Pub Date : 2022-09-01DOI: 10.1080/21646821.2022.2108267
David Ernesto Geney-Castro, María Clara Velásquez-González, Fabio Salinas-Durán, Jesús Plata-Contreras
Demonstration of the possibility to obtain the sensory nerve action potential (SNAP) of sural nerve in patients over 60 years old, without peripheral neuropathy. Prospective study on 101 patients older than 60 years of age. Stimulation was applied 12 cm proximal to the recording point. Two hundred and two SNAPs of the sural nerve were collected with an average peak latency of 3.2 ms, onset latency of 2.6 ms, peak-to-peak amplitude of 15.2 μV and velocity of 45.7 m/s. It was possible to obtain the sural nerve SNAP in all tested patients older than 60, without peripheral neuropathy. The values obtained in this study prove to be useful as a reference in the evaluation of patients older than 60 years of age.
{"title":"Characterization of the Sensory Nerve Action Potential of the Sural Nerve in Patients Over 60 Years of Age without Peripheral Neuropathy.","authors":"David Ernesto Geney-Castro, María Clara Velásquez-González, Fabio Salinas-Durán, Jesús Plata-Contreras","doi":"10.1080/21646821.2022.2108267","DOIUrl":"https://doi.org/10.1080/21646821.2022.2108267","url":null,"abstract":"<p><p>Demonstration of the possibility to obtain the sensory nerve action potential (SNAP) of sural nerve in patients over 60 years old, without peripheral neuropathy. Prospective study on 101 patients older than 60 years of age. Stimulation was applied 12 cm proximal to the recording point. Two hundred and two SNAPs of the sural nerve were collected with an average peak latency of 3.2 ms, onset latency of 2.6 ms, peak-to-peak amplitude of 15.2 μV and velocity of 45.7 m/s. It was possible to obtain the sural nerve SNAP in all tested patients older than 60, without peripheral neuropathy. The values obtained in this study prove to be useful as a reference in the evaluation of patients older than 60 years of age.</p>","PeriodicalId":22816,"journal":{"name":"The Neurodiagnostic Journal","volume":"62 3","pages":"156-163"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40344447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01Epub Date: 2022-08-19DOI: 10.1080/21646821.2022.2075671
Ammar Alobaidy, Sami Al-Rawas, Maryam Al-Kiyumi, Iman Al-Afifi, Rajesh Poothrikovil, Prabhakaran Venugopal
The aim of this audit study was to establish the utility of follow-up and sleep-deprived electroencephalography testing to improve the detection of interictal abnormalities in a tertiary referral center in Oman. As part of our ongoing auditing process, a total of 3010 EEGs were included in this study. All EEGs were routinely performed for Omanis aged 13 years and above, who were referred for possible diagnosis of seizure disorders. Each EEG was performed over an average period of 20-30 minutes. Of the 3010 EEGs, there were 553 follow-up and sleep-deprived EEGs, including initial baseline EEG studies which were analyzed for this study. The total progressive yield of serial follow-up EEGs to detect overall EEG changes was 53.5%, distributed as 8.8%, 11.4%, 0%, and 33.3% for the second, third, fourth, and fifth serial EEG studies, respectively. For the sleep deprivation EEG group, the yield was 6.5% for detecting overall EEG changes compared to the initial EEG studies. A limitation in this study was the small sample size in the subsequent follow-up and sleep deprivation EEGs. In conclusion, we found a minimal contribution of serial follow-up and sleep deprivation methods in improving the EEG abnormality detection in our study. National guidelines and an increase in awareness among physicians are required to increase the benefit of these well-established, yet not optimally utilized EEG methods.
{"title":"The Role of Serial Follow-up and Sleep Deprivation Methods in Improving Electroencephalography Diagnostic Yield in a Cohort of Omanis Aged 13 Years and Above: A Clinical Audit Study.","authors":"Ammar Alobaidy, Sami Al-Rawas, Maryam Al-Kiyumi, Iman Al-Afifi, Rajesh Poothrikovil, Prabhakaran Venugopal","doi":"10.1080/21646821.2022.2075671","DOIUrl":"https://doi.org/10.1080/21646821.2022.2075671","url":null,"abstract":"<p><p>The aim of this audit study was to establish the utility of follow-up and sleep-deprived electroencephalography testing to improve the detection of interictal abnormalities in a tertiary referral center in Oman. As part of our ongoing auditing process, a total of 3010 EEGs were included in this study. All EEGs were routinely performed for Omanis aged 13 years and above, who were referred for possible diagnosis of seizure disorders. Each EEG was performed over an average period of 20-30 minutes. Of the 3010 EEGs, there were 553 follow-up and sleep-deprived EEGs, including initial baseline EEG studies which were analyzed for this study. The total progressive yield of serial follow-up EEGs to detect overall EEG changes was 53.5%, distributed as 8.8%, 11.4%, 0%, and 33.3% for the second, third, fourth, and fifth serial EEG studies, respectively. For the sleep deprivation EEG group, the yield was 6.5% for detecting overall EEG changes compared to the initial EEG studies. A limitation in this study was the small sample size in the subsequent follow-up and sleep deprivation EEGs. In conclusion, we found a minimal contribution of serial follow-up and sleep deprivation methods in improving the EEG abnormality detection in our study. National guidelines and an increase in awareness among physicians are required to increase the benefit of these well-established, yet not optimally utilized EEG methods.</p>","PeriodicalId":22816,"journal":{"name":"The Neurodiagnostic Journal","volume":"62 3","pages":"137-146"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40427404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-03DOI: 10.1080/21646821.2022.2060011
Ross Green, Akash Mishra, Daniel Schneider, Salem Najjar, R. D’Amico, D. Sciubba, S. Lo, Justin W. Silverstein
ABSTRACT Direct wave (D-wave) intraoperative neurophysiological monitoring (IONM) is used during intramedullary spinal cord tumor (IMSCT) resection to assess corticospinal tract (CST) integrity. There are several obstacles to obtaining consistent and reliable D-wave monitoring and modifications to standard IONM procedures may improve surgical resection. We present the case of a subependymoma IMSCT resection at the T2–T6 spinal levels where subdural D-wave monitoring was implemented. A 47-year-old male was presented with a five-year history of numbness in his right foot eventually worsening to sharp upper back pain with increased lower extremity spasticity. MRI revealed an expansile non-contrast enhancing multi-loculated cystic lesion spanning T2–T6 as well as a separate T1–T2 lesion. A T2–T6 laminoplasty was performed for intramedullary resection of the lesion. A spinal electrode was placed in the epidural space caudal to the surgical site to monitor CST function; however, action potentials could not be obtained. Post durotomy, the electrode was placed in the subdural space under direct visualization. This resulted in a reliable D-wave recording, which assisted surgical decision-making during the procedure upon D-wave and limb motor evoked potential attenuation. Surgical intervention led to the recovery of the D-wave recording. Subdural D-wave monitoring serves as an alternative in patients where reliable D-waves from the epidural space are unable to be obtained. Further investigation is required to improve the recording technique, including exploring various types of contacts and lead placement locations.
{"title":"Subdural Direct Wave Intraoperative Neurophysiological Monitoring in Intramedullary Spinal Cord Tumor Resection: Case Report","authors":"Ross Green, Akash Mishra, Daniel Schneider, Salem Najjar, R. D’Amico, D. Sciubba, S. Lo, Justin W. Silverstein","doi":"10.1080/21646821.2022.2060011","DOIUrl":"https://doi.org/10.1080/21646821.2022.2060011","url":null,"abstract":"ABSTRACT Direct wave (D-wave) intraoperative neurophysiological monitoring (IONM) is used during intramedullary spinal cord tumor (IMSCT) resection to assess corticospinal tract (CST) integrity. There are several obstacles to obtaining consistent and reliable D-wave monitoring and modifications to standard IONM procedures may improve surgical resection. We present the case of a subependymoma IMSCT resection at the T2–T6 spinal levels where subdural D-wave monitoring was implemented. A 47-year-old male was presented with a five-year history of numbness in his right foot eventually worsening to sharp upper back pain with increased lower extremity spasticity. MRI revealed an expansile non-contrast enhancing multi-loculated cystic lesion spanning T2–T6 as well as a separate T1–T2 lesion. A T2–T6 laminoplasty was performed for intramedullary resection of the lesion. A spinal electrode was placed in the epidural space caudal to the surgical site to monitor CST function; however, action potentials could not be obtained. Post durotomy, the electrode was placed in the subdural space under direct visualization. This resulted in a reliable D-wave recording, which assisted surgical decision-making during the procedure upon D-wave and limb motor evoked potential attenuation. Surgical intervention led to the recovery of the D-wave recording. Subdural D-wave monitoring serves as an alternative in patients where reliable D-waves from the epidural space are unable to be obtained. Further investigation is required to improve the recording technique, including exploring various types of contacts and lead placement locations.","PeriodicalId":22816,"journal":{"name":"The Neurodiagnostic Journal","volume":"62 1","pages":"87 - 98"},"PeriodicalIF":0.0,"publicationDate":"2022-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47397111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-03DOI: 10.1080/21646821.2022.2072156
Justin W. Silverstein, Omer Doron, Jason A. Ellis
ABSTRACT Aneurysms arising from the anterior communicating artery (ACOA) are the most common intracranial aneurysms encountered. Most aneurysms can be treated with surgical clipping or endovascular coiling; however, there are times when parent vessel sacrifice (PVS) is necessary such as aneurysms with fragile necks or large/giant aneurysms. Application of intraoperative neurophysiological monitoring (IONM) can assist in guiding permissive temporary vessel occlusion during complex aneurysm clippings. However, to-date there is no literature that describes how IONM can be used as a predictor of post-operative neurological status when PVS is employed or as a guide to determine whether PVS is safe. We present a case where IONM guided the sacrifice of the A1 and anterior communicating arteries after 2 hours and 25 min of temporary vessel occlusion. No attenuation was noted in the IONM at any point during the procedure, and the IONM predicted the patient would awake neurologically intact.
{"title":"Deliberate Parent Artery Sacrifice Guided by Intraoperative Neurophysiological Monitoring During Complex Surgical Clipping of a Ruptured Anterior Communicating Artery Aneurysm","authors":"Justin W. Silverstein, Omer Doron, Jason A. Ellis","doi":"10.1080/21646821.2022.2072156","DOIUrl":"https://doi.org/10.1080/21646821.2022.2072156","url":null,"abstract":"ABSTRACT Aneurysms arising from the anterior communicating artery (ACOA) are the most common intracranial aneurysms encountered. Most aneurysms can be treated with surgical clipping or endovascular coiling; however, there are times when parent vessel sacrifice (PVS) is necessary such as aneurysms with fragile necks or large/giant aneurysms. Application of intraoperative neurophysiological monitoring (IONM) can assist in guiding permissive temporary vessel occlusion during complex aneurysm clippings. However, to-date there is no literature that describes how IONM can be used as a predictor of post-operative neurological status when PVS is employed or as a guide to determine whether PVS is safe. We present a case where IONM guided the sacrifice of the A1 and anterior communicating arteries after 2 hours and 25 min of temporary vessel occlusion. No attenuation was noted in the IONM at any point during the procedure, and the IONM predicted the patient would awake neurologically intact.","PeriodicalId":22816,"journal":{"name":"The Neurodiagnostic Journal","volume":"62 1","pages":"108 - 119"},"PeriodicalIF":0.0,"publicationDate":"2022-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48179652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-03DOI: 10.1080/21646821.2022.2046414
Justin W. Silverstein, R. D’Amico
Facial nerve motor evoked potentials (FNMEP) are an important adjunct to facial nerve monitoring in cerebellopontine angle (CPA) tumorectomy. Numerous studies have shown a high specificity and moderate sensitivity in predicting immediate postoperative facial nerve function as well as long term facial nerve function when FNMEPs are evaluated (Bovo et al. 2021; Hong et al. 2020; Matthies et al. 2011; Song et al., 2018; Tawfik et al. 2019). When acquired, especially for resections of large tumors, FNMEPs are advantageous over traditional spontaneous electromyography (s-EMG) and direct nerve stimulation (DNS) since they can evaluate the entire length of the nerve in real-time before the nerve is encountered intraoperatively. Where s-EMG will only activate if the nerve is irritated and the DNS will only acquire a compound muscle action potential (CMAP) when the nerve is in the vicinity of the stimulation device (Song et al., 2018). Acquiring FNMEPs can be technically challenging compared to acquiring MEPs from limb muscles. This is partly due to the proximity of the branches of the facial nerve in the face relative to the stimulation electrodes. Taniguchi et al. (1993) describes needing multipulse high-frequency stimulation to activate an MEP in an anesthetized patient. Building on this principle, Dong et al. (2005) and Sarnthein et al. (2013) discuss using a single pulse stimulation to ensure activating a centrally conducted CMAP versus a peripherally conducted CMAP. Both groups show that a centrally conducted CMAP
面神经运动诱发电位(FNMEP)是桥小脑角(CPA)肿瘤切除术中面神经监测的重要辅助手段。大量研究表明，在评估fnmep时，预测术后即时面神经功能和长期面神经功能具有高特异性和中等敏感性(Bovo等，2021;Hong et al. 2020;Matthies et al. 2011;Song et al.， 2018;Tawfik et al. 2019)。当获得时，特别是对于大肿瘤的切除，FNMEPs比传统的自发肌电图(s-EMG)和直接神经刺激(DNS)更有优势，因为它们可以在术中遇到神经之前实时评估神经的整个长度。其中s-EMG只有在神经受到刺激时才会激活，而DNS只有在神经处于刺激装置附近时才会获得复合肌肉动作电位(CMAP) (Song et al.， 2018)。与从肢体肌肉中获取mep相比，获取fnmep在技术上具有挑战性。这部分是由于面部神经分支相对于刺激电极的接近。Taniguchi等人(1993)描述了需要多脉冲高频刺激来激活麻醉患者的MEP。基于这一原理，Dong等人(2005)和Sarnthein等人(2013)讨论了使用单脉冲刺激来确保激活中央传导的CMAP而不是外围传导的CMAP。两组都显示了一个集中进行的CMAP
{"title":"Waveform Window #52: Nuances in Evaluating Facial Nerve Motor Evoked Potentials","authors":"Justin W. Silverstein, R. D’Amico","doi":"10.1080/21646821.2022.2046414","DOIUrl":"https://doi.org/10.1080/21646821.2022.2046414","url":null,"abstract":"Facial nerve motor evoked potentials (FNMEP) are an important adjunct to facial nerve monitoring in cerebellopontine angle (CPA) tumorectomy. Numerous studies have shown a high specificity and moderate sensitivity in predicting immediate postoperative facial nerve function as well as long term facial nerve function when FNMEPs are evaluated (Bovo et al. 2021; Hong et al. 2020; Matthies et al. 2011; Song et al., 2018; Tawfik et al. 2019). When acquired, especially for resections of large tumors, FNMEPs are advantageous over traditional spontaneous electromyography (s-EMG) and direct nerve stimulation (DNS) since they can evaluate the entire length of the nerve in real-time before the nerve is encountered intraoperatively. Where s-EMG will only activate if the nerve is irritated and the DNS will only acquire a compound muscle action potential (CMAP) when the nerve is in the vicinity of the stimulation device (Song et al., 2018). Acquiring FNMEPs can be technically challenging compared to acquiring MEPs from limb muscles. This is partly due to the proximity of the branches of the facial nerve in the face relative to the stimulation electrodes. Taniguchi et al. (1993) describes needing multipulse high-frequency stimulation to activate an MEP in an anesthetized patient. Building on this principle, Dong et al. (2005) and Sarnthein et al. (2013) discuss using a single pulse stimulation to ensure activating a centrally conducted CMAP versus a peripherally conducted CMAP. Both groups show that a centrally conducted CMAP","PeriodicalId":22816,"journal":{"name":"The Neurodiagnostic Journal","volume":"62 1","pages":"120 - 125"},"PeriodicalIF":0.0,"publicationDate":"2022-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42479354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-03DOI: 10.1080/21646821.2022.2073164
Two ASET Continuing Education Units (ASET-CEUs) will be awarded for reading The Neurodiagnostic Journal and answering the posttest questions with 80% accuracy. This is an open-book quiz. Access to the journal online is free for members and is available for non-members to purchase through Taylor & Francis (h ttps://www. tandfonline.com/loi/utnj19). Answers must be entered online by June 30, 2025, to receive ASET-CEUs. The quiz is only available for purchase through the ASET online store (https://portal. aset.org/aset-store?cat=quizzes) and is free for ASET members ($40.00 for nonmembers). Members should log into the website before purchasing for free access.
{"title":"ASET-CEU Quiz","authors":"","doi":"10.1080/21646821.2022.2073164","DOIUrl":"https://doi.org/10.1080/21646821.2022.2073164","url":null,"abstract":"Two ASET Continuing Education Units (ASET-CEUs) will be awarded for reading The Neurodiagnostic Journal and answering the posttest questions with 80% accuracy. This is an open-book quiz. Access to the journal online is free for members and is available for non-members to purchase through Taylor & Francis (h ttps://www. tandfonline.com/loi/utnj19). Answers must be entered online by June 30, 2025, to receive ASET-CEUs. The quiz is only available for purchase through the ASET online store (https://portal. aset.org/aset-store?cat=quizzes) and is free for ASET members ($40.00 for nonmembers). Members should log into the website before purchasing for free access.","PeriodicalId":22816,"journal":{"name":"The Neurodiagnostic Journal","volume":"62 1","pages":"126 - 128"},"PeriodicalIF":0.0,"publicationDate":"2022-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43377445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-03DOI: 10.1080/21646821.2022.2062190
Qing Yue, T. Hale, J. Gotoff, M. Mercuri
ABSTRACT We report two cases of unilateral loss of TceMEP secondary to spinal instrumentation errors and the subsequent recovery of TceMEP responses following prompt intervention. During the period of TceMEP loss, there were no concomitant SSEP changes beyond the threshold criteria. Postoperative physical examination revealed normal strength and motion in the affected extremities in both patients. These cases illustrate that in addition to being a reliable intraoperative diagnostic tool, TceMEP monitoring displays therapeutic usefulness in appraising corrective actions to the existential risk of neurological injuries.
{"title":"Intraoperative Transcranial Electrical Motor Evoked Potential (TceMEP) as a Therapeutic Tool in Spine Surgery: A Case Series Report","authors":"Qing Yue, T. Hale, J. Gotoff, M. Mercuri","doi":"10.1080/21646821.2022.2062190","DOIUrl":"https://doi.org/10.1080/21646821.2022.2062190","url":null,"abstract":"ABSTRACT We report two cases of unilateral loss of TceMEP secondary to spinal instrumentation errors and the subsequent recovery of TceMEP responses following prompt intervention. During the period of TceMEP loss, there were no concomitant SSEP changes beyond the threshold criteria. Postoperative physical examination revealed normal strength and motion in the affected extremities in both patients. These cases illustrate that in addition to being a reliable intraoperative diagnostic tool, TceMEP monitoring displays therapeutic usefulness in appraising corrective actions to the existential risk of neurological injuries.","PeriodicalId":22816,"journal":{"name":"The Neurodiagnostic Journal","volume":"62 1","pages":"99 - 107"},"PeriodicalIF":0.0,"publicationDate":"2022-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44348987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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