Pitfalls in intraoperative nerve monitoring during vestibular schwannoma surgery

2012 ◽  
Vol 33 (3) ◽  
pp. E5 ◽  
Author(s):  
Matthew L. Kircher ◽  
Jack M. Kartush
Keyword(s):  
Vestibular Schwannoma ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Nerve Monitoring ◽  
Surgeon Training ◽  
Monitoring Process ◽  
Recurrent Laryngeal Nerves ◽  
American Society ◽  
Intraoperative Nerve Monitoring ◽  
American Society Of Anesthesiologists

Despite the widespread acceptance of intraoperative neurophysiological monitoring in skull base surgery over the last 2 decades, surgeon training in the technical and interpretive aspects of nerve monitoring has been conspicuously lacking. Inadequate fundamental knowledge of neurophysiological monitoring may lead to misinterpretations and an inability to troubleshoot system errors. Some surgeons perform both the technical and interpretive aspects of monitoring themselves while others enjoin coworkers (surgical residents, nurses, anesthetists, or a separate monitoring service) to perform the technical portion. Regardless, the surgeon must have a thorough understanding to avoid potential medical and legal pitfalls because poor monitoring is worse than no monitoring. A structured curriculum and protocol in both the technical and interpretive aspects of monitoring is recommended for all personnel involved in the monitoring process. This paper details the technical, interpretive, and surgical correlates necessary for optimal intraoperative nerve monitoring during vestibular schwannoma surgery with an emphasis on electromyographic monitoring for facial and recurrent laryngeal nerves. Just as the American Society of Anesthesiologists' 1986 “Standards for Basic Anesthetic Monitoring” became a useful tool for both patients and anesthesiologists, impending guidelines in intraoperative neurophysiological monitoring should likewise become an important instrument for optimizing intraoperative neurophysiological monitoring.

scholarly journals Intraoperative neurophysiological monitoring in vestibular schwannoma surgery: advances and clinical implications

2009 ◽  
Vol 27 (4) ◽  
pp. E9 ◽  
Author(s):  
A. Samy Youssef ◽  
Angela E. Downes
Keyword(s):  
Facial Nerve ◽  
Functional Outcome ◽  
Vestibular Schwannoma ◽  
Cranial Nerve ◽  
Evoked Potential ◽  
Hearing Preservation ◽  
Auditory Evoked Potential ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Clinical Series

Object Intraoperative neurophysiological monitoring has become an integral part of vestibular schwannoma surgery. The aim of this article was to review the different techniques of intraoperative neurophysiological monitoring in vestibular schwannoma surgery, identify the clinical impact of certain pathognomonic patterns on postoperative outcomes of facial nerve function and hearing preservation, and highlight the role of postoperative medications in improving delayed cranial nerve dysfunction in the different reported series. Methods The authors performed a review of the literature regarding intraoperative monitoring in acoustic/vestibular schwannoma surgery. The different clinical series representing different monitoring techniques were reviewed. All the data from clinical series were analyzed in a comprehensive and comparative model. Results Intraoperative brainstem auditory evoked potential monitoring, direct cochlear nerve action potential monitoring, and facial nerve electromyography are the main tools used to assess the functional integrity of an anatomically intact cranial nerve. The identification of pathognomonic brainstem auditory evoked potential and electromyography patterns has been correlated with postoperative functional outcome. Recently, perioperative administration of intravenous hydroxyethyl starch and nimodipine as vasoactive and neuroprotective agents was shown to improve vestibular schwannoma functional outcome in few reported studies. Conclusions Recent advances in electrophysiological technology have considerably contributed to improvement in functional outcome of vestibular neuroma surgery in terms of hearing preservation and facial nerve paresis. Perioperative intravenous nimodipine and hydroxyethyl starch may be valuable additions to surgery.

scholarly journals Application of intraoperative nerve monitoring for recurrent laryngeal nerves in minimally invasive McKeown esophagectomy

2021 ◽  
Author(s):  
Luo Zhao ◽  
Jia He ◽  
Yingzhi Qin ◽  
Hongsheng Liu ◽  
Shanqing Li ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pulmonary Complications ◽  
Control Group ◽  
Postoperative Pulmonary Complications ◽  
Nerve Monitoring ◽  
Mediastinal Lymphadenectomy ◽  
Significant Difference ◽  
Recurrent Laryngeal Nerves ◽  
Intraoperative Nerve Monitoring ◽  
Mckeown Esophagectomy

Abstract Background Mediastinal lymphadenectomy is of great importance during esophagectomy for esophageal squamous cell carcinoma. However, recurrent laryngeal nerve (RLN) injury is a severe complication caused by lymphadenectomy along the RLN. Intraoperative nerve monitoring (IONM) can effectively identify the RLN and reduce the incidence of postoperative vocal cord paralysis (VCP). Here, we describe the feasibility and effectiveness of IONM in minimally invasive McKeown esophagectomy. Methods A total of 150 patients who underwent minimally invasive McKeown esophagectomy from 2016 to 2020 were enrolled in this study. We divided the patients into two groups: a neuromonitoring group (IONM, n = 70) and a control group (control, n = 80). Clinical data, surgical variables, and postoperative complications were retrospectively analyzed and compared. Results There was no significant difference in baseline data between the two groups. Postoperative VCP occurred in six cases (8.6%) in the IONM group, which was lower than that in the control group (21.3%, P = 0.032). Postoperative pulmonary complications were found in five cases (7.1%) and 14 in the control group (18.8%, P = 0.037). The postoperative hospital stay in the IONM group was significantly shorter than that in the control group (8 vs. 12, median, P < 0.001). The number of RLN lymph nodes harvested in the IONM group was higher than that in the control group (13.74 ± 5.77 vs. 11.03 ± 5.78, P = 0.005). The sensitivity and specificity of IONM monitoring VCP were 83.8% and 100%, respectively. A total of 66.7% of patients with a reduction in signal showed transient VCP, whereas 100% with a loss of signal showed permanent VCP. Conclusion IONM is feasible in minimally invasive McKeown esophagectomy. It showed advantages for distinguishing RLN and achieving thorough mediastinal lymphadenectomy with less RLN injury. Abnormal IONM signals can provide an accurate prediction of postoperative VCP incidence.

scholarly journals Feasibility of Attachable Ring Stimulator for Intraoperative Neuromonitoring during Thyroid Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Jongjin Kim ◽  
Hyeon Jong Moon ◽  
Young Jun Chai ◽  
Jung-Man Lee ◽  
Ki-Tae Hwang ◽  
...  
Keyword(s):  
Thyroid Surgery ◽  
Medical Records ◽  
Electric Stimulation ◽  
Intraoperative Neuromonitoring ◽  
Vagus Nerves ◽  
Nerve Monitoring ◽  
Continuous Feedback ◽  
The Mean ◽  
Recurrent Laryngeal Nerves ◽  
Intraoperative Nerve Monitoring

Objective. Stimulator-attached dissecting instruments are useful for intraoperative nerve monitoring during thyroidectomy. The aim of this study was to evaluate the feasibility of an attachable ring stimulator (ARS) by comparing the electromyography (EMG) amplitudes evoked by an ARS and a conventional stimulator. Methods. Medical records of fourteen patients who underwent thyroidectomy using intraoperative neuromonitoring between June and August 2019 were retrospectively reviewed. The amplitudes of V1, R1, R2, and V2 signals were checked using both the ARS and a conventional stimulator, at the same point. Results. Both stimulators were tested on 20 recurrent laryngeal nerves (RLNs) and 20 vagus nerves (VNs). In all the nerves, the amplitudes of V1, R1, R2, and V2 were greater than 500 μV. The mean amplitudes of V1, R1, R2, and V2 checked with the ARS were 1175, 1432, 1598, and 1279 μV, respectively. The mean amplitudes of V1, R1, R2, and V2 checked with the conventional stimulator were 1140, 1425, 1557, and 1217 μV, respectively. Difference between amplitudes evoked by the two stimulators for V1, R1, R2, and V2 was 77, 110, 102, and 99 μV, respectively. There was no statistical difference in the amplitudes between the two groups for V1, R1, R2, and V2. Conclusion. The ARS transferred electric stimulation as effectively as the conventional stimulator. It is an effective tool for repeated stimulation and facilitates continuous feedback regarding the functional integrity of nerves during thyroid surgery.

Superior laryngeal nerve monitoring using laryngeal surface electrodes and intraoperative neurophysiological monitoring during thyroidectomy

2014 ◽  
Vol 28 (4) ◽  
pp. 460-466 ◽  
Author(s):  
Benjamin L. Hodnett ◽  
Nicole C. Schmitt ◽  
Daniel R. Clayburgh ◽  
Alex Burkowsky ◽  
Jeffrey Balzer ◽  
...  
Keyword(s):  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Nerve Monitoring ◽  
Surface Electrodes

Developing Intraoperative Cochlear Nerve Monitoring during Vestibular Schwannoma Surgery

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
A. Kasbekar ◽  
Y. Tam ◽  
R. Carlyon ◽  
J. Deeks ◽  
N. Donnelly ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Cochlear Nerve ◽  
Nerve Monitoring

Current status of intraoperative nerve monitoring of laryngeal nerves in thyroid surgery

2020 ◽  
Vol 31 (3) ◽  
pp. 256-269
Author(s):  
M Durán Poveda ◽  
L Zarain Obrador ◽  
O Garnés Camarena
Keyword(s):  
Thyroid Surgery ◽  
Current Status ◽  
Nerve Monitoring ◽  
Laryngeal Nerves ◽  
Calidad De Vida ◽  
Intraoperative Nerve Monitoring

Resumen La lesión de la rama externa del nervio laríngeo superior (RE-NLS) puede producir una disfunción laríngea postoperatoria con afectación directa sobre la voz. La lesión del nervio laríngeo recurrente (NR) es una complicación temida en la cirugía tiroidea por su importante repercusión en la calidad de vida del paciente. Su lesión se asocia con una importante morbilidad que afecta directamente y en diferente grado a la voz, deglución y respiración del paciente. Al deterioro de la calidad de vida de los pacientes se unen los costes clínicos, socio-económicos y repercusiones médico legales derivadas de esta complicación. La incidencia de lesión del NR oscila entre el 2,3% y el 9,8%. La monitorización nerviosa intraoperatoria (MNI) de los nervios laríngeos se introdujo en la cirugía tiroidea para reducir las lesiones nerviosas. Aunque su uso rutinario no está universalmente extendido entre todos los profesionales y su papel dentro de la cirugía tiroidea es controvertido, cada vez son más los cirujanos que recurren a la MNI de forma sistemática, ya que representa un instrumento que complementa a la identificación visual del nervio durante la intervención. La MNI ayuda a la identificación inicial del nervio y a la posterior disección del mismo. Además, permite predecir la función postoperatoria del NR y del NLS en el campo quirúrgico, así como identificar el mecanismo y la localización de la lesión nerviosa durante la intervención, en caso de producirse.

A Comparison of Colectomy Outcomes Utilizing Open, Laparoscopic, and Robotic Techniques

2020 ◽  
pp. 000313482097338
Author(s):  
Elizabeth McCarthy ◽  
Benjamin L. Gough ◽  
Michael S. Johns ◽  
Alexandra Hanlon ◽  
Sachin Vaid ◽  
...  
Keyword(s):  
Postoperative Recovery ◽  
Logistic Regression Models ◽  
Community Institution ◽  
Physical Status Classification ◽  
Estimated Blood Loss ◽  
Comparative Review ◽  
Significant Difference ◽  
American Society ◽  
The Individual ◽  
American Society Of Anesthesiologists

Introduction Robotic colectomy could reduce morbidity and postoperative recovery over laparoscopic and open procedures. This comparative review evaluates colectomy outcomes based on surgical approach at a single community institution. Methods A retrospective review of all patients who underwent colectomy by a fellowship-trained colon and rectal surgeon at a single institution from 2015 through 2019 was performed, and a cohort developed for each approach (open, laparoscopic, and robotic). 30-day outcomes were evaluated. For dichotomous outcomes, univariate logistic regression models were used to quantify the individual effect of each predictor of interest on the odds of each outcome. Continuous outcomes received a similar approach; however, linear and Poisson regression modeling were used, as appropriate. Results 115 patients were evaluated: 14% (n = 16) open, 44% (n = 51) laparoscopic, and 42% (n = 48) robotic. Among the cohorts, there was no statistically significant difference in operative time, rate of reoperation, readmission, or major complications. Robotic colectomies resulted in the shortest length of stay (LOS) (Kruskal-Wallis P < .0001) and decreased estimated blood loss (EBL) (Kruskal-Wallis P = .0012). Median age was 63 years (interquartile range [IQR] 53-72). 54% (n = 62) were female. Median American Society of Anesthesiologists physical status classification was 3 (IQR 2-3). Median body mass index was 28.67 (IQR 25.03-33.47). A malignant diagnosis was noted on final pathology in 44% (n = 51). Conclusion Among the 3 approaches, there was no statistically significant difference in 30-day morbidity or mortality. There was a statistically significant decreased LOS and EBL for robotic colectomies.

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