Search results for "Neurophysiological Monitoring"
showing 10 items of 17 documents
Modeling the pelvic region for non-invasive pelvic intraoperative neuromonitoring
2016
Abstract Finite element analysis (FEA) of electric current distribution in the pelvis minor may help to assess the usability of non-invasive surface stimulation for continuous pelvic intraoperative neuromonitoring. FEA requires generation of quality volumetric tetrahedral mesh geometry. This study proposes the generation of a suitable mesh based on MRI data. The resulting volumetric mesh models the autonomous nerve structures at risk during total mesorectal excision. The model also contains the bone, cartilage, fat, skin, muscle tissues of the pelvic region, and a set of electrodes for surface stimulation. The model is ready for finite element analysis of the discrete Maxwell’s equations.
Description of the response of a new multi-parametric brain sensor to physiological and pathophysiological challenges in the cortex of juvenile pigs
2014
AIM Monitoring of intracranial pressure (ICP), local cerebral blood flow (CBF) and oxygen is part of modern intensive critical care medicine. Preclinical evaluation of newly developed catheters that should monitor several parameters simultaneously is reported poorly in the literature. The goal of our study was (1) to evaluate a new multi-parametric sensor in brain tissue and (2) to establish a testing protocol using pathophysiological challenges that target measured parameters of the sensor and autoregulatory boundaries and could be used as preclinical standard protocol in future studies. MATERIAL AND METHODS We describe data from 12 new multi-parametric brain sensors (MPBS) that were impla…
Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascu…
2015
Ischaemic spinal cord injury (SCI) remains the Achilles heel of open and endovascular descending thoracic and thoracoabdominal repair. Neurological outcomes have improved coincidentially with the introduction of neuroprotective measures. However, SCI (paraplegia and paraparesis) remains the most devastating complication. The aim of this position paper is to provide physicians with broad information regarding spinal cord blood supply, to share strategies for shortening intraprocedural spinal cord ischaemia and to increase spinal cord tolerance to transitory ischaemia through detection of ischaemia and augmentation of spinal cord blood perfusion. This study is meant to support physicians cari…
Intraoperative brain mapping of language, cognitive functions, and social cognition in awake surgery of low-grade gliomas located in the right non-do…
2020
Abstract Objective The aim of our study was to evaluate the usefulness of cortical-subcortical intraoperative brain mapping (ioBM) in resective awake surgery of low-grade gliomas (LGG) of the right non-dominant hemisphere (RndH). It was estimated how ioBM may affect both the extent of resection and postoperative outcome of language, spatial cognition, social cognition, and executive functions including attention and working memory. Patients and Methods : Fifteen patients that underwent ioBM in resective awake surgery of LGG located on the RndH, were included. A cohort of 15 patients with the same tumour location operated under general anaesthesia without brain mapping was used as control. S…
Isolated Pediatric Intramedullary Schwannoma: Case Report and Review of Literature
2018
Background: Intramedullary (IM) schwannomas are rare entities representing 0.3%−1% of intramedullary tumors and 1.1% of spinal schwannomas. Beside many theories proposed, their rare occurrence might be related to the absence of Schwann cells in the spinal cord. Pediatric IM schwannomas are uncommon, and in the absence of neurofibromatosis they are extremely rare. To date, few cases have been reported in the literature. Case Description: We describe the case of an 8-year-old female affected by a progressive paraparesis. Neuroradiologic investigations showed an oval-shaped mass at the level of T10-T11. The patient underwent surgery, performed under neurophysiologic monitoring. The patient was…
Inhaled anesthesia in neurosurgery: Still a role?
2021
In patients undergoing craniotomy, general anesthesia should be addressed to warrant good hypnosis, immobility, and analgesia, to ensure systemic and cerebral physiological status and provide the best possible surgical field. Regarding craniotomies, it is unclear if there are substantial differences in providing general anesthesia using total intravenous anesthesia (TIVA) or balanced anesthesia (BA) accomplished using the third generation halogenates. New evidence highlighted that the last generation of halogenated agents has possible advantages compared with intravenous drugs: rapid induction, minimal absorption and metabolization, reproducible pharmacokinetic, faster recovery, cardioprote…
A rare case of extra-intramedullary dorsal tanycitic ependymoma, radically removed with intraoperative neurophysiological monitoring
2015
Introduction: Tanycitic dorsal extra and intramedullary ependymoma is a rare form of tumor. From the histological point of view, these tumors show several aspects that make difficult the differential diagnosis from schwannomas and pilocytic astrocytomas. Tanycytic variant, often occurs in the thoracic tract of the spinal cord, and it is constituted by tanycites, that are typical elongated and bipolar cells that give to the tumor fibrillary aspects. Tanycitic variant has been recently characterized as a variant of ependymoma, since the 2000 World Health Organization (WHO) system. Case presentation: A 57 years old woman presented with intractable back pain often radiating to the left leg. Neu…
Transcutaneous sacral nerve stimulation for intraoperative verification of internal anal sphincter innervation.
2017
Background: The current standard for pelvic intraoperative neuromonitoring (pIONM) is based on intermittent direct nerve stimulation. This study investigated the potential use of transcutaneous sacral nerve stimulation for non‐invasive verification of pelvic autonomic nerves. Methods: A consecutive series of six pigs underwent low anterior rectal resection. For transcutaneous sacral nerve stimulation, an array of ten electrodes (cathodes) was placed over the sacral foramina (S2 to S4). Anodes were applied on the back, right and left thigh, lower abdomen, and intra‐anally. Stimulation using the novel method and current standard were performed at different phases of the experiment…
Extracorporeal Stimulation of Sacral Nerve Roots for Observation of Pelvic Autonomic Nerve Integrity: Description of a Novel Methodological Setup.
2017
Introduction: Neurophysiologic monitoring can improve autonomic nerve sparing during critical phases of rectal cancer surgery. Objectives: To develop a system for extracorporeal stimulation of sacral nerve roots. Methods: Dedicated software controlled a ten-electrode stimulation array by switching between different electrode configurations and current levels. A built-in impedance and current level measurement assessed the effectiveness of current injection. Intra-anal surface electromyography (sEMG) informed on targeting the sacral nerve roots. All tests were performed on five pig specimens. Results: During switching between electrode configurations, the system delivered 100% of the set cur…
Navigated Transcranial Magnetic Stimulation Motor Mapping Usefulness in the Surgical Management of Patients Affected by Brain Tumors in Eloquent Area…
2021
Background: The surgical strategy for brain glioma has changed, shifting from tumor debulking to a more careful tumor dissection with the aim of a gross-total resection, extended beyond the contrast-enhancement MRI, including the hyperintensity on FLAIR MR images and defined as supratotal resection. It is possible to pursue this goal thanks to the refinement of several technological tools for pre and intraoperative planning including intraoperative neurophysiological monitoring (IONM), cortico-subcortical mapping, functional MRI (fMRI), navigated transcranial magnetic stimulation (nTMS), intraoperative CT or MRI (iCT, iMR), and intraoperative contrast-enhanced ultrasound. This systematic re…