%) fair and 1 (2.5%) poor results, and no factors correlated with unfavorable outcome. Increased UNCSA on MRI was associated with unfavorable outcome at 6 months but not at 2 years. This study suggests that morphologic ulnar nerve changes can predict delayed nerve recovery after surgery for CuTS.
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Affiliation(s)
- J S Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - G M Shah
- Department of Orthopedics and Trauma Surgery, Patan Academy of Health Sciences, Lagankhel-5, 44700 Bagmati, Nepal
| | - Y J Chae
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - J S Hwang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
| | - J M Ahn
- Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - H S Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
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Limbekar NS, Soong MC, Vytopil MM, Blanchet DT, Paci GM, Ho DT. High-Resolution Ultrasound in the Diagnosis and Surgical Management of Ulnar Neuropathy at the Elbow. Orthopedics 2021; 44:285-288. [PMID: 34590945 DOI: 10.3928/01477447-20210819-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
High-resolution ultrasound (HRU) has recently demonstrated the potential to facilitate diagnosis and treatment of upper extremity compression neuropathy. The authors hypothesized that HRU can improve preoperative evaluation of ulnar neuropathy at the elbow (UNE) and that changes in ulnar nerve cross-sectional area (CSA) after cubital tunnel release may correlate with outcomes. Nineteen adult patients diagnosed with UNE who were scheduled for surgical decompression by a single hand surgeon were enrolled. Electrodiagnostic (EDX) testing, HRU of the ulnar nerve, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and McGowan grade were obtained pre- and postoperatively. Fourteen patients completed the study. Statistically significant improvements were found in CSA measurements and QuickDASH scores. High-resolution ultra-sound was found to confirm UNE in all 7 patients with positive results on EDX, and additionally detected UNE in 3 of 6 patients with negative results on EDX and in 1 patient with equivocal (nonlocalized) EDX testing. All 4 of these additional HRU-detected cases improved clinically and by CSA measurements after surgery. In this series, HRU was superior to EDX testing in the diagnosis of UNE and demonstrated objective improvement in ulnar nerve CSA after successful cubital tunnel release. This modality, which is better tolerated, less costly, and less time-consuming than EDX testing or magnetic resonance imaging, should therefore be considered in the diagnosis and surgical management of UNE, particularly in cases with negative or equivocal results on EDX testing, or when outcomes are suboptimal. [Orthopedics. 2021;44(5):285-288.].
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Egiazaryan KA, Chulovskaya IG, Skvortsova MA, Lobachev EV, Ershov NS. STUDY OF EFFICIENCY OF SURGICAL TREATMENT OF TUNNEL NEUROPATHY OF THE UPPER EXTREMITY AT ELDERLY PATIENTS. SURGICAL PRACTICE 2020. [DOI: 10.38181/2223-2427-2020-2-15-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The research objective are the assessment and increase in efficiency of treatment of tunnel neuropathy of the upper extremities at patients aged from 60 years and also more senior.Material and methods - the examination and the subsequent treatment of 115 patients of age category 60 years and more senior with compression pathology of nerves of the upper extremity. Diagnostic process included clinical examination, an ultrasonography, an electroneuromyography (EMG).Results - total number of cases of neuropathy is 140 at 115 patients due to the multiple combined compression of nerves in several channels in 25 cases. All patients included in a research had performed open decompression of a nerve . The excellent result was received at 32 (27.8%) patients, good - in 68 (59.1%) cases, satisfactory - at 13 (11.3%) patients, unsatisfactory - at 2 (1.7%) patients.The conclusion - expeditious treatment of tunnel neuropathy at elderly patients allows to improve quality of life of patients and gives low level of complications.
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Affiliation(s)
- K. A. Egiazaryan
- Pirogov Russian National Research Medical University Of Ministry Of Healthcare Of The Russian Federation (RNRMU)
| | - I. G. Chulovskaya
- Pirogov Russian National Research Medical University Of Ministry Of Healthcare Of The Russian Federation (RNRMU); The Stand-Alone Structural Unit of the Pirogov Russian National Research Medical University the "Russian Clinical Research Center for Gerontology" of the Ministry of Healthcare of the Russian Federation
| | - M. A. Skvortsova
- Pirogov Russian National Research Medical University Of Ministry Of Healthcare Of The Russian Federation (RNRMU)
| | - E. V. Lobachev
- The Stand-Alone Structural Unit of the Pirogov Russian National Research Medical University the "Russian Clinical Research Center for Gerontology" of the Ministry of Healthcare of the Russian Federation
| | - N. S. Ershov
- Pirogov Russian National Research Medical University Of Ministry Of Healthcare Of The Russian Federation (RNRMU)
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Abstract
Nerve imaging is an important component in the assessment of patients presenting with suspected peripheral nerve pathology. Although magnetic resonance neurography and ultrasound are the most commonly utilized techniques, several promising new modalities are on the horizon. Nerve imaging is useful in localizing the nerve injury, determining the severity, providing prognostic information, helping establish the diagnosis, and helping guide surgical decision making. The focus of this article is imaging of damaged nerves, focusing on nerve injuries and entrapment neuropathies.
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Affiliation(s)
- David A Purger
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Sarada Sakamuri
- Department of Neurology and Neurological Sciences, 213 Quarry Road, MC 5979, Palo Alto, CA 94304, USA
| | - Nicholas F Hug
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Sandip Biswal
- Department of Radiology, Stanford University, 300 Pasteur Drive, S-068B, Stanford, CA 94305, USA
| | - Thomas J Wilson
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, R293, Stanford, CA 94305, USA.
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Rayegani SM, Raeissadat SA, Kargozar E, Rahimi-Dehgolan S, Loni E. Diagnostic value of ultrasonography versus electrodiagnosis in ulnar neuropathy. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:81-88. [PMID: 30863191 PMCID: PMC6390865 DOI: 10.2147/mder.s196106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose Ulnar neuropathy at elbow is the second-most common compression neuropathy. The main aim of this study was to assess the diagnostic value of ultrasonography (US) as an alternative method to electrodiagnosis (EDX), which had traditionally been used as the method of choice. Methods This diagnostic study was conducted on 66 participants (32 patients` elbows and 34 normal elbows) referred for EDX. Both groups were reassessed by US to evaluate the consistency of the two tests. The quantitative parameters of US, such as cross-sectional area (CSA) of the ulnar nerve at three different levels around the medial epicondyle (ME) were compared between groups. Results Our findings demonstrated that CSA at the ME and 2 cm distal to the ME were significantly larger in the patient group than normal participants. This higher nerve size was more prominent among those who had predominant axonal loss rather than demyelinating lesions (P<0.01). Finally, we evaluated US diagnostic value with the best singular feature (2 cm distal to ME) at a cutoff of 9 mm2, which revealed specificity of 80% and sensitivity 84%. Conclusion Based on these results we can conclude that US is a sensitive and specific method in diagnosing ulnar neuropathy at the elbow and can be used as an acceptable complementary method, in particular when EDX is not available.
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Affiliation(s)
- Seyed Mansoor Rayegani
- Physical Medicine and Rehabilitation Department and Research Center, Shohada-e-Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad Raeissadat
- Clinical Development Research Center of Shahid Modarres Hospital, Physical Medicine and Rehabilitation Department and Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Kargozar
- Physical Medicine and Rehabilitation Department, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Shahram Rahimi-Dehgolan
- Physical Medicine and Rehabilitation Department, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Elham Loni
- Physical Medicine and Rehabilitation Department, Rofaydeh Rehabilitation Hospital, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran,
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