Neuromonitoring:- a Review on PubMed Publications

We do not get much time to go read all the published papers on Neuromonitoring, unlike during the Laboratory research days, my visit to PubMed is less frequent, but yet I do not give up on my practice to go here and spend some time in catching up with the latest papers.  In my recent visit to the PubMed, I found the following ongoing research activities in the field of neuromonitoring. 

This is a very brief review, will help re-route the interested readers or visitors to the PubMed original article. Right now, I have access to only the abstracts, so just by going through the abstracts of recently published article I thought to list the recent papers here. 

PubMed Search "Neuromonitoring" check the links direct to the articles.

1.Therapeutic hypothermia for cardiac arrest: a practical approach.

Curr Treat Options Neurol. 2009 Mar;11(2):137-49.

Seder DB, Jarrah S argues that though Therapeutic Hypothermia (TH) is the most immediate and well known technique to review patients suffering from cardiac arrest (known as Encephalopathic survivors), a combined approach that involves various emerging tools such as critical care or Neuromonitoring can yield better outcome of patients, usage of neuromonitoring is critical during decooling phase...!

In the same journal of Curr Treat Options Neurol, another article emphasize the knowledge and usage of multimodality neuromonitoring for better outcome of patients aneurysmal subarachnoid hemorrhage (SAH)

a non traumatic hemmorrhage caused by either a tumor,infection or vascular malformation. 

2.Critical care management of subarachnoid hemorrhage."This article reviews the natural history of aneurysmal SAH and

strategies for disease management in the acute setting, including available tools for monitoring brain function.

Intensive care management of patients with SAH focuses on prevention of further neurologic injury. Aneurysmal rebleeding, hydrocephalus, seizures, and delayed ischemic injury represent major threats"

In vascular surgeries like carotid endarterectomy and when the internal carotid artery (ICA) is clamped the neuromonitoring playes an important role in giving early warning of Ischemia or embolism, especially the Sensory evoked potential and EEG monitoring.  Some of the techniques used are Transcranial Doppler (TCD) to measure the mean blood flow velocity, and Near-infrared Spectroscopy (NIRS) to assess the dynamics of "haemoglobine", but these techniques according to Bein B, Fudickar A, Scholz J. the practicability of using TCD and NIRS posses problems in about 20% patients?. Bein et all suggests the "Gold Standard" for better outcome and patient safety is to use intraoperative monitoring of SSEP?.

 3. [Anesthesia in vascular surgery--monitoring of cerebral function].

"Use of somatosensory evoked potentials (SEP) is the most widespread cerebral neuromonitoring during vascular surgery due to its high reliability and simple application. Sensitivity and specifity for ischemic lesions are 100% and 94%-99%, respectively. SEP are regarded as the gold standard for cerebral neuromonitoring in anaesthetized patients".

 Br J of Surg , In this British Journal of Surgery Publication,

4. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy.  Barczyński M, Konturek A, Cichoń S discuss about testing the hypothesis "Neuromonitoring of Recurrent Layrngeal nerves during Thyroidectomy?.  Unlike Barczyriski et al., who concluded the that the neuromonitoring in their surgical procedures

"Nerve monitoring decreased the incidence of transient but not permanent RLN paresis compared with visualization alone, particularly in high-risk patients".

These Italian surgery team in  video-assisted thyroidectomy (VAT) a same day surgical procedure, they found Intraoperative monitoring of reccurrent laryngeal monitoring helped prevent permanent damages to laryngeal nerves. 

5. Video-assisted thyroidectomy performed in a one-day surgery setting.

"Intraoperative neuromonitoring (IONM) was used for RLN identification. Intact parathyroid hormone (iPTH) levels were determined early postoperatively at +6-h. Postoperative complications, conversion rate were analyzed. RESULTS: No cases required conversion to open surgery or ordinary recovery (i.e. >24h). Incidence of temporary hypoparathyroidism was 11.6% (5/43) with no case of symptomatic hypocalcemia. Incidence of temporary RLN injury was 2.3% (1 patient) with no case of permanent or bilateral RLN injury. All patients were satisfied with the type of recovery. CONCLUSIONS: This preliminary report is an example of the safe incorporation between new technologies (IONM, early iPTH measurement) with improvement of the quality and safety of VAT performed in a one-day surgery setting. (this is a Dec 2008 article, not 2009?)

 6. In this latest issue of Laryngoscope, risks of VOICE alterations? (vocal cord damage due to laryngeal nerve injury) has been discussed. The Columbia University surgical team presents their data in this interesting finding and the authors conclude that there was 100% preservation of vocal cords during this minimally invasive, local anesthesia induced thyroidectomy.  The authors 

"Inabnet WB, Murry T, Dhiman S, Aviv J, Lifante JC discuss that the dentification and preservation of the external branch of the superior laryngeal nerve (EBSLN) is paramount for normal vocal function preservation after thyroidectomy. 

Thyroidectomy was successfully completed under local anesthesia in all cases. The recurrent laryngeal nerve(s) was identified and preserved in each patient as demonstrated by normal perioperative transnasal flexible laryngoscopy.

A total of 15 EBSLNs were at risk, but only 8 EBSLNs (53%) were definitively identified.

 Neuromonitoringdemonstrated preservation of the EBSLN in 100% of cases.

The analysis of the results of the VHI-10 questionnaire before and 3 weeks after surgery indicated no significant change in patients' perception of voice severity. CONCLUSION:: Monitoring of the EBSLN during thyroidectomy under local anesthesia is a feasible alternative to conventional nerve monitoring under general anesthesia. This technique may be useful for the preservation of voice quality during a minimally invasive thyroidectomy under local anesthesia"

Human Atlas:- Video Education of Anatomy?

As the above caption suggests, if you click one of the topics, you can see and listen to a beautiful and quite simple description of different anatomical structure of human Body. 

For someone who is just learning Anatomy or atlas of the Human body,  this is a good place to start......... you can start here. 

Audio and visual learning is more effective than just reading, though nothing can replace a careful and thorough reading habit. Modern tools makes learning much more easier and simpler. 

Here it is, hope you will find it useful.

One of the topic I clicked to see the video was "Anatomy of Spine", quite simple but appropriate information to begin learning the spine anatomy.

This can be a very good tool for someone who might be interested in learning neuroanatomy and neurophysiology. These 3D descriptions can be useful for non-neuroscience as well as neuroscience students, for Neuromonitoring newbies?.. and even for those who know the field, a quick refresher. 

Few Example Video's:

3D: Anatomy of Spine

3D: Lumbar Laminectomy

3D: Spinal Stenosis

Link:http://www.atlantichealth.org/en/atlantic/healthinformation/human+atlas+videos.html

Neurophysiology Recitation of Texts Only: 1824-1889?

Today, we have the most sophisticated tools to study and learn science and medical subjects. Most of the ground breaking scientific and medical findings came out of a laboratory research that involves animal research or human research, without practical research, can't imagine the fate of our medical and scientific achievements. If that is true for general science and medical field, the progress we made in neuroscience in general and clinical neuroscience like Neurophysiology and Intraoperative neuromonitoring is an amazing break through of our learning using modern tools. What were they during just 200 years ago in physiology and neurophysiology?. Not much.......... Physiology was studied and taught by only reciting the texts like some of those Jabber's of religious scriptures in temples, really?. 

Yes, 

it seems during early to late 1800's the Physiology was taught by reciting the texts. For the very first time live animal demonstration in anesthetized animals was introduced in America by Dalton.

Neurology 2000;55:859-864
© 2000 American Academy of Neurology 

---

Historical Neurology

John Call Dalton, Jr., MD

America’s first neurophysiologist

Edward J. Fine, MD, Tara Manteghi, BA, Sidney H. Sobel, MD and Linda A. Lohr, MA

From the Department of Veterans’ Affairs Medical Center and Department of Neurology (Dr. Fine and Ms. Manteghi), State University of New York at Buffalo; Finger Lakes Radiation Oncology (Dr. Sobel), Clifton Springs, NY; and the Robert L. Brown, MD, History of Medicine Collection (Ms. Lohr), State University at Buffalo, NY.

Address correspondence and reprint requests to Dr. Edward J. Fine, Neurology Service, Department of Veterans’ Affairs Medical Center, 3495 Bailey Avenue, Buffalo, NY 14215.

Before the discoveries of John Call Dalton, Jr., MD (1824–1889), innervation of laryngeal muscles, long-term effects of cerebellar lesions, and consequences of raised intracranial pressure were poorly understood. Dalton discovered that the posterior cricoarytenoid muscles adducted the vocal cords during inspiration. He confirmed Flourens’ observations that acute ablation of the cerebellum of pigeons caused loss of coordination. Dalton observed that properly cared for pigeons gradually recovered "coordinating power." Dalton observed that prolonged raised intracranial pressure caused tachycardia and then fatal bradycardia in dogs. Before Dalton published his photographic atlas of the human brain, neuroanatomy atlases were sketched by Europeans and imported into the United States. Dalton’s atlas of the human brain contained precise photographs of vertical and horizontal sections that equal modern works. Before Dalton introduced live demonstrations of animals, physiology was taught by recitation of texts only. Dalton was the first American-born professor to teach physiology employing demonstrations of live animals operated on under ether anesthesia. He wrote an essay advocating experimentation on animals as the proper method of acquiring knowledge of function and that humane animal experimentation would ultimately improve the health of man and animals. His eloquent advocacy for humane experimental physiology quelled attacks by contemporaneous antivivisectionists. Dalton was America’s first experimental neurophysiologist.

73% of Patients suffered Complications, 11 out of 15 Patient?, What kind of IONM Company serves such a Surgeon?

Today's "Daily Record" carried the following news about a"medical malpractice suit"filed against Northwest Medical Center. In addition to the hospital and the surgeon, the neuromonitoring company known as American Intraoperative  Monitoring LLC? is also in trouble?.

"If" one has to go by this report and the number of surgeries done by the surgeon involved in this suit, 11 out of 15 patients (73%) had complications after spinal corrections (it not clear what kind of surgical procedure done on all the 15 surgical procedures, but the current case that is reported here is an anterior discectomy and fusion simply known as ACDF?). The number of patients suffering from post surgical complications are very significant, going by this report. This amount of surgical complications in the first place is rare, I haven't heard of a 73% complications (unless someone send me some past reports or ref?). 

Nevertheless, for argument I am wondering, what kind of a Neuromonitoring Company will provide neurophyisological monitoring services to a surgeon of this kind reported in this law suit?. Why?. Are you part of a bad practice and demoralized medical ethics, do you know what you are doing inside the OR?.

The report also claims that the Neuromonitoring Staff, seems to be an RN trained in neuromonitoring was aware about abnormalities (?? is this SSEPs loss? or Motor Loss or Spinal cord damage or what?) but did not warn the surgeon while it was happening during the surgery, neither he or she reported this after the surgical procedure?............Immmmmm...?

Northwest Medical Center added to malpractice suit

By Scott F. Davis Northwest Arkansas Times

Posted on Friday, January 23, 2009

Email this story | Printer-friendly version

FAYETTEVILLE - A Bentonville couple amended their malpractice lawsuit Thursday against Dr. Cyril "Tony" Anthony Raben and his clinic, Northwest Arkansas Spine and Orthopedic Associates, adding three new parties as defendants.

Theresa Paulino and her husband, Eddie Paulino, seek damages because she lost the use of her legs following neck surgery by Raben on Dec. 17, 2008, according to the complaint.

The Paulinos added Northwest Medical Center to the lawsuit, claiming "negligent credentialing" after learning that an audit by the Arkansas State Medical Board showed a very high complication rate for Raben's prior surgeries.

Read the full story: click the topic of this news linked to the original news.

Dexmedetomidine- A New Short Term Sedative?

Interesting Review on "Dexmedetomidine", the most recent sedative approved by the FDA.

Dexmedetomidine: a novel sedative-analgesic agent Ralph Gertler, MD,1 H. Cleighton Brown, MD,1 Donald H. Mitchell, MD,1 and Erin N. Silvius, MD1 1From the Department of Anesthesiology and Pain Management, Baylor University Medical Center, Dallas, Texas; and Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center at Dallas. Corresponding author. Corresponding author: Ralph Gertler, MD, Department of Anesthesiology and Pain Management, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, Texas 75246 (e-mail: Ralph_Gertler10@excite.com). Since the first report of clonidine, an α2-adrenoceptor agonist, the indications for this class of drugs have continued to expand. In December 1999, dexmedetomidine was approved as the most recent agent in this group and was introduced into clinical practice as a short-term sedative (<24 style="font-size: 0.8em; line-height: 0.8em; white-space: nowrap; ">2-Adrenoceptor agonists have several beneficial actions during the perioperative period. They decrease sympathetic tone, with attenuation of the neuroendocrine and hemodynamic responses to anesthesia and surgery; reduce anesthetic and opioid requirements; and cause sedation and analgesia. They allow psychomotoric function to be preserved while letting the patient rest comfortably. With this combination of effects, α2-adrenoceptor agonists may offer benefits in the prophylaxis and adjuvant treatment of perioperative myocardial ischemia. Furthermore, their role in pain management and regional anesthesia is expanding. Side effects consist of mild to moderate cardiovascular depression, with slight decreases in blood pressure and heart rate. The development of new, more selective α2-adrenoceptor agonists with improved side effect profiles may provide a new concept for the administration of perioperative anesthesia and analgesia. This review aims to give background information to improve understanding of the properties and applications of the novel α2-adrenoceptor agonist, dexmedetomidine.

Neuromonitoring & Peadiatric Cardiopulmonary bypass surgical procedures?:- Boosts Evidence Based practice & Best Practice?

Usage of intraoperative neurophysiologic monitoring during Peadiatric cardiopulmonary bypass surgical procedures reported in the following research papers, addition of IONM tothe surgical team has helped them to improve the post surgical neurological complications. Two of the following studies one published recently in Sept-Oct 2008 and the other in 2007, both in peer reveiwed journals discuss the importance of IONM usage in terms of reducing neurological risk, patient safety and faster discharge of patients that could be benefitial to both the patients and the hospitals.

The influence of neurophysiologic monitoring on the management of pediatric cardiopulmonary bypass.

ASAIO J. 2008 Sep-Oct;54(5):467-9

Kimatian SJ, Saliba KJ, Soler X, Valentine EA, Coleman ML, Kunselman AR, Schuler HG, Barnes ML,Thirumala PD, Myers JL.

Department of Anesthesiology, Penn State College of Medicine, Hershey, Pennsylvania 17033, USA. skimatian@hmc.psu.edu

We describe a process by which we sought to determine how the addition of intraoperative neurophysiologic monitoring (IONM) impacted the management of cardiopulmonary bypass (CPB) during pediatric cardiac surgery.

While maintaining a consistent team of surgeons, anesthesiologists, nurses, and perfusionists, a multi-modal, IONM program was established consisting of Near Infrared Spectroscopy, Transcranial Doppler, and eight channel electroencephalography. A retrospective review of cases from 1 year before the institution of the IONM program was compared with data obtained from cases performed after neurophysiologic monitoring was established as a standard of care for pediatric patients on CPB.

This comparative analysis of CPB management revealed a significant increase in the use of donor blood added to the CPB circuit prime as well as in the maintenance of a higher hematocrit during the bypass period after the implementation of IONM.

These changes in the management of pediatric CPB correlated with recommendations of previous studies that examined postoperative neurophysiologic outcomes, suggesting that these changes were not only consistent with best practices, but that the presence of IONM data facilitated a transition to evidence-based practice.

Benefit of neurophysiologic monitoring for pediatric cardiac surgery.

Austin EH 3rd, Edmonds HL Jr, Auden SM, Seremet V, Niznik G, Sehic A, Sowell MK, Cheppo CD, Corlett KM.

Department of Surgery, University of Louisville School of Medicine, Ky., USA.

BACKGROUND: Pediatric patients undergoing repair of congenital cardiac abnormalities have a significant risk of an adverse neurologic event. Therefore this retrospective cohort study examined the

potential benefit of interventions based on intraoperative neurophysiologic monitoring in decreasing both postoperative neurologic sequelae and length of hospital stay as a cost proxy.

METHODS: With informed parental consent approved by the institutional review board,

electroencephalography, transcranial Doppler ultrasonic measurement of middle cerebral artery blood flow velocity, and transcranial near-infrared cerebral oximetry were monitored in 250 patients.

An interventional algorithm was used to detect and correct specific deficiencies in cerebral perfusion or oxygenation or to increase cerebral tolerance to ischemia or hypoxia. RESULTS: Noteworthy changes in brain perfusion or metabolism were observed in 176 of 250 (70%) patients. Intervention that altered patient management was initially deemed appropriate in 130 of 176 (74%) patients with neurophysiologic changes.

Obvious neurologic sequelae (i.e., seizure, movement, vision or speech disorder) occurred in five of 74 (7%) patients without noteworthy change, seven of 130 (6%) patients with intervention, and 12 of 46 (26%) patients without intervention (p = 0.001). Survivors' median length of stay was 6 days in the no-change and intervention groups but 9 days in the no-intervention group. In addition, the percentage of patients in the no-intervention group discharged from the hospital within 1 week (32%) was significantly less than that in either the intervention (51%, p = 0.05) or no-change (58%, p = 0.01) groups.

On the basis of an estimated hospital neurologic complication cost of $1500 per day, break-even analysis justified a hospital expenditure for neurophysiologic monitoring of $2142 per case. CONCLUSIONS:

Interventions based on neurophysiologic monitoring appear to decrease the incidence of postoperative neurologic sequelae and reduce the length of stay. Inasmuch as the break-even cost for neurophysiologic monitoring is more than four times the actual average charge, both patients and hospital may profit from this service.

Because this study was not a truly randomized clinical trial, unintentional statistical bias may have occurred and caution is urged in interpreting the magnitude of apparent intergroup outcome differences.

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.

Neurophysiology News!

Neurophysiolgy & Pudental Nerve Connection:-

Beyond the Abstract - Evaluation of the Safety and Efficacy of ... UroToday - Berkeley,CA,USA Neurophysiological studies give invaluable information on the involvement of the parts of the nervous system which are essential in the control of sexual ... See all stories on this topic

Neuroscience Boot Camp ScienceBlogs - USA Laboratory visits will include a trip to an MRI scanner, an EEG/ERP lab, an animal neurophysiologylab, and a transcranial magnetic stimulation lab. ... See all stories on this topic

PEOPLE IN BUSINESS Delmarva Now - Salisbury,MD,USA She completed a clinical fellowship in neurophysiology at Henry Ford. In addition to her training in general neurology care, including headache and migraine ... See all stories on this topic

Medical Acupuncture Gaining Acceptance by the US Air Force MarketWatch - USA Based on modern neurophysiological concepts, Niemtzow developed a variation of acupuncture that involves inserting very tiny semi-permanent needles into ... See all stories on this topic

Novel method of chaotic communication proposed by physicists eTaiwan News - Taiwan In addition to use in communications, Hu went on, temporal transfer entropy can also be applied to many different scientific fields, such as neurophysiology ... See all stories on this topic

Blackrock can build bigger ICU Irish Medical Times - Dublin,Ireland The building to be knocked down contains a pharmacy, neurophysiology services and a prayer room. The current unit will also be revamped as part of the ... See all stories on this topic

Get lost ... and get better architecture MSNBC - USA ... before a single brick is ever laid, said Edelstein, a trained neurophysiologist and a visiting scholar at the University of California at San Diego. ... See all stories on this topic

IBIA-Brain Injury Conference?

 

NEWS

An Invitation to Washington D.C. As Chairperson and President of the IBIA 8th World Congress on Brain Injury to be held March 10 - 14, 2010 in Washington, D.C., USA, we would like to invite the participation of all professionals involved with serving persons with acquired brain injury to this international Congress and meeting of minds. We are very excited about having the meeting in the United States and in particular, its capital, Washington, D.C.  This is the first time in our history that a World Congress has been held in the USA.  Washington, D.C. is a culturally diverse city with many fine hotels, restaurants, museums, culture events and historical landmarks.  The meeting is expected to be the largest IBIA meeting in our history and in many ways the most exciting.  We hope that you will join us for this unprecedented event.

Transient Loss of TcMEP during L5-S1 posterior fusion?

In the following case report, a posterior lower lumbar surgical procedure done on a Spondylolisthesis (L5/S1) patient resulted in a transient loss of motor evoked potentials despite the patient had no neurological injury?. The motor loss was occurred after epidural injection of 2.4mg of morphine?. The authors believe it could be due to the pressure caused by the injection would have compressed cauda equina?.

Even a small injection of this kind could lead to evoked potential changes should be noted. Though the TcMEP recovered after 1h, care  must be taken to make sure prolonged compression does not take place!.

Case report

Transient loss of motor-evoked responses associated with caudal injection of morphine in a patient with spondylolisthesis undergoing spinal fusion

PETER R.J. GIBSON MBBS FANZCA*, Pediatric Anesthesia, Volume 16 Issue 5, Pages 568 - 572, 2005

A 7-year-old girl having posterior spinal fusion for Grade 3 anterior spondylolisthesis at the L5/S1 level was administered 2.5 mg of morphine in 10 ml saline via the caudal epidural route before surgery.

Motor-evoked responses were markedly diminished in her lower limbs for 1 h following this but returned spontaneously. She suffered no neurological injury. The cause for this is postulated to be transient cauda equina compression from the volume of injectate. This complication of caudal injection has not been reported before. The possible mechanisms for this are discussed. We believe that significant L5/S1 spondylolisthesis should be considered a contraindication to the use of caudal epidural injections.

Wave P300 (ERP) & Temporal Lobe Epilepsey

In this latest issue of the journal of Human Brain Mapping, the authors suggest that wave P300 an endogenous event related evoked potential seems to be altered in pateints with temporal lobe epilepsy, a change in the latency and amplitude of P300 was observed in 10 patients suffering from TLE (same number of normal recording was conduted for comparison). 

Hum Brain Mapp. 2008 Nov 25. [Epub ahead of print] 

Attention impairment in temporal lobe epilepsy: A neurophysiological approach via analysis of the P300 wave.

Bocquillon P, Dujardin K, Betrouni N, Phalempin V, Houdayer E, Bourriez JL, Derambure P, Szurhaj W.
Department of Clinical Neurophysiology, Lille University Medical Center, Lille, France.
Purpose:

Attention is often impaired in temporal lobe epilepsy (TLE). The P300 wave (an endogenous, event-related potential) is a correlate of attention which is usually recorded during an "oddball paradigm," where the subject is instructed to detect an infrequent target stimulus presented amongst frequent, standard stimuli.

Modifications of the P300 wave's latency and amplitude in TLE have been suggested, but it is still not known whether the source regions also differ. Our hypothesis was that temporal lobe dysfunction would modify the P3 source regions in TLE patients. Methods: A comparative, high density, 128-channel electroencephalographic analysis of the characteristics of P300 (P3b latency and amplitude) was performed in 10 TLE patients and 10 healthy controls during auditory and visual oddball paradigms. The P3b sources were localized on individual 3D MR images using the LORETA method and intergroup statistical comparisons were performed using SPM2(R) software. Results: Our main results (in both individual analyses and intergroup comparisons) revealed a reduction in temporal (and more particularly mesiotemporal) sources and, to a lesser extent, frontal sources in TLE patients, compared with controls. Discussion: This reduction may reflect direct, local cortical dysfunction caused by the epileptic focus or more complex interference between epileptic networks and normal attentional pathways. Hum Brain Mapp, 2009. (c) 2008 Wiley-Liss, Inc.

PMID: 19034898 [PubMed - as supplied by publisher]

BMP in Back surgery?:- What and Who?

Bone Morphogenic protein (BMP) is used in certain surgical procedures that involves lower lumbar surgery, but not in other procedures why?. Is BMP good compared to patients own bone transplantation or bone marrow substitute?. Right now it seems lime the FDA has approved BMP to be used only in lower lumbar cases such as L5-S1 procedures?. But, if BMP has anything to do with neurophysiological signals, not sure if there are any reports?.

Brain writes in this column about BMP, it's present usages and more...!. The full article can be read from his original site spine universe, click the topic for the link. 

BMP: The What and the Who

Brian R. Subach, MD, FACS
Neurosurgeon/Spine Surgeon
Virginia Spine Institute
Reston, VA

The title of this article asks two completely different but equally important questions. First, the "what." RhBMP-2 (recombinant bone morphogenetic protein, BMP) is a genetically engineered protein which both recruits bone forming cells to the surgical area and "turns on" local cells to the bone-making process. BMP is used for conditions requiring spinal fusion and stimulation of bone growth.

ABRET changes the Eligibility Requirement for All Exams?

ABRET has announced a major change in the eligibility requirement for exams like CNIM, Long Term Monitoring, EEG and EP technologists.  These news changes will be effective for some exams from Jan 2009 and for others from 2012. The change will apply to all the exams conducted by ABRET.  

The new requirements for CNIM exam is the candidate should undergo prior EEG credentialing???

There are two major requirements, of which the second one is already known to the folks in this area, but the first requirement:

1.An electroneurodiagnostic credential; R. EEG T. or R. EP T. or Canadian equivalent. A copy of current registration must accompany the Application.

For someone with a graduate degree or PhD or MD, if they wanted to be neuromonitoring specialist, they must undergo EEG or EP credentialing through ABRET?, does this makes any sense to those advanced degree holders?. It simply sounds to be ridiculous that ABRET is bent on making such changes as this would drive the PhDs and other advanced degree holders, there are already lots of shortage in neuromonitoring, it is difficult for companies to hire graduates with specialization in neurophysiology or neuroscience, with this new requirements, it is going to get worst to find someone with a credentialing in EEG or EP. 

As of January 1, 2010 the following eligibility requirements will be in effect for the CNIM Examination

The Certification Examination in Neurophysiologic Intraoperative Monitoring is designed and written for the advanced level electroneurodiagnostic professional who is currently practicing in an intraoperative environment.

All candidates must meet the following requirements by the application deadline. There are no alternative routes.

1. An electroneurodiagnostic credential; R. EEG T. or R. EP T. or Canadian equivalent. A copy of current registration must accompany the Application.

Disposable Surgical Face Masks: A Systematic Review

Here is an review on Surgical Masks, a careful review on Masks that looks at all the studies done so far and compares the various usage and it's safety.

Disposable Surgical Face Masks:

A Systematic Review

DISPOSABLE SURGICAL FACE MASKS: A SYSTEMATIC REVIEW

Authors: Allyson Lipp RN DipN RNT MA MSc, Principal Lecturer, School of Care
Sciences, University of Glamorgan, UK.
Peggy Edwards RN Dip Operating
Practice BSc Professional Practice, Welsh Risk Pool Assessor, Pontypridd,
UK
Acknowledgements: Cochrane Collaboration Wounds Group and the Theatre
Nursing Trust Fund. Extracts of systematic review reproduced by kind permission
of: Update Software, Oxford.

ABSTRACT

Surgical face masks were originally developed to contain and
filter droplets of microorganisms expelled from the mouth and nasopharynx of
healthcare workers during surgery, thereby providing protection for the
patient.

However, there are several ways in which surgical face masks could potentially contribute to contamination of the surgical wound. Surgical face masks have recently been advocated as a protective barrier between the surgical team and the patient, but the role of the surgical face mask as an effective measure in preventing surgical wound infections is questionable.
The aim of the systematic review is to identify and review all randomised controlled trials evaluating disposable surgical face masks worn by the surgical team during clean surgery to prevent postoperative surgical wound infection.

First Spinal Cord Endoscope Surgery Conducted in Iran

Can you imagine in this 21st century with so much of medical knowledge and medical care a first spinal endoscope surgical procedure is done on Oct 14, 2008?. A first spinal surgery in Iran, wow....finaly a surgical procedure to help patients with back or spinal problems is introduced in Iran by an American spine surgeon?.

Iran News Page One > Iran News First Spinal Cord Endoscope Surgery Conducted in Iran Oct 15, 2008 Iranian.ws The first spinal cord endoscope surgery was conducted in Iran, yesterday morning, by Professor John Chio, head of California Vertebrarium Research Center. Shedding light on details of such a surgery, Chio said: “During this surgery the tissues are not cut and the muscles are placed aside with highly delicate tools in order to reach the spinal cord and to lower disc pressure. Meanwhile, in order to stitch the wound, laser is used.” He added that in this surgery the patient does not bleed and therefore blood transfusion does not take place. The surgeon further underlined that the patient can leave three hours after surgery, resuming his social life within six days and commencing his athletic activities within three weeks. “The operation is also economically justified,” he added. He further said that one of his main goals is to train Iranian physicians, stressing that Iranian physicians are intelligent and can easily learn this operation.