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Dauleac C, Boulogne S, Barrey CY, Guyotat J, Jouanneau E, Mertens P, Berhouma M, Jung J, André-Obadia N. Predictors of functional outcome after spinal cord surgery: Relevance of intraoperative neurophysiological monitoring combined with preoperative neurophysiological and MRI assessments. Neurophysiol Clin 2022; 52:242-251. [PMID: 35396150 DOI: 10.1016/j.neucli.2022.03.004] [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: 12/13/2021] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To assess the accuracy of intraoperative neurophysiological monitoring (IONM) in predicting immediate and 3-month postoperative neurological new deficit (or deterioration) in patients benefiting from spinal cord (SC) surgery; and to identify factors associated with a higher risk of postoperative clinical worsening. METHODS Consecutive patients who underwent SC surgery with IONM were included. Pre and postoperative clinical (modified McCormick scale), radiological (lesion-occupying area ratio), and electrophysiological features were collected. RESULTS A total of 99 patients were included: 14 (14.1%) underwent extradural surgery, 50 (50.5%) intradural extramedullary surgery, and 35 (35.4%) intramedullary surgery. Cumulatively, multimodal IONM (motor and somatosensory evoked potentials, D-wave whenever possible) significantly predicted postoperative deficits (p<0.001), with a sensitivity, specificity, positive predictive value, and negative predictive value of 0.81, 0.93, 0.83, and 0.92, respectively. Sixty (60.6%) patients displayed no IONM change, whereas 39 (39.4%) displayed IONM worsening. In multivariate analysis, predictors for postoperative clinical worsening were: abnormal preoperative electrophysiological assessment (p=0.03), intramedullary tumor (p<0.001), lesion-occupying area ratio ≥0.7 (p<0.001), and IONM alterations (p<0.001). Three months after the surgical procedure, in patients presenting at least one of the risk factors described above, 45/81 (55.6%) and 19/81 (23.5%) were clinically and electrophysiologically improved, respectively; while 13/81 (16.0%) and 10/81 (12.3%) were clinically and electrophysiologically worsened. CONCLUSION Multimodal IONM is an essential tool to guide SC surgery, and enables the accurate prediction of postoperative neurological outcome. Specific attention should be given to patients presenting with preoperative electrophysiological abnormalities, large tumor volume, and intramedullary tumor location.
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Affiliation(s)
- Corentin Dauleac
- Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Service de Neurologie Fonctionnelle et Epileptologie, Lyon, France; Université Lyon I, Université Claude Bernard, Lyon, France; Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, INSA-Lyon; Université de Lyon I, Lyon, France.
| | - Sébastien Boulogne
- Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Service de Neurologie Fonctionnelle et Epileptologie, Lyon, France; Université Lyon I, Université Claude Bernard, Lyon, France; Centre de Recherche de Neurosciences de Lyon, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, F-69000 Lyon, France
| | - Cédric Y Barrey
- Université Lyon I, Université Claude Bernard, Lyon, France; Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Service de Neurochirurgie C, Lyon, France
| | - Jacques Guyotat
- Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Service de Neurochirurgie D, Lyon, France
| | - Emmanuel Jouanneau
- Université Lyon I, Université Claude Bernard, Lyon, France; Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Service de Neurochirurgie B, Lyon, France
| | - Patrick Mertens
- Université Lyon I, Université Claude Bernard, Lyon, France; Centre de Recherche de Neurosciences de Lyon, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, F-69000 Lyon, France; Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Service de Neurochirurgie A, Lyon, France
| | - Moncef Berhouma
- Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Service de Neurologie Fonctionnelle et Epileptologie, Lyon, France; Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, INSA-Lyon; Université de Lyon I, Lyon, France; Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Service de Neurochirurgie D, Lyon, France
| | - Julien Jung
- Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Service de Neurologie Fonctionnelle et Epileptologie, Lyon, France; Université Lyon I, Université Claude Bernard, Lyon, France; Centre de Recherche de Neurosciences de Lyon, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, F-69000 Lyon, France
| | - Nathalie André-Obadia
- Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Service de Neurologie Fonctionnelle et Epileptologie, Lyon, France; Université Lyon I, Université Claude Bernard, Lyon, France; Centre de Recherche de Neurosciences de Lyon, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, F-69000 Lyon, France
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Delval A, Girard B, Lacan L, Chaton L, Flamein F, Storme L, Derambure P, The Tich SN, Lamblin MD, Betrouni N. Neurophysiological recordings improve the accuracy of the evaluation of the outcome in perinatal hypoxic ischemic encephalopathy. Eur J Paediatr Neurol 2022; 36:51-56. [PMID: 34890946 DOI: 10.1016/j.ejpn.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 09/20/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Our objective was to evaluate the potential additional value of electroencephalogram (EEG) and evoked potentials in neonates with hypoxic-ischemic encephalopathy to predict their disability at 1 and 2 years old. METHODS 30 full-term infants after perinatal asphyxia who underwent therapeutic hypothermia were evaluated at 1 year and 2 years for disability using International Classification of Functioning, Disability and Health classification. Scores for EEG, sensory evoked potentials and brainstem auditory evoked potentials were evaluated after withdrawal of therapeutic hypothermia that lasted 72 h. A regression approach was investigated to build models allowing to distinguish neonates according to their disability at 1 and 2 years. Two models were built, the first by considering the clinical data and EEG before and after therapeutic hypothermia and the second by incorporating evoked potentials recording. RESULTS Adding EEG and evoked potentials data after rewarming improved dramatically the accuracy of the model considering outcome at 1 and 2 years. INTERPRETATION We propose to record systematically EEG and evoked potentials following rewarming to predict the outcome of neonates with hypoxic ischemic encephalopathy. Combination of altered evoked potentials with no improvement of EEG after rewarming appeared to be a robust criterion for a poor outcome.
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Affiliation(s)
- Arnaud Delval
- Univ. Lille, Inserm, U1172 - Lille, Neuroscience Cognition, F-59000, Lille, France; Clinical Neurophysiology Department, Lille University Medical Center, F-59000, Lille, France.
| | - Barbara Girard
- Children Department of Physical Medicine and Rehabilitation, Institut Régional de Réadaptation, Flavigny sur Moselle, France
| | - Laure Lacan
- EA4489, Environnement Périnatal et Santé, Faculté de Médecine, Université de Lille, France; Pediatric Neurology Department, Lille University Medical Center, F-59000, Lille, France
| | - Laurence Chaton
- Clinical Neurophysiology Department, Lille University Medical Center, F-59000, Lille, France
| | - Florence Flamein
- EA4489, Environnement Périnatal et Santé, Faculté de Médecine, Université de Lille, France
| | - Laurent Storme
- Pediatric Neurology Department, Lille University Medical Center, F-59000, Lille, France
| | - Philippe Derambure
- Univ. Lille, Inserm, U1172 - Lille, Neuroscience Cognition, F-59000, Lille, France; Clinical Neurophysiology Department, Lille University Medical Center, F-59000, Lille, France
| | - Sylvie Nguyen The Tich
- EA4489, Environnement Périnatal et Santé, Faculté de Médecine, Université de Lille, France; Pediatric Neurology Department, Lille University Medical Center, F-59000, Lille, France
| | - Marie-Dominique Lamblin
- Clinical Neurophysiology Department, Lille University Medical Center, F-59000, Lille, France
| | - Nacim Betrouni
- Univ. Lille, Inserm, U1172 - Lille, Neuroscience Cognition, F-59000, Lille, France
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Rossi L, Bianchi AM, Merzagora A, Gaggiani A, Cerutti S, Bracchi F. Single trial somatosensory evoked potential extraction with ARX filtering for a combined spinal cord intraoperative neuromonitoring technique. Biomed Eng Online 2007; 6:2. [PMID: 17204138 PMCID: PMC1770921 DOI: 10.1186/1475-925x-6-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Accepted: 01/04/2007] [Indexed: 11/10/2022] Open
Abstract
Background When spinal cord functional integrity is at risk during surgery, intraoperative neuromonitoring is recommended. Tibial Single Trial Somatosensory Evoked Potentials (SEPs) and H-reflex are here used in a combined neuromonitoring method: both signals monitor the spinal cord status, though involving different nervous pathways. However, SEPs express a trial-to-trial variability that is difficult to track because of the intrinsic low signal-to-noise ratio. For this reason single trial techniques are needed to extract SEPs from the background EEG. Methods The analysis is performed off line on data recorded in eight scoliosis surgery sessions during which the spinal cord was simultaneously monitored through classical SEPs and H-reflex responses elicited by the same tibial nerve electrical stimulation. The single trial extraction of SEPs from the background EEG is here performed through AutoRegressive filter with eXogenous input (ARX). The electroencephalographic recording can be modeled as the sum of the background EEG, which can be described as an autoregressive process not related to the stimulus, and the evoked potential (EP), which can be viewed as a filtered version of a reference signal related to the stimulus. The choice of the filter optimal orders is based on the Akaike Information Criterion (AIC). The reference signal used as exogenous input in the ARX model is a weighted average of the previous SEPs trials with exponential forgetting behavior. Results The moving average exponentially weighted, used as reference signal for the ARX model, shows a better sensibility than the standard moving average in tracking SEPs fast inter-trial changes. The ability to promptly detect changes allows highlighting relations between waveform changes and surgical maneuvers. It also allows a comparative study with H-reflex trends: in particular, the two signals show different fall and recovery dynamics following stressful conditions for the spinal cord. Conclusion The ARX filter showed good performances in single trial SEP extraction, enhancing the available information concerning the current spinal cord status. Moreover, the comparison between SEPs and H-reflex showed that the two signals are affected by the same surgical maneuvers, even if they monitor the spinal cord through anatomically different pathways.
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Affiliation(s)
- Lorenzo Rossi
- Department of Human Physiology, University of Milan, Italy
- Department of Biomedical Engineering, Polytechnic of Milan, Italy
| | | | - Anna Merzagora
- Department of Biomedical Engineering, Polytechnic of Milan, Italy
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | | | - Sergio Cerutti
- Department of Biomedical Engineering, Polytechnic of Milan, Italy
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MacDonald DB, Al Zayed Z, Khoudeir I, Stigsby B. Monitoring scoliosis surgery with combined multiple pulse transcranial electric motor and cortical somatosensory-evoked potentials from the lower and upper extremities. Spine (Phila Pa 1976) 2003; 28:194-203. [PMID: 12544939 DOI: 10.1097/00007632-200301150-00018] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective case review was performed. OBJECTIVE To assess the value, rapidity, and safety of combined multiple-pulse transcranial electric stimulation motor-evoked potential and somatosensory-evoked potential monitoring during scoliosis surgery. SUMMARY OF BACKGROUND DATA Leg somatosensory-evoked potentials can miss motor deficits, and a 50% amplitude warning criterion can produce false alarms. METHODS For this study, 33 scoliosis surgeries in neurologically normal patients under propofol/fentanyl anesthesia omitting neuromuscular blockade were monitored with four-extremity multiple-pulse transcranial electric stimulation muscle motor-evoked potentials and cortical somatosensory-evoked potentials. Instead of amplitude criteria, parallel (same-direction) change was used to identify systemic alteration and nonparallel (one- or two-limb) deterioration to identify focal neurologic compromise. Clinical observation and intraoperative electroencephalography were used to assess adverse effects. RESULTS Instantaneous motor-evoked potentials and rapidly reproducible cortical somatosensory-evoked potentials provided comprehensive feedback every 0.8 to 6.7 minutes (median, 2.4 minutes) without adverse effects. Parallel (systemic) changes without alarm or deficit included motor-evoked potential fading or temporary loss and leg somatosensory-evoked potential amplitudes below 50% of initial, maximum, or median intraoperative values in 10% to 37% of the cases. Three nonparallel changes occurred: 1) abrupt bilateral leg somatosensory-evoked potential 20% to 30% reduction without motor-evoked potential change during instrumentation resolving spontaneously over 30 minutes, with transient postoperative sensory symptoms; 2) right-arm somatosensory-evoked potential and motor-evoked potential reduction during hyperabduction restored after repositioning, without deficit; 3) abrupt bilateral leg motor-evoked potential loss preceding 30% to 60% somatosensory-evoked potential reduction during derotation rapidly restored after instrumentation release, without deficit. CONCLUSIONS In neurologically normal patients, the combined methods are safe and rapid, and could improve the sensitivity and specificity of scoliosis monitoring. Arm controls facilitate differentiation between systemic alterations and focal neurologic compromise.
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Affiliation(s)
- David B MacDonald
- Section of Clinical Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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Debailleul AM, Bortlein ML, Touzet G, Krivosic-Horber R. [Anesthetic particularities of stereotaxic neurosurgery]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2002; 21:170-8. [PMID: 11915477 DOI: 10.1016/s0750-7658(01)00504-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Functional neurosurgery procedures are long and specific. Cooperation of the patient may be necessary during surgery. The interference of anaesthetic agents with electrophysiological monitoring should be as little as possible. Local anaesthesia combined with intravenous sedation is often used, but general anaesthesia is more comfortable and secure. Since awakening during the procedure is generally planed, it has to be quick, reliable and of excellent quality. These requirements are fulfilled by the association of propofol by target-controlled infusion (TCI) and a continuous infusion of remifentanil.
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Affiliation(s)
- A M Debailleul
- Département d'anesthésie-réanimation chirurgicale 1, hôpital Roger Salengro, CHRU Lille, rue E. Laine, 59037 Lille, France.
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