Special Issue "Intraoperative Neurophysiology: Optimizing Current and Developing New Techniques"

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 20 October 2023 | Viewed by 1469

Special Issue Editor

Dr. Gea Drost
E-Mail Website1 Website2
Guest Editor
Department Neurosurgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
Interests: clinical neurophysiology especially Intraoperative neurophysiology; brain death

Special Issue Information

Dear Colleagues,

Intraoperative neurophysiological monitoring (IONM) has grown from an interesting investigational procedure to a widely used clinical method. IONM plays an important role in various surgeries in which the nervous system is at high risk of damage. Its goal is to protect patients from neurological injury during surgery. Modalities used in IONM are mostly well-known adapted neurophysiological techniques such as EEG, EMG, and evoked potentials (EPs). These modalities are not just about continuous monitoring the nervous system, e.g., motor and sensory pathways, but also about mapping. Mapping provides rapid anatomical identification and localization of neural structures. Current intraoperative monitoring and mapping techniques are being optimized, and new methods are being developed to obtain the best possible post-operative neurological outcome for each patient.

New surgical options require new IONM techniques to achieve optimal therapeutic outcome. For example, in neuromodulation, which has become a standard of care in movement disorders, other intraoperative monitoring techniques such as accelerometry are used to achieve this. Although IONM techniques have become indispensable in high-risk surgery, there is a lack of prospective studies. This Special Issue includes such studies and focuses on the improvement of IONM techniques, as well as the development of new ones.

Dr. Gea Drost
Guest Editor

Manuscript Submission Information

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Keywords

  • intraoperative neuromonitoring
  • motor evoked potentials
  • stereotactic surgery
  • evidence-based medicine
  • neurolog-ical outcome

Published Papers (2 papers)

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Research

Article
Use of NEedle Versus suRFACE Recording Electrodes for Detection of Intraoperative Motor Warnings: A Non-Inferiority Trial. The NERFACE Study Part II
J. Clin. Med. 2023, 12(5), 1753; https://doi.org/10.3390/jcm12051753 - 22 Feb 2023
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Abstract
In the NERFACE study part I, the characteristics of muscle transcranial electrical stimulation motor evoked potentials (mTc-MEPs) recorded from the tibialis anterior (TA) muscles with surface and subcutaneous needle electrodes were compared. The aim of this study (NERFACE part II) was to investigate [...] Read more.
In the NERFACE study part I, the characteristics of muscle transcranial electrical stimulation motor evoked potentials (mTc-MEPs) recorded from the tibialis anterior (TA) muscles with surface and subcutaneous needle electrodes were compared. The aim of this study (NERFACE part II) was to investigate whether the use of surface electrodes was non-inferior to the use of subcutaneous needle electrodes in detecting mTc-MEP warnings during spinal cord monitoring. mTc-MEPs were simultaneously recorded from TA muscles with surface and subcutaneous needle electrodes. Monitoring outcomes (no warning, reversible warning, irreversible warning, complete loss of mTc-MEP amplitude) and neurological outcomes (no, transient, or permanent new motor deficits) were collected. The non-inferiority margin was 5%. In total, 210 (86.8%) out of 242 consecutive patients were included. There was a perfect agreement between both recording electrode types for the detection of mTc-MEP warnings. For both electrode types, the proportion of patients with a warning was 0.12 (25/210) (difference, 0.0% (one-sided 95% CI, 0.014)), indicating non-inferiority of the surface electrode. Moreover, reversible warnings for both electrode types were never followed by permanent new motor deficits, whereas among the 10 patients with irreversible warnings or complete loss of amplitude, more than half developed transient or permanent new motor deficits. In conclusion, the use of surface electrodes was non-inferior to the use of subcutaneous needle electrodes for the detection of mTc-MEP warnings recorded over the TA muscles. Full article
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Article
Comparing Motor-Evoked Potential Characteristics of NEedle versus suRFACE Recording Electrodes during Spinal Cord Monitoring—The NERFACE Study Part I
J. Clin. Med. 2023, 12(4), 1404; https://doi.org/10.3390/jcm12041404 - 10 Feb 2023
Cited by 1 | Viewed by 795
Abstract
Muscle-recorded transcranial electrical stimulation motor-evoked potentials (mTc-MEPs) are used to assess the spinal cord integrity. They are commonly recorded with subcutaneous needle or surface electrodes, but the different characteristics of mTc-MEP signals recorded with the two types of electrodes have not been formally [...] Read more.
Muscle-recorded transcranial electrical stimulation motor-evoked potentials (mTc-MEPs) are used to assess the spinal cord integrity. They are commonly recorded with subcutaneous needle or surface electrodes, but the different characteristics of mTc-MEP signals recorded with the two types of electrodes have not been formally compared yet. In this study, mTc-MEPs were simultaneously recorded from the tibialis anterior (TA) muscles using surface and subcutaneous needle electrodes in 242 consecutive patients. Elicitability, motor thresholds, amplitude, area under the curve (AUC), signal-to-noise ratio (SNR), and the variability between mTc-MEP amplitudes were compared. Whereas amplitude and AUC were significantly higher in subcutaneous needle recordings (p < 0.01), motor thresholds and elicitability were similar for surface and subcutaneous needle recordings. Moreover, the SNRs were >2 in more than 99.5% of the surface and subcutaneous needle recordings, and the variability between consecutive amplitudes was not significantly different between the two recording electrode types (p = 0.34). Surface electrodes appear to be a good alternative to needle electrodes for spinal cord monitoring. They are non-invasive, can record signals at similar threshold intensities, have adequately high SNRs, and record signals with equivalent variability. Whether surface electrodes are non-inferior to subcutaneous needle electrodes in detecting motor warnings is investigated in part II of the NERFACE study. Full article
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