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?.

IONM: Neurological Testing or Neurophysiological Divining? J. G. Salamy, Ph.D.

Editorial Link:

Dr Joe Salamy writes a thought provoking and insightful Editorial Review about Intraoperative NeuroMonitoring, where do we stand?, what do we have to do to bring in new approach and newer technologies to avoid the IONM field become a stagnant one?..

IONM: Neurological Testing or Neurophysiological Divining? 

J. G. Salamy, Ph.D.  

VERTECz: surgical neurophysiology, Las Vegas, Nevada 

2012 All Rights Reserved

Email: 

Summary

During the last three decades IONM has followed an objective probability-based clinical model whichfocused attention almost exclusively upon the detection of specific events.  IONM practices, however, donot neatly conform to those of conventional clinical testing procedures.  It is suggested herein that futureefforts be directed toward developing additional models which elucidate the dynamic and subjectivequalities of IONM and recognize the importance of sequences and their influence upon decision making. Heretofore, the temporal and linguistic aspects of IONM have been largely ignored.  It is proposed that weexamine IOMN as an ongoing interactive process, and develop new tools to help accomplish this task.

For full Article , visit this Special Editorial column under the tabs: or click the following link

http://neuromonitoring1.blogspot.com/p/special-editorials.html

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.

Detached Skull But Intact Spinal Cord: Massive Accident with damages to Nervous System, 9 Y Boy Survives!!!

Pic from The MedGuru.com

Though Neurophysiological Details are not available, no Cranial Nerve restoration details are available in news reports, it is not clear how much of spinal cord functionally spared by the accident, how much motor and sensory functions of the boy was lost and recovered following the procedure is not clear. Despite the details are not out there on the news, surgical team and hospital certainly will have detailed information, the survival of this young Boy is unique, special and a medical achievement. 

A 9 year old boy after a fatal accident who was determined to have only 2% chance of survival is making great recovery after neurosurgical procedures?. 

This is a rare fatal accident almost sounds like a movie story but a real event happened in Hillsboro Texas, it is just amazing to realize a orthopedic decapitation is possible for a surgeon to work and fix the head and nerves back to functioning condition, though details are not available, but even considering this at a news level, it is nothing but Amazing. This is also the medical and surgical achievement of the surgeon and the crew.

Catharine Paddock, PhD writes at the Medical News Today, about a nearly decapitated 9 year old dcapitated boy was operated by Dr Richard Roberts, a pediatric neurosurgeon at the Cook Childrens' Medical Center in Fort Worth, as per the news below, the surgeon was able to fix the head back and the boy is recovering?. It will be interesting to know about how the facial and other Cranial nerves were placed back, if at all?. If all the Cranial nerves have damages or completely severed, how did the surgical team managed to keep the vital functions going?. 

Nearly Decapitated 9-Year Old Car Crash Boy Recovers

Jordan Taylor, a nine year old boy from Hillsboro, Texas, is making a rare and astonishing recovery from surgery to reattach his head to his neck after suffering an orthopedic decapitation three months ago; the youngster was buckled in the back seat of a car his mother was driving when they were hit by a dump truck that the authorities say ran a stop sign.

'Internal Decapitation': Boy's amazing recovery

Tuesday, December 23, 2008 | 1:42 PM

Surviving an 'Internal Decapitation'

Doctors quickly pointed out that an atlanto-occipital dislocation cannot be called a "decapitation" in the traditional sense. For one thing, even though the skull is disjoined form the spinal column, the head does not technically leave the body. And in Jordan's case, as with others, the spinal cord -- that crucial superhighway of nerve fibers that connects the brain to the rest of the body -- was not severed.

Still, Dr. Phillip Tibbs, chair of neurosurgery at the University of Kentucky, says that in many cases, the end result is much the same.

Health and Wellness News

Texas Boy Survives Orthopedic Decapitation

Atlanta, GA 12/22/2008 05:41 PM GMT (TransWorldNews)

A 9-year-old Hillsboro, Texas boy’s recovery from a near decapitation is being called a miracle. Jordan Taylor only had a 1-2 percent chance to live after suffering an orthopedic decapitation in a car accident 3 months again.

Jordan was riding in the back seat of a car his mother Stacey Perez was driving when a dump truck ran a stop sign and hit the vehicle. The boy’s skull separated from his neck but his spinal cord remained intact.

“The energy basically made his head lift up off his neck, and then move forward. All of the connective tissue that essentially keeps your head connected to your neck was destroyed,” says Dr. Richard Roberts, the pediatric neurosurgeon who operated on Jordan.

Jordan’s skull and neck has been reattached with a metal plate and titanium rods. Dr. Roberts says it’s a miracle that Jordan is able to walk and talk.

Click here for more People News

9 year old boy miraculously survives car crash decapitation

Texas, United States, December 23: A 9 year old boy from Texas was involved in a motor vehicle accident that separated his skull from his vertebrae three months ago, but doctors miraculously reattached his head to his neck and now he’s fully recovered.

According to his mother he’s planning to go back to school after Christmas break.

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

Remifentenil Reduces Patient Movement during Neurosurgery?

Doctors Guide is a very informative website on various fields of medicine and related subjects, mainly aimed to serve the doctors and information seekers in the allied health field and general public. http://www.docguide.com. It is freely accessible, if you want to personalize, you have to register and it is free.

The following article is relevant and interesting to neurophysiologists who do intraoperative neuromonitoring, also for anesthesiologists and the neurosurgeons who are concerned about patient movement during surgical procedure. In the recent annual meeting of the "American Soceity of Anesthesiologists the following work on Remifentanil was presented. Arushi Sinha, PhD writes about a presentation on how remifentanil can reduce patient movement during neurosurgery.


New Approaches for Reducing Patient Movement During Neurosurgery:
Presented at ASA
By Arushi Sinha, PhDSAN FRANCISO, CA -- October 23, 2007 --
Remifentanil reduces the risk of movement in the absence of muscle relaxants among patients undergoing elective craniotomy, researchers reported here at the Annual Meeting of the American Society of Anesthesiologists (ASA).In the case of neuroanaesthesia surgeries, muscle relaxants may not be indicated, particularly if intraoperative monitoring of motor evoked potentials or electromyography are involved. Alternative agents, such as remifentanil and propofol, may be used in such settings according to recent research.Marco Maurtua, MD, Assistant Professor, Department of Anesthesiology, Cleveland Clinic Foundation, Cleveland, Ohio, United States, and his colleagues designed a study to characterise the role of remifentanil in reducing movement associated with neurosurgical stimuli and to examine the incidence of bradycardia and hypotension in elective craniotomy patients.

[Presentation title: Remifentanil Prevents Movement During Neurosurgery in the Absence of Neuromuscular Blockade. Abstract A1481]

Some Stats about CNIM Exam

CNIM Written Exam 2003-2006
One of the following must be met and verified for candidates

to be eligible to take the CNIM Exam:

Health care credential plus documentation of 100 cases monitored
Bachelor’s degree plus documentation of 100 cases monitored
68% passed on their first attempt. The pass rate for repeaters was 46%.
39% had another health care credential. Their pass rate was 50%.
61% of candidates had a bachelor’s degree or higher and a 61% pass rate.
Some of the candidates with bachelor’s or advanced degrees, also documented they had another health care credential.
Procedures Performed in the OR Totals
Totals Percentage
Spinal Nerve EMG 911 83%
Motor Pathway 783 71%
Intraop Scalp EEG 719 65%
BAEP 661 60%
Cranial Nerve EMG 619 56%
Cortical mapping 337 31%
ECOG 197 18%
VEP 139 13%

41% of candidates stated CNIM was a Job Requirement. This was the most common reason stated for taking the exam. The second most common response was Professional Advancement (34%) and the third reason selected was Personal Goal (18%).