Pub Date : 2022-12-30DOI: 10.1097/01.CNE.0000905140.06180.9a
Brandon W. Smith, M. Jack, R. Spinner
including spasticity and hyperreflexia. In this review, we describe many different causes of common peroneal neuropathy, and how an overly simplistic diagnostic process could impact patient workup and outcomes. Some of these scenarios represent potential misses of various pathologic entities, which can be avoided with knowledge of different pathologies that result in foot drop and by using various imaging modalities to differentiate these lesions. We believe that high-resolution imaging [either MRI and/or ultrasound (US)] should be performed not only to help localize the lesion but also to define it. 4
{"title":"Foot Drop: The Importance of Imaging as Part of the Peripheral Nerve Evaluation","authors":"Brandon W. Smith, M. Jack, R. Spinner","doi":"10.1097/01.CNE.0000905140.06180.9a","DOIUrl":"https://doi.org/10.1097/01.CNE.0000905140.06180.9a","url":null,"abstract":"including spasticity and hyperreflexia. In this review, we describe many different causes of common peroneal neuropathy, and how an overly simplistic diagnostic process could impact patient workup and outcomes. Some of these scenarios represent potential misses of various pathologic entities, which can be avoided with knowledge of different pathologies that result in foot drop and by using various imaging modalities to differentiate these lesions. We believe that high-resolution imaging [either MRI and/or ultrasound (US)] should be performed not only to help localize the lesion but also to define it. 4","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48790944","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 : 2022-11-30DOI: 10.1097/01.CNE.0000902656.27844.bd
Taylor Cave, Michael J. Marino, D. Lal, Z. Soler, B. Bendok, A. Miglani
munication of the subarachnoid space with the paranasal sinuses, placing patients at risk of ascending meningitis and pneumocephalus.1 The classification of CSF rhinorrhea is commonly divided into 2 categories: traumatic and nontraumatic (spontaneous).2,3 Spontaneous cerebrospinal fluid (sCSF) leaks of the skull base are thought to be primarily caused by increased intracranial pressures (ICPs) with a strong association with idiopathic intracranial hypertension (IIH).4,5 IIH and sCSF leaks share similar risk factors, occurring most commonly in obese, middle-aged female populations. However, in rarer instances, sCSF leaks may be secondary to hydrocephalus and intracranial neoplasms.1,2 sCSF leaks are associated with higher rates of repair failure, and their refractory nature is thought to be directly related to increased ICPs.5,6 This report primarily focuses on sCSF rhinorrhea in context of IIH.
{"title":"Surgical Management of Spontaneous Cerebrospinal Fluid Rhinorrhea","authors":"Taylor Cave, Michael J. Marino, D. Lal, Z. Soler, B. Bendok, A. Miglani","doi":"10.1097/01.CNE.0000902656.27844.bd","DOIUrl":"https://doi.org/10.1097/01.CNE.0000902656.27844.bd","url":null,"abstract":"munication of the subarachnoid space with the paranasal sinuses, placing patients at risk of ascending meningitis and pneumocephalus.1 The classification of CSF rhinorrhea is commonly divided into 2 categories: traumatic and nontraumatic (spontaneous).2,3 Spontaneous cerebrospinal fluid (sCSF) leaks of the skull base are thought to be primarily caused by increased intracranial pressures (ICPs) with a strong association with idiopathic intracranial hypertension (IIH).4,5 IIH and sCSF leaks share similar risk factors, occurring most commonly in obese, middle-aged female populations. However, in rarer instances, sCSF leaks may be secondary to hydrocephalus and intracranial neoplasms.1,2 sCSF leaks are associated with higher rates of repair failure, and their refractory nature is thought to be directly related to increased ICPs.5,6 This report primarily focuses on sCSF rhinorrhea in context of IIH.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"44 1","pages":"1 - 8"},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46107462","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 : 2022-11-15DOI: 10.1097/01.CNE.0000896728.73864.40
Megan M. J. Bauman, Jhon E Bocanegra-Becerra, Evelyn L. Turcotte, D. Patra, A. Turkmani, C. Krishna, P. Bolton, A. Koht, H. Hunt Batjer, B. Bendok
technically demanding procedure and requires adaptive skills that greatly vary based on the features of each unique aneurysm. Depending on the location of the aneurysm, a neurosurgeon may be faced with challenges including accessing difficult locations through narrow operative corridors, maneuvering around vital neurologic structures, and manipulating fragile tissues. One of the important challenges and potential complications during aneurysm clipping is intraoperative aneurysm rupture (IAR).1 This can be daunting especially when it occurs before adequate dissection and exposure of vessel(s) essential for proximal and distal control. Uncontrolled bleeding further obscures the surgical field and hurried maneuvers of an unprepared surgeon increase the risk of neurologic damage. Therefore, it is crucial that a variety of tools and strategies exist for use during intracranial aneurysm clipping to combat any potential challenges that may arise. Although a variety of techniques exist to reduce blood flow to and through the aneurysm during dissection and clipping, temporary arterial occlusion via placement of temporary clips on the parent vessels is the most reliable.2,3 Placement, however, can be challenging if the rupture occurs early or if the anatomy does not facilitate complete trapping. Prolonged temporary clip placement also increases ischemic risks.4 Rarely, temporary clips can result in vasospasm of the parent arteries.3,4 An alternative to temporary clipping is systemic flow arrest through the IV administration of adenosine. Adenosine administered as a bolus transiently slows sinus rate and atrioventricular (AV) nodal conduction resulting in brief asystole.5 Spontaneous return of sinus rhythm occurs within seconds as this naturally occurring nucleoside is transported into cells and rapidly deaminated. Significant hypotension from vasodilation often occurs after asystole and return of circulation.
{"title":"Adenosine-Assisted Clipping of Intracranial Aneurysms","authors":"Megan M. J. Bauman, Jhon E Bocanegra-Becerra, Evelyn L. Turcotte, D. Patra, A. Turkmani, C. Krishna, P. Bolton, A. Koht, H. Hunt Batjer, B. Bendok","doi":"10.1097/01.CNE.0000896728.73864.40","DOIUrl":"https://doi.org/10.1097/01.CNE.0000896728.73864.40","url":null,"abstract":"technically demanding procedure and requires adaptive skills that greatly vary based on the features of each unique aneurysm. Depending on the location of the aneurysm, a neurosurgeon may be faced with challenges including accessing difficult locations through narrow operative corridors, maneuvering around vital neurologic structures, and manipulating fragile tissues. One of the important challenges and potential complications during aneurysm clipping is intraoperative aneurysm rupture (IAR).1 This can be daunting especially when it occurs before adequate dissection and exposure of vessel(s) essential for proximal and distal control. Uncontrolled bleeding further obscures the surgical field and hurried maneuvers of an unprepared surgeon increase the risk of neurologic damage. Therefore, it is crucial that a variety of tools and strategies exist for use during intracranial aneurysm clipping to combat any potential challenges that may arise. Although a variety of techniques exist to reduce blood flow to and through the aneurysm during dissection and clipping, temporary arterial occlusion via placement of temporary clips on the parent vessels is the most reliable.2,3 Placement, however, can be challenging if the rupture occurs early or if the anatomy does not facilitate complete trapping. Prolonged temporary clip placement also increases ischemic risks.4 Rarely, temporary clips can result in vasospasm of the parent arteries.3,4 An alternative to temporary clipping is systemic flow arrest through the IV administration of adenosine. Adenosine administered as a bolus transiently slows sinus rate and atrioventricular (AV) nodal conduction resulting in brief asystole.5 Spontaneous return of sinus rhythm occurs within seconds as this naturally occurring nucleoside is transported into cells and rapidly deaminated. Significant hypotension from vasodilation often occurs after asystole and return of circulation.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2022-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48396296","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 : 2022-06-30DOI: 10.1097/01.CNE.0000873388.63276.a9
W. T. Rahman, J. Griauzde, Suzanne T. Chong
Acute Ischemic Stroke Acute ischemic stroke accounts for the majority of acute neurovascular emergencies, with approximately 795,000 cases of new or recurrent stroke occurring annually. An estimated 6.6 million Americans over the age of 20 have had a stroke. In the United States, a stroke occurs every 40 seconds while a stroke-related death occurs every 4 minutes. The first-line imaging examination for stroke is unenhanced head CT to exclude a brain mass or intracranial hemorrhage and to identify early signs of ischemia. These early signs of ischemic stroke on CT include hypoattenuation of the lentiform nuclei and insular cortex, loss of graywhite differentiation, sulcal effacement, and dense vessels representing intra-arterial thrombus (Figure 1). CT or MR angiography can identify arterial occlusion. CT perfusion may be performed to differentiate infarcted from viable brain tissue at risk of ischemia that may benefit from early intervention. On MRI, early hyperacute ischemia, defined as occurring within 0 to 6 hours of arterial occlusion, demonstrates restricted diffusion. Fluid-attenuated inversion recovery (FLAIR) signal can be variable in this period. Late hyperacute stroke, occurring within 6 to 24 hours of arterial occlusion, also will restrict diffusion; however, there is usually high FLAIR signal and T1 hypointensity after 16 hours. Acute stroke presenting from 24 hours to 1 week after symptom onset will demonstrate restricted diffusion, FLAIR hyperintensity, low T1 signal, and high T2 signal. The intensity of restricted diffusion diminishes as the stroke evolves from acute to chronic, and arterial enhancement can occur at any time point. The mainstay of stroke therapy is IV recombinant tissuetype plasminogen activator (tPA), which should be administered before endovascular treatment and within 4.5 hours of symptom onset to improve outcome. Unenhanced CT should be performed before any stroke treatment to exclude the contraindications of acute intracranial hemorrhage or brain tumor. Patients are eligible to receive endovascular therapy with a stent retriever device if they meet specific criteria (Table 1). The Alberta Stroke Program Early CT Score (ASPECTS) may affect eligibility for tPA therapy, which quantifies ischemic changes in the middle cerebral artery (MCA)
{"title":"Neurovascular Emergencies: Imaging Diagnosis and Neurointerventional Therapy","authors":"W. T. Rahman, J. Griauzde, Suzanne T. Chong","doi":"10.1097/01.CNE.0000873388.63276.a9","DOIUrl":"https://doi.org/10.1097/01.CNE.0000873388.63276.a9","url":null,"abstract":"Acute Ischemic Stroke Acute ischemic stroke accounts for the majority of acute neurovascular emergencies, with approximately 795,000 cases of new or recurrent stroke occurring annually. An estimated 6.6 million Americans over the age of 20 have had a stroke. In the United States, a stroke occurs every 40 seconds while a stroke-related death occurs every 4 minutes. The first-line imaging examination for stroke is unenhanced head CT to exclude a brain mass or intracranial hemorrhage and to identify early signs of ischemia. These early signs of ischemic stroke on CT include hypoattenuation of the lentiform nuclei and insular cortex, loss of graywhite differentiation, sulcal effacement, and dense vessels representing intra-arterial thrombus (Figure 1). CT or MR angiography can identify arterial occlusion. CT perfusion may be performed to differentiate infarcted from viable brain tissue at risk of ischemia that may benefit from early intervention. On MRI, early hyperacute ischemia, defined as occurring within 0 to 6 hours of arterial occlusion, demonstrates restricted diffusion. Fluid-attenuated inversion recovery (FLAIR) signal can be variable in this period. Late hyperacute stroke, occurring within 6 to 24 hours of arterial occlusion, also will restrict diffusion; however, there is usually high FLAIR signal and T1 hypointensity after 16 hours. Acute stroke presenting from 24 hours to 1 week after symptom onset will demonstrate restricted diffusion, FLAIR hyperintensity, low T1 signal, and high T2 signal. The intensity of restricted diffusion diminishes as the stroke evolves from acute to chronic, and arterial enhancement can occur at any time point. The mainstay of stroke therapy is IV recombinant tissuetype plasminogen activator (tPA), which should be administered before endovascular treatment and within 4.5 hours of symptom onset to improve outcome. Unenhanced CT should be performed before any stroke treatment to exclude the contraindications of acute intracranial hemorrhage or brain tumor. Patients are eligible to receive endovascular therapy with a stent retriever device if they meet specific criteria (Table 1). The Alberta Stroke Program Early CT Score (ASPECTS) may affect eligibility for tPA therapy, which quantifies ischemic changes in the middle cerebral artery (MCA)","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"44 1","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42523110","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 : 2022-05-15DOI: 10.1097/01.cne.0000871848.66204.a5
Jaafar Basma, M. Muhlbauer
fascinated with the way its nerves display a complex anatomic matrix of anastomoses (Figure 1). Those are further hidden between the upper chest, neck, and shoulder, making their surgical exposure difficult. William Smellie is credited with the first description of brachial plexus palsy in the 18th century, which he noticed in a newborn. There is evidence however of a much earlier clinical diagnosis in the Syriac Book of Medicines from the 12th century. Traumatic brachial plexus injury was studied by Flaubert, Duplay, and Reclus in the 1800s. Erb and Klumpke described upper and lower injuries, respectively, and idiopathic brachial plexopathy was defined by Parsonage and Turner in 1948. Thorburn performed the first brachial plexus anastomosis in the 20th century. Nerve transfers were reported in the late 19th century (facial nerve, radial to median nerve), but successful brachial plexus transfers with good long-term follow-up functions were not reported until the mid-20th century, with the efforts of Lurje, Seddon, Kotani, and many others.
{"title":"Brachial Plexus: Part I—Anatomy, Clinical Syndromes, and Trauma","authors":"Jaafar Basma, M. Muhlbauer","doi":"10.1097/01.cne.0000871848.66204.a5","DOIUrl":"https://doi.org/10.1097/01.cne.0000871848.66204.a5","url":null,"abstract":"fascinated with the way its nerves display a complex anatomic matrix of anastomoses (Figure 1). Those are further hidden between the upper chest, neck, and shoulder, making their surgical exposure difficult. William Smellie is credited with the first description of brachial plexus palsy in the 18th century, which he noticed in a newborn. There is evidence however of a much earlier clinical diagnosis in the Syriac Book of Medicines from the 12th century. Traumatic brachial plexus injury was studied by Flaubert, Duplay, and Reclus in the 1800s. Erb and Klumpke described upper and lower injuries, respectively, and idiopathic brachial plexopathy was defined by Parsonage and Turner in 1948. Thorburn performed the first brachial plexus anastomosis in the 20th century. Nerve transfers were reported in the late 19th century (facial nerve, radial to median nerve), but successful brachial plexus transfers with good long-term follow-up functions were not reported until the mid-20th century, with the efforts of Lurje, Seddon, Kotani, and many others.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45654789","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 : 2022-03-31DOI: 10.1097/01.CNE.0000890328.16724.c7
Ashwini Kulkarni, A. Geimadi, A. Sobieh, Mohamed Qayati, A. Abbassy, Aly H Abayazeed
The anatomy of cranial nerves is complex and its knowledge is a crucial first step in identifying nerve-related pathology. This article provides a comprehensive pictorial overview of cranial nerves using high-resolution steady-state free precession MRI sequences (SSFP).
{"title":"A Pictorial Review of Cranial Nerves Imaging Anatomy and Pathology: Part 1—Anatomy","authors":"Ashwini Kulkarni, A. Geimadi, A. Sobieh, Mohamed Qayati, A. Abbassy, Aly H Abayazeed","doi":"10.1097/01.CNE.0000890328.16724.c7","DOIUrl":"https://doi.org/10.1097/01.CNE.0000890328.16724.c7","url":null,"abstract":"The anatomy of cranial nerves is complex and its knowledge is a crucial first step in identifying nerve-related pathology. This article provides a comprehensive pictorial overview of cranial nerves using high-resolution steady-state free precession MRI sequences (SSFP).","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49189248","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 : 2022-02-28DOI: 10.1097/01.cne.0000853252.68850.7c
Due to the narrow endoscopic view, subtle microanatomical differences in the lumbar, thoracic, and cervical regions are not always easy to visually discern. To address this challenge, the book contains detailed procedural descriptions and images mirroring endoscopic views spine surgeons encounter in the OR. Organized anatomically, 53 chapters guide readers systematically through lumbar, thoracic, cervical, and craniocervical junction procedures for pathologies ranging from low back pain and deformities to tumors, lesions, infections, and trauma.Key features:More than 1000 high quality images including color procedural photographs and medical illustrations provide in-depth visual understanding.Spinal pathologies and procedures delineated in 75 videos accessible via the Media Center from case studies to step-by-step technique tutorials.Covers the full spectrum of spine endoscopy including percutaneous approaches, microdiscectomy, laminectomy, discectomy foraminotomy, hemilaminectomy, thoracic decompressions, fusion, fixation, and thoracoscopic procedures.The use of state-of-the-art technology such as ultrasonic bone dissectors, endoscopic radiofrequency denervation, the video telescope operating monitor (VITOM), minimally invasive tubular retractors, and 3D stereo-tubular endoscopic systems.
{"title":"Endoscopic Spine Surgery","authors":"","doi":"10.1097/01.cne.0000853252.68850.7c","DOIUrl":"https://doi.org/10.1097/01.cne.0000853252.68850.7c","url":null,"abstract":"Due to the narrow endoscopic view, subtle microanatomical differences in the lumbar, thoracic, and cervical regions are not always easy to visually discern. To address this challenge, the book contains detailed procedural descriptions and images mirroring endoscopic views spine surgeons encounter in the OR. Organized anatomically, 53 chapters guide readers systematically through lumbar, thoracic, cervical, and craniocervical junction procedures for pathologies ranging from low back pain and deformities to tumors, lesions, infections, and trauma.Key features:More than 1000 high quality images including color procedural photographs and medical illustrations provide in-depth visual understanding.Spinal pathologies and procedures delineated in 75 videos accessible via the Media Center from case studies to step-by-step technique tutorials.Covers the full spectrum of spine endoscopy including percutaneous approaches, microdiscectomy, laminectomy, discectomy foraminotomy, hemilaminectomy, thoracic decompressions, fusion, fixation, and thoracoscopic procedures.The use of state-of-the-art technology such as ultrasonic bone dissectors, endoscopic radiofrequency denervation, the video telescope operating monitor (VITOM), minimally invasive tubular retractors, and 3D stereo-tubular endoscopic systems.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41728560","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 : 2021-12-01DOI: 10.1097/01.CNE.0000854824.33022.b3
Daniel N Kiridly, A. Satin, P. Derman
which allows for access to relevant anatomy. However, spine surgery often requires positions that would not be well tolerated for a prolonged period in an awake patient. Such positions can place abnormal forces upon different aspects of the patient’s anatomy, including peripheral nerves. Prolonged operative duration or improper positioning can therefore produce perioperative peripheral nerve injury (PPNI). The incidence of PPNI in a heterogeneous mix of surgical cases has been reported as 0.03%, although orthopedic and neurosurgical procedures may be associated with significantly increased risk. PPNI has a significant impact on patient quality of life and frequently leads to malpractice claims; however a specific mechanism of injury is not identified in the majority of claims related to PPNI. Prevention, and early detection and intervention, is paramount to reducing PPNI and associated adverse outcomes and malpractice claims. The use of intraoperative neuromonitoring (IONM) theoretically allows the surgical team to detect and intervene on impending PPNI during surgery. We review the current literature on PPNI and explore the extent to which IONM may help prevent such injuries.
{"title":"Positioning-Related Peripheral Nerve Injury During Spine Surgery and the Role of Intraoperative Neuromonitoring","authors":"Daniel N Kiridly, A. Satin, P. Derman","doi":"10.1097/01.CNE.0000854824.33022.b3","DOIUrl":"https://doi.org/10.1097/01.CNE.0000854824.33022.b3","url":null,"abstract":"which allows for access to relevant anatomy. However, spine surgery often requires positions that would not be well tolerated for a prolonged period in an awake patient. Such positions can place abnormal forces upon different aspects of the patient’s anatomy, including peripheral nerves. Prolonged operative duration or improper positioning can therefore produce perioperative peripheral nerve injury (PPNI). The incidence of PPNI in a heterogeneous mix of surgical cases has been reported as 0.03%, although orthopedic and neurosurgical procedures may be associated with significantly increased risk. PPNI has a significant impact on patient quality of life and frequently leads to malpractice claims; however a specific mechanism of injury is not identified in the majority of claims related to PPNI. Prevention, and early detection and intervention, is paramount to reducing PPNI and associated adverse outcomes and malpractice claims. The use of intraoperative neuromonitoring (IONM) theoretically allows the surgical team to detect and intervene on impending PPNI during surgery. We review the current literature on PPNI and explore the extent to which IONM may help prevent such injuries.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"44 1","pages":"1 - 5"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46562881","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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