TBI or Sports Brain Injuries-Diagnosis without Opening the Skull?

My Editorial and Review on Recent Trends in Brain Damage is next, in the mean time, this is the latest news about Traumatic Brain Injruy (TBI) and how Spreading Depolarization can be tapped using neuromonitoring and how that can be used to understand and interpret the brain damage without opening the skull, what I meant is without a neurosurgery?.

LLIF-Lateral Lumbar Interbody Fusion Procedure

This particular video taken during the Lateral Lumbar Interbody Fusion procedure at UPMC by Dr.Kanter and his team is a treat to watch the intricacy of surgical steps during lateral Spine procedure, you might have been into the OR or  probably done neuromonitoring for procedures including various lumbar level fusion procedures, but if there is no live camera equipped in the OR,  it is often difficult to know where exactly is the surgeon is and what is he/she is doing at a particular stage of the procedure, it will be just a guess work and that is not acceptable in the medical/health care field (all the stakeholders inside the OR must know exactly about the procedure) and that is not how things can go inside the Operating Room. Every team member from Anesthesiologist to Neurophysiologist to nurses must know every step of the way what exactly the surgeon is doing in order to help or figure out if there is any issue arise during surgical procedure. Unfortunately, most ORs are not equipped with the video transmission inside the OR or if there is one they normally do not use it (but in most neurosurgery ORs they do use). Those professionals who work inside the OR must acquaint themselves with surgical  steps of the surgeons, one way to do is watch it live or recorded one, or a demo before participating in such surgical procedure. It will provide a deeper understanding and realistic perception of how a particular procedure is done, with that knowledge handy, it will be more appropriate to provide feed back to the surgeon on neurophysiology or anesthesia or other relevant modalities to be monitored inside the OR. Even the X-Ray tech's must know the basics (most often that is not the case), ironically the cell saver and other tech's who come inside the OR have no clue about anything in the OR except that little machine collecting the blood?. Knowing exactly what the surgeon is doing every step of the way inside the OR provides a lot more close to a  realistic perception than reading it from a book or listening someone describe it. For those graduates or tech's who have not seen the details of this procedure, this is a good one to watch. Thanks to Dr.Kanter and his colleagues from UPMC for presenting this procedure so well.

How to be a Better Surgeon, apart from Surgereries what else can play important role to be the best surgeon?.

Professor Steve Bogdewic talks about Surgeons and how to be a better surgeon!...

Watch the video:  Link

Dr. George W. Copeland Professor of Family Medicine

Indiana University, Indianapolis

Dr. Stephen P. Bogdewic is the Dr. George W. Copeland Professor of Family Medicine and the Executive Associate Dean for Faculty Affairs and Professional Development at Indiana University School of Medicine. Dr. Bogdewic received his Ph.D. in Adult Education and Organizational Development from the University of North Carolina. Dr. Bogdewic has served as President of the Society of Teachers of Family Medicine (STFM) and was the recipient of the Society’s highest teaching award, the Excellence in Education Award.

Dr. Bogdewic’s scholarly interests include faculty development, leadership development, and qualitative research methodologies. Office: (317) 278-5461; E-mail: bogdewic@iupui.edu

Electrocautery and Spinal Cord damage- loss of motor activities..!

Nerve damages or spinal cord damage during brain and spine surgical procedures depends upon various myraids of factors, one of them is mechanical. However, how many of you even thought of an electrocautery can produce spinal cord damage resulting EMGs and motor activity loss?. This report published in an porcine model discusses a case. I have not read a human case yet, but it is a real possibility, it can happen during surgery.  If anyone knows a human case or clinical scenario's, please post a comment below.

Spinal cord injury from electrocautery: observations in a porcine model using electromyography and motor evoked potentials. Stanley A. Skinner, et al  Journal of Clinical Monitoring and Computing November 2012

Abstract

We have previously investigated electromyographic (EMG) and transcranial motor evoked potential (MEP) abnormalities after mechanical spinal cord injury. We now report thermally generated porcine spinal cord injury, characterized by spinal cord generated hindlimb EMG injury activity and spinal cord motor conduction block (MEP loss). Electrocautery (EC) was delivered to thoracic level dural root sleeves within 6–8 mm of the spinal cord (n = 6). Temperature recordings were made near the spinal cord. EMG and MEP were recorded by multiple gluteobiceps intramuscular electrodes before, during, and after EC. Duration of EC was titrated to an end-point of spinal motor conduction block (MEP loss). In 5/6 roots, ipsilateral EMG injury activity was induced by EC. In 4/5 roots, EMG injury activity was identified before MEP loss. In all roots, a minimum of 20 s EC and a temperature maximum of at least 57 °C at the dural root sleeve were required to induce MEP loss. Unexpectedly, conduction block was preceded by an enhanced MEP in 4/6 trials. EMG injury activity, preceding MEP loss, can be seen during near spinal cord EC. Depolarization and facilitation of lumbar motor neurons by thermally excited descending spinal tracts likely explains both hindlimb EMG and an enhanced MEP signal (seen before conduction block) respectively. A thermal mechanism may play a role in some unexplained MEP losses during intraoperative monitoring. EMG recordings might help to detect abnormal discharges and forewarn the monitorist during both mechanical and thermal injury to the spinal cord.

Full PDF: click on the top right corner of the journal for pdf article. Link:

Vascular Complications During Thoracic Pedicle Screw Placement: What?. Is this even Possible, yes!.

Surgery insight: During surgical performance or surgical procedures and providing patient care, there is nothing like oh you mean that?, well that is very simple or take for granted in a casual way, one must show at most attention and care in every small to big steps, so do the neuromonitoring and anesthesia professionals, you can be of great help to surgeon when you detect changes or unusual activity that can get surgeons attention right away. Ofcourse for surgeons, there is no room for error but absolutely there is no room for Oh I have done 1000s of surgery, pricking a nerve or artery during my pedicle screw insertion is not going to happen, oh well, it did. The following paper describes a case and death of a patient two weeks after the surgery, so be diligent.

While reading this article :Thoracic pedicle screw placement: Free-hand technique  by Yongjung J. Kim, Lawrence G. Lenke regarding Scoliosis and thoraci pedicle screw placement, I came across the two back reference that startled me, an important and interesting reference about how vascular complications can occur by careless pedicle screw placement?..

Vascular complications 

22.Heini P, Scholl E, Wyler D, Eggli S. Fatal cardiac tamponade associated with posterior 
spinal instrumentation. A case report. Spine 1998;23:2226–30.  

Heini et al[22] described a case of fatal cardiac tamponade that
was due to a prick injury of the right coronary artery by a Kirschner
Neurology India | December 2005 | Vol 53 | Issue 4
CMYK517 517 Kim et al: Thoracic pedicle screw placement
wire. The injury was confirmed by autopsy after the patient died
12 days after surgery.

14. Suk SI, Kim WJ, Lee SM, Kim JH, Chung ER. Thoracic pedicle screw fixation in 
spinal deformities: are they really safe? Spine 2001;26:2049–57.   

Suk et al [14] described a case of an over­penetrated screw causing irritation of the thoracic aorta resulting in severe chest pain.

 25. Minor ME, Morrissey NJ, Peress R, Carroccio A, Ellozy S, Agarwal G, et al. 
Endovascular treatment of an iatrogenic thoracic aortic injury after spinal 
instrumentation: case report. J Vasc Surg 2004;39:893–6

 Recently Minor et al [25] reported endovascular  treatment of an iatrogenic aortic injury by misplaced thoracic pedicle screw at T5. 

I have not yet read all these three papers, I will comment further after I go through them all.

New Guidlines for TCD!

J Neuroimaging. 2010 Mar 17. [Epub ahead of print]
American Society of Neurophysiologic Monitoring and American Society of Neuroimaging Joint Guidelines for Transcranial Doppler Ultrasonic Monitoring.

Edmonds HL Jr, Isley MR, Sloan TB, Alexandrov AV, Razumovsky AY.
The American Society of Neurophysiologic Monitoring (ASNM) and American Society of Neuroimaging (ASN) Guidelines Committees formed a joint task force and developed guidelines to assist in the use of transcranial Doppler (TCD) monitoring in the surgical and intensive care settings. Specifically, these guidelines: (1) delineate the objectives of TCD monitoring; (2) characterize the responsibilities and behaviors of the sonographer during monitoring; (3) describe methodological and ethical issues uniquely relevant to monitoring. The ASNM and ASN strongly support the positions that (1) acquisition and interpretation of intraoperative TCD ultrasonograms be performed by qualified individuals, (2) service providers define their diagnostic criteria and develop on-going self-validation programs of these performance criteria in their practices. We agree with the guidelines of other professional societies regarding the technical and professional qualifications of individuals responsible for TCD signal acquisition and interpretation (Class III evidence, Type C recommendation). On the basis of current clinical literature and scientific evidence, TCD monitoring is an established monitoring modality for the: (1) assessment of cerebral vasomotor reactivity and autoregulation; (2) documentation of the circle of Willis functional status; (3) identification of cerebral hypo- and hyperperfusion, recanalization and re-occlusion; and (4) detection of cerebral emboli (Class II and III evidence, Type B recommendation). J Neuroimaging 2010;XX:1-7.

New on PubMed:

Investigation of the regeneration potential of the recurrent laryngeal nerve (RLN) after compression injury, using neuromonitoring.

Moskalenko V, Hüller M, Gasser M, Demidchik Y, Thiede A, Timm S, Ulrichs K, Hamelmann W.

Department of General and Visceral Surgery, Hospital of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, D-55131, Mainz, Germany. moskalenko@tut.by

INTRODUCTION:

The aim of this study was to investigate the regeneration potential of RLN after the compression of the nerve, without disrupting its continuity, using neuromonitoring.

METHODS: In the first operation, the RLN and nervus vagus of adult Goettingen minipigs were dissected free, and the neuromonitoring parameters (amplitude, threshold and lag time of signal) were measured. Injury of the RLN was induced using a "bulldog" clamp. When the signal was no longer detectable, after the 15 min regeneration phase, the operation was finished. The neuromonitoring studies (see above) were repeated in a second operation 6 months later. RESULTS: (1) After the first operation, acute clamping of the RLN led to a reduction in the amplitude of the neuromonitoring signal; the lag time and the threshold of signal remained. Complete restitution of the signal was observed during the first regeneration phase. Repeated clamping led to complete disappearance of the signal. (2) During the second operation, i.e., after 6 months of regeneration, the neuromonitoring signals of both RLN and nervus vagus were detected in 93% of the GMP. No statistical differences (p = 0.17) were noticed between the amplitude of the RLN before the nerve injury (first operation) and after nerve regeneration (second operation). A significant increase in the lag time (p <>

PMID: 18751999 [PubMed - indexed for MEDLINE]

What's New in Pediatric Orthopaedics???- Review by Kim and Noonan

In the latest issue of the journal JB and JS,  authours Young-Jo Kim, MD, PhD¹ 

and Kenneth J. Noonan, MD published their reviews on"Pediatric Orthopaedics". 

They discuss about the recent advancements in the field of Pediatric Orthopadics 

with emphasis on various spine deformity, neurological disorders in childrens with 

appropirate surgical methods used. They have done an excellent review of the literature, 

the 82 references listed can be useful for those in the Pediatric Ortho as well as for 

Neurophysiologists. There is a section on basic science applications and in another 

section on spine, they talk about effectiveness of Intraoperative monitoring 

using motor evoked potentials.

The effectiveness of spinal cord monitoring during spinal deformity surgery was recently reported in two large studies (involving >1000 patients), with the incidence of spinal cord injury approaching 1%^66,67. Transcranial motor-evoked potentials are exquisitely sensitive to threatened spinal cord function, andtheir use together with traditional somatosensory evoked potentials improves the accuracy of spinal cord monitoring. Somatosensory evoked potentials may not detect all problems and may not detect problems as rapidly as transcranial motor-evoked potentials do⁶⁷, and the sensitivity of transcranial motor-evoked potentials has led some centers to abandon somatosensory evoked potentials in favor of motor monitoring alone. For instance, Hsu et al.⁶⁸ reported 100% sensitivity for the detection of a clinically important neurological event in a consecutive series of 144 patients. The authors defined a neurological event as either a new postoperative deficit or a 50% decrease in the monitoring potential over a one-minute period. The rapidity with which motor monitoring detects spinal cord compromise makes it a valuable tool for sagittal plane correction, and prompt detection of a problem can lead to its resolution before a permanent deficit results^69,70.

The Journal of Bone and Joint Surgery (American). 2009;91:743-751.doi:10.2106/JBJS.H.01689

NEUROMONITORING RESEARCH Articles -PubMed

A quick search or  browsing on the PubMed on the subject neuromonitoring produced these results summarised in My NCBI column here.

This is the summary of publications thus far available in the pubmed search. Because of the way the robotic search is conducted using terms/words we "type in", there is a possiblity of exlusion of some related research papers, or inclusion of unrelated papers in the cumulative numbers. But, to the most part I believe these are the numbers reflecting published works on neuromonitoring. 

My NCBI
Welcome drmuni. [Sign Out]
U.S. National Library of Medicine
National Institutes of Health
ePubMedProteinNucleotideGSSESTStructureGenomeBooksCancerChromosomesConserved DomainsdbGaP3D DomainsGeneGenome ProjectGENSATGEO ProfilesGEO DataSetsHomoloGeneJournalsMeSHNCBI Web SiteNLM CatalogOMIAOMIMPMCPopSetProbeProtein ClustersPubChem BioAssayPubChem CompoundPubChem SubstanceSNPTaxonomyToolKitUniGeneUniSTS forSearch term  Items 1 - 20 of 312, of Page 16  Next  ,     Review: 72 forSearch term  Display SummaryBriefAbstractAbstractPlusCitationMEDLINEXMLUI ListLinkOutASN.1Related ArticlesCited in BooksCancerChrom LinksDomain Links3D Domain LinksdbGaP LinksGEO DataSet LinksGene LinksGene (OMIM) LinksGene (GeneRIF) LinksGenome LinksProject LinksGENSAT LinksGEO Profile LinksHomoloGene LinksNucleotide LinksNucleotide (RefSeq) LinksEST LinksEST (RefSeq) LinksGSS LinksGSS (RefSeq) LinksOMIA LinksOMIM (calculated) LinksOMIM (cited) LinksBioAssay LinksCompound LinksCompound (MeSH Keyword)Compound (Publisher) LinksSubstance LinksSubstance (MeSH Keyword)Substance (Publisher) LinksPMC LinksCited in PMCPopSet LinksProbe LinksProtein LinksProtein (RefSeq) LinksProtein (Weighted) LinksProtein Cluster LinksCited ArticlesSNP LinksSNP (Cited)Structure LinksTaxonomy via GenBankUniGene LinksUniSTS LinksAll: 179  of Page 9   Next,     Review: 34

EMG=61225 (3062 Pages), Reviews:3119

EEG=108037 (5402 Pages), Reviews: 7224        
TcMEP=23 (2 Pages), Reviews: 1           
SSEPs (the term SSEP alone does not produce result on somatosensory
but unrelated articles, but SSEPs is the correct term to use)
= 411 (21 Pages), Reviews:18          
Intraoperative, Cortical Mapping= 459 (23 Pages), Reviews:69
Carotid Endarctomy, Neuromonitoring= 28 (2 Pages), Reviews=6               
Scoliosis= 12 (1 Page), Review:1

Pubmed search of the topic Neuromonitoring using words "neuromonitoring, intraoperative neuromonitoring resulted in about 312 research article, 72 reviews for the term neuromonitoring and 179 research article and 34 reviews for the term intraoperative neuromonitoring respectively.

While there are several combination of word search to know the publication lists in this field, the search I posted here pretty much compiles most of them. Some of the other ways to look at the publications in this field using the search words such as "MEP, SSEP, EMG, EEG, Cortical Mapping, Carotid Endarctomy, Scoliosis. Some of the key words required a combination search with the word intraoperative to get specific research articles. In the following section, I will discuss the latest research reports on neuromonitoring comprising works done in 2008.

Ulnar Neuropathy? If the surgery site is lower Lumosacral level, why should you monitor upper limp SSEPs?

This article in the latest Spine Journal (an electronic publication) demonstrates that upper limp SSEP monitoring is quite handy in detecting ulnar nerve neuropathy during lower back surgeries??.

PubMed-NCBI Spine J. 2008 Aug 4. [Epub ahead of print] Upper-limb somatosensory evoked potential monitoring in lumbosacral spine surgery: a prognostic marker for position-related ulnar nerve injury.

BACKGROUND CONTEXT: Somatosensory evoked potential (SSEP) is used to monitor integrity of the brain, spinal cord, and nerve roots during spinal surgery. It records the electrical potentials from the scalp after electrical stimulation of the peripheral nerves of the upper or lower limbs. The standard monitoring modality in lumbosacral spine surgery includes lower-limb SSEP and electromyography (EMG). Upper-limb SSEP monitoring has also been used to detect and prevent brachial plexopathy and peripheral nerve injury in thoracic and lumbosacral spine surgeries. We routinely monitor lower-limb SSEP and EMG in lumbosacral spine procedures at our institution. However, a few patients experienced postoperative numbness and/or pain in their ulnar distribution with uneventful lower-limb SSEP and EMG.

Neuromonitoring Signal Changes during Spinal Epidural Hematoma?

Are there non-surgical factors that can cause spinal cord damage???......,

oh yes, 

there are few non-surgically induced damages that might go unnoticed in the absence of intraoperative neuromonitoring such as ischaemia, hematoma, stroke and so on...?.

 The following work demonstrates the timely detection of epidural hematoma by neurophysiological wave form changes.

the disappearance of evoked potentials and the subsequent appearance of paraplegia in our patient was unlikely to be caused by the epidural LA, but probably by the occurrence of the spinal epidural hematoma as a complication of epidural catheterization.

Acute spinal cord dysfunction was revealed by INM, then elucidated by imaging of the spine. The whole sequence of events led to timely urgent neurosurgical intervention which resulted in complete restoration of motor and sensory functions.

Our patient’s case supports the value of evoked-potential monitoring during spinal surgery.

This case and previous work offer arguments that evoked potentials are relatively insensitive to epidural LAs, but nevertheless we suggest that neuraxial LAs better be avoided in cases in which INM is used.

NEUROMONITORING COMPANIES IN AMERICA: How Many? & Who are they?

• Neuromonitoring1 ......is the only place on the internet or offline on any books where you will find list of companies that provide Neuromonitoring in America, it is not clear at this moment how many countries health care system applies this approach (there is no data on it, but I am sure there are only handful of nations like USA, Canada, UK, Sweden, Singapore so far known to employ or have companies doing this service, among them the most widely established neuromonitoring practices occur in US.
  
• 
  
• This list is by far the comprehensive, though it does not reflect one hundred percent of companies in US but certainly most of them with a webaddress and well known names are listed here.
  

A list of all these neuromonitoring companies are documented at the bottom of this blog under separate topic: Neuromonitoring Companies!!.

You will be able to get more details of those companies such as name brand, directors, office staff, company goals, operating areas and schedules etc., along with the link to each company at the very bottom of this blog under title Neuromonitoring Companies and Centers.

Two of the latest addition are Synapse neuromonitoring and Argos Neuromonitoring, the list will be updated periodically.

Neuromonitoring News!

Biotronics-a neuromonitoring company based in Ann-Arbor acquired another company :American Neuromonitoring of Farmington Hills. Here is the story......

Deal positions Biotronics for growth
"This is historically a very fragmented industry. ... Only in the last few years have (companies) begun to build to serving 20, 40 and, in our case, hundreds of clinicians in the field. Once you get yourself in a larger scale, you're able to provide a better price point to hospitals." - Gene Balzer, Biotronics chief executive officer.

By TINA REEDThe Ann Arbor News
As the practice of monitoring patients' nerve functions during spinal surgeries grows in popularity, an Ann Arbor-based company said it's aggressively trying to grow itself to make the practice more accessible to U.S. hospitals.

Biotronic NeuroNetwork recently acquired American Neuromonitoring of Farmington Hills in a move it hopes will position itself for future acquisitions and increase its monitoring expertise, said Gene Balzer, Biotronics chief executive officer.

How Much Risk Surgery Posses & What Neuromonitoring can Do?

Michael Dinkel et al., writes about the possible risks and outcomes of patients with disability in various surgery, and how neuromonitoring can help prevent such risks by identifying and localizing the risks in time?.

Intraoperative Neurophysiologic Monitoring
Michael Dinkel, M.D.
Department of Anaesthesiology Frankenwaldklinik
Ulrich Beese, M.D.
Department of Anaesthesiology University of Erlangen-Nuremberg
Michael Messner, M.D.
Department of Anaesthesiology University of Erlangen-Nuremberg
Citation:

Michael Dinkel, Ulrich Beese, Michael Messner: Intraoperative Neurophysiologic Monitoring .
The Internet Journal of Neuromonitoring. 2001 . Volume 2 Number 2.


The rate of permanent recurrent laryngeal nerve paresis after thyroidectomy for instance comes up to 9%. Almost 40% of patients with acute dissection of the thoracoabdominal aorta suffer from paraplegia after aneurysm repair. Despite a wake-up test 0.7 to 1.6% are paraplegic after corrective procedures for scoliosis. After cardiac procedures with extracorporal circulation there is a 1 to 3% incidence of severe neurologic deficits and an incidence of cognitive deficits running up to 80%. Finally the stroke rate after carotid endarterectomy comes to 7% in well documented series [2, 3 , 4 ,5,7].
Further Reading: click the above topic linked.....!

Cardiovascular Surgery (like Cardiopulmanory bypass-CPB) & Neuromonitoring!

The following article demonstrates that neuromonitoring is very useful in cardiovascular surgeries, especially in patients with cerebrovascular diseases.

Intraoperative neuromonitoring in cardiac surgical patients with severe cerebrovascular disease
Alexander Kulik, MD, Rosendo A. Rodriguez, MD PhD, Howard J. Nathan, MD and Marc Ruel, MD MPH
University of Ottawa, Ottawa, Canada, E-mail: akulik@ottawaheart.ca

To the Editor:
Patients with severe cerebrovascular disease are at a high risk of neurologic complications during cardiac surgery, as a result of cerebral embolization or hypoperfusion during cardiopulmonary bypass (CPB). Intraoperative neuromonitoring, including transcranial Doppler ultrasound (TCD) and electroencephalography (EEG), may be particularly useful in patients with cerebrovascular disease.1 We hereby present two cases that illustrate the use of intraoperative neuromonitoring during cardiac surgery in patients with severe cerebrovascular disease.

Auditory "Brain stem Implant Electrode"- Frequency Tuning?

How important it is to fine tune the frequency specificity in the ventral cochlear nucleus and central inferior collicular neurons, the following research work published in the Oct 2007 issue of "Journal of Neurophysiology" used multichannel microelectrodes to map the frequency specfic patterns of activity in VCN and Inferior colliculus neurons.

TRANSLATIONAL PHYSIOLOGY
Inferior Colliculus Responses to Multichannel Microstimulation of the Ventral Cochlear Nucleus: Implications for Auditory Brain Stem Implants

Mohit N. Shivdasani1,2,3, Stefan J. Mauger1,2,3, Graeme D. Rathbone1,3 and Antonio G. Paolini1,2

Submitted 7 June 2007; accepted in final form 6 October 2007

Multichannel techniques were used to assess the frequency specificity of activation in the central nucleus of the inferior colliculus (CIC) produced by electrical stimulation of localized regions within the ventral cochlear nucleus (VCN). Data were recorded in response to pure tones from 141 and 193 multiunit clusters in the rat VCN and the CIC, respectively. Of 141 VCN sites, 126 were individually stimulated while recording responses in the CIC.....................

Hearing Loss, what is Trigeminal Nerve doing instead of VIII Nerve?

Dorsal cochlear nucleus responses to somatosensory stimulation are enhanced after noise-induced hearing loss
S. E. Shore1,2,3
1Department of Otolaryngology, Kresge Hearing Research Institute
2Department of Molecular and Integrative Physiology and
3Department of Biomedical Engineering, University of Michigan Medical School, Ann Arbor, MI 48109, USA,
S. Koehler1,3
1Department of Otolaryngology, Kresge Hearing Research Institute
3Department of Biomedical Engineering, University of Michigan Medical School, Ann Arbor, MI 48109, USA,
M. Oldakowski1
1Department of Otolaryngology, Kresge Hearing Research Institute,
L. F. Hughes4
4Southern Illinois University School of Medicine, Department of Surgery/Otolaryngology, Springfield, IL, USA and
S. Syed1
1Department of Otolaryngology, Kresge Hearing Research Institute

The above article published in the latest issue of "European Journal of Neuroscience, discusses issues on hearing loss and possible involvement of trigeminal nerve?

Abstract:
Hearing loss due to VIII nerve damage or loss of synaptic connectivity of VIII nerve in the cochlear nucleus is a common degenerative changes observed in models of noise damage, similar degeneration of terminals also reported in cases of hearing loss in humans. However, the above article discusses the possiblity of the involement of "Trigeminal Nerve" as a compensatory response to the loss of VIII nerve connections following noise induced hearing loss in animal models. How much of this compensatory response is due to hearing loss or changes in VIII nerve connectivity is not clear, however, it is interesting to note how the neighbouring cranial nerve respond.

The authors observe the following changes in responses to trigeminal stimulation: The guinea pigs with noise-induced hearing loss had significantly lower thresholds, shorter latencies and durations, and increased amplitudes of response to trigeminal stimulation than normal animals. Noise-damaged animals also showed a greater proportion of inhibitory and a smaller proportion of excitatory responses compared with normal. Authors also argue that there is increased inhibitory responses and increased activity of somatosensory response, prompting them to conclude a role of somatosensory inputs in noise induced hearing loss? is yet to be clarified by extensive studies!.

Here is a Science Daily which is jumbing into conclusions of the following kind?.
'Ringing In The Ears' May Be Caused By Overactive Nerves, Acupuncture May Help, Study Suggests
ScienceDaily (Jan. 10, 2008) — Do your ears ring after a loud concert? Nerves that sense touch in your face and neck may be behind the racket in your brain, University of Michigan researchers say.
Note: the above image is from Science Daily.

SAFETY IN THE OR: By Association of Peri Operative Registered Nurses, ALAMEDA county #0501

The Peri-Operative registered Nurses of Alameda country chapter #0501 has this fabulous informative site about what and what not to do in the OR, OR safety and policies. Though it was written for vendors (the suppliers and tech's), it is a great informative sources for anyone in the OR, the neurophysiolgosits and neuromonitoring crew's may find this very useful and informative, I did so. Thanks to the AORN for such a useful resources of knowledge in OR.

Vendor Policy - AORN of Alameda County
VendorsIn The Operating Room

Following completion of the self-directed learning module, the Vendor will be able to:
1. Classify various areas within the surgical suite, (e.g., restricted, semirestricted and unrestricted).
2. Describe proper surgical attire.
3. Describe proper handwashing technique and its importance.
4. Compare and contrast the communicability of HIV, HAV and HBV.
5. Describe steps to follow during a fire in the operating room.
6. Describe basic procedure during electrical outage.
7. Name plans for prevention of tuberculosis exposure.

Aseptic Technique
Aseptic technique is essential in all operating rooms. It should be considered the "law of the land". If breached, the consequences can be far-reaching and potentially devastating to the patient and the reputation of the hospital involved. The patient is particularly at risk for invasion of exogenous bacterial infections because the most significant protective barrier (the skin) is interrupted during surgery. Therefore, this is one of the most important sections in this module.

For the full site and details of the safety policy, read at:

http://www.blogger.com/post-create.g?blogID=3615506595623153265

the above images are obtained from the article:

Making the Operating Room a Safer Place
Michael Garvin, MHA11/01/2002
Making the Operating Room a Safer Place
By Michael Garvin, MHA

American Society of Anesthesiologissts: Upcoming Conference & Abstracts on Neuromonitoring

Tha annual meeting of American Association of Anesthesiologist will be held during

October 13-17, 2007 San Francisco, CA. There are several interesting research and clinical studies on using neuromonitoring, how different anesthesia affects the intraoperative recording. You can click this highligted assn "Amer Assoc Anesthesiologist Meeting" and read all the important abstracts.

Here is a sample abstrat:

A1 October 13, 2007 9:00 AM - 10:30 PM

Room 301
Somatosensory and Motor Evoked Potentials during Sevoflurane and Propofol Anesthesia

Michael S. Kincaid, M.D., Michael J. Souter, M.D., Patrick D. Bryan, Mark Klein, Arthur M. Lam, M.D.Anesthesiology, University of Washington, Seattle, Washington

Background and Purpose: Transcranial electrical motor evoked potentials (MEP) have joined somatosensory evoked potentials (SSEP) as an important aspect of neurophysiologic monitoring during both intracranial and spine surgery. General anesthesia is known to diminish the quality of signals with SSEP, decreasing amplitude and increasing latency, with volatile anesthesia having a greater effect than intravenous anesthesia. There is little quantitative information on the comparative effect of volatile and intravenous anesthetics on MEP signal quality, however. The purpose of this study is to describe the effects of propofol and sevoflurane on SSEP and MEP in patients undergoing both spine and neurosurgical procedures.

Neuromuscular Scoliosis- Intraoperative Neuromonitoring: Challenges!

Nature Clinical Practice Neurology (2007) 3, 318-319
doi:10.1038/ncpneuro0502
Received 7 December 2006 Accepted 5 April 2007
Published online: 8 May 2007

Intraoperative monitoring during spinal surgery for neuromuscular scoliosis
Michael G Fehlings* and Michael O Kelleher
Correspondence *Suite 4WW-446, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada Email michael.fehlings@uhn.on.ca

This article has no abstract so we have provided the first paragraph of the full text.

The avoidance of iatrogenic neurological injury is of paramount importance during spinal surgery, and multimodality intraoperative monitoring using a combination of MEPs, SSEPs and electromyographic (EMG) signals is increasingly used in this setting.1, 2 During corrective procedures for neuromuscular scoliosis, however, the successful application of intraoperative monitoring is a challenge

, particularly in the most severely deformed and neurologically compromised patients.3 Difficulties in obtaining reliable baseline recordings of conventional (cortical and subcortical) SSEPs and transcranial MEPs in patients with neuromuscular scoliosis has prompted the use of an epidural electrode to record spinal SSEPs and evoke neurogenic MEPs.