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Khalil Salame, Shimon Maimon, Gilad J. Regev, Tali Jonas Kimchi, Akiva Korn, Laurence Mangel, and Zvi Lidar

(AKA; also called the arteria radicularis magna) was significantly high. The goal of the present case series study was to check whether the use of electrophysiological monitoring (EPM) during temporary occlusion of radicular or radiculomedullary arteries (RMAs) while performing preoperative angiography can predict the safety of occluding these vessels in patients scheduled for TES of thoracic spine tumors. Methods Patient Characteristics This study was approved by our local institutional review board. Five patients who underwent preoperative embolization

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Sandeep Mittal, Jean-Pierre Farmer, Chantal Poulin, and Kenneth Silver

C erebral palsy is primarily a motor function disorder caused by perinatal insults to the developing cerebrum. Selective posterior rhizotomy aims to relieve the ensuing spasticity, which is predominantly seen in the lower limbs, and to improve motor function. 31 In an effort to optimize the balance between elimination of spasticity and preservation of strength, most medical centers rely on intraoperative electrophysiological monitoring based on, or modified from, the original technique described by Fasano and colleagues. 8 Clinically significant improvements

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Tetsuya Goto, Yuichiro Tanaka, Kunihiko Kodama, Shoji Yomo, Yosuke Hara, Atsushi Sato, and Kazuhiro Hongo

P revention of postoperative neurological deficits is essential in neurosurgery. With IEM, it is possible to directly evaluate patients' neurological function while they are in a state of general anesthesia. 5 Somato-sensory evoked potential, ABR, MEP, and VEP have been developed for IEM. 1 , 3 , 4 , 6 Improvements in electrophysiolog-ical devices and in our knowledge regarding the use of anesthetic agents during various types of electrophysiological monitoring have made IEM a routine procedure. 7 It is often difficult to maintain a stable connection

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Hiroshi Ryu, Seiji Yamamoto, Kenji Sugiyama, and Kenichi Uemura

side affected by the tinnitus. We describe the case of a patient with severe intractable tinnitus, in whom we successfully performed selective cochlear neurotomy in the cerebellopontine (CP) cistern while preserving normal vestibular functions with the aid of electrophysiological monitoring. Case Report This 55-year-old man was injured in a traffic accident that occurred in May 1993. He did not lose consciousness, but suffered a mild neck sprain. Persistent high-pitched tinnitus in his left ear started just after the accident and gradually became louder until

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Daniel K. Resnick, Paul A. Anderson, Michael G. Kaiser, Michael W. Groff, Robert F. Heary, Langston T. Holly, Praveen V. Mummaneni, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. Vresilovic, and Paul G. Matz

Object

The objective of this systematic review was to use evidence-based medicine to examine the diagnostic and therapeutic utility of intraoperative electrophysiological (EP) monitoring in the surgical treatment of cervical degenerative disease.

Methods

The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to cervical spine surgery and EP monitoring. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.

Results

The reliance on changes in EP monitoring as an indication to alter a surgical plan or administer steroids has not been observed to reduce the incidence of neurological injury during routine surgery for cervical spondylotic myelopathy or cervical radiculopathy (Class III). However, there is an absence of study data examining the benefit of altering a surgical plan due to EP changes.

Conclusions

Although the use of EP monitoring may serve as a sensitive means to diagnose potential neurological injury during anterior spinal surgery for cervical spondylotic myelopathy, the practitioner must understand that intraoperative EP worsening is not specific—it may not represent clinical worsening and its recognition does not necessarily prevent neurological injury, nor does it result in improved outcome (Class II). Intraoperative improvement in EP parameters/indices does not appear to forecast outcome with reliability (conflicting Class I data).

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Laura M. Muncie, Nathaniel R. Ellens, Emeline Tolod-Kemp, Claudio A. Feler, and John S. Winestone

laminectomy, scarring in the epidural space from prior procedures, medical comorbidities, allergies to local anesthesia, or communication barriers. 1 , 6 Falowski et al. suggests that the incidence of device failure for patients whose leads were placed using electrophysiological monitoring (intraoperative EMG) was lower when compared with patients receiving lead placement via sedation and intraoperative trial. 6 Balzer et al. incorporated the use of SSEP monitoring to assist with the localization of SCS leads in both the cervical and cervicomedullary spine. In this study

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Alok Sharan, Michael W. Groff, Andrew T. Dailey, Zoher Ghogawala, Daniel K. Resnick, William C. Watters III, Praveen V. Mummaneni, Tanvir F. Choudhri, Jason C. Eck, Jeffrey C. Wang, Sanjay S. Dhall, and Michael G. Kaiser

Recommendations There is no evidence that conflicts with the previous recommendations regarding electrophysiological monitoring published in the original version of the “Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine.” Grade I The use of direct screw stimulation evoked electromyography (EMG) responses, as a diagnostic modality during lumbar fusion surgery, is an option since evidence suggests that EMG monitoring can be highly sensitive in detecting breaches of the pedicle (one Level III study). The

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Daniel K. Resnick, Tanvir F. Choudhri, Andrew T. Dailey, Michael W. Groff, Larry Khoo, Paul G. Matz, Praveen Mummaneni, William C. Watters III, Jeffrey Wang, Beverly C. Walters, and Mark N. Hadley

as adjunctive options during instrumented lumbosacral fusion procedures for degenerative spinal disease. The use of any of these modalities has not been convincingly demonstrated to influence patient outcome favorably. Rationale Intraoperative electrophysiological monitoring of spinal cord and nerve root function is used in a variety of clinical scenarios. Various techniques are thought to be useful for the detection and prevention of neurological deficits during surgery to repair aortic aneurysms, correct scoliotic or traumatic spinal deformities, and

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Derek L. G. Hill, Andrew D. Castellano Smith, Andrew Simmons, Calvin R. Maurer Jr., Timothy C. S. Cox, Robert Elwes, Michael Brammer, David J. Hawkes, and Charles E. Polkey

S everal authors have recently compared the results of fMR studies with those of subsequent electrophysiological studies performed using chronically implanted subdural electrodes or intraoperative evoked potentials and stimulation in neurosurgical patients. 6, 12, 18, 19, 27, 28 These studies, which are reviewed later, contribute to an understanding of the relationship between functional regions localized using fMR imaging and the same regions localized using invasive electrophysiological monitoring. However, they do not demonstrate that fMR imaging is

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Tal Shahar, Akiva Korn, Gal Barkay, Tali Biron, Amir Hadanny, Tomer Gazit, Erez Nossek, Margaret Ekstein, Anat Kesler, and Zvi Ram

composed of axons arising in the lateral geniculate nucleus and terminating in the primary visual cortex of the calcarine fissure. Study Participants During the study period (May 2009 to March 2014), 18 patients (8 men and 10 women) with a mean age of 50.2 ± 15.1 years (range 26–78 years) underwent awake craniotomy for tumor resection and intraoperative electrophysiological monitoring to evaluate the posterior visual pathway located within or adjacent to the OR. Patient characteristics, including tumor locations, pathological diagnosis, and preoperative VF evaluations