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Terrance M. Darcey, Erik J. Kobylarz, Michael A. Pearl, Patricia J. Krauss, Stephanie A. Ferri, David W. Roberts and David F. Bauer

. Stereotact Funct Neurosurg 88 : 345 – 352 , 2010 10 Kanal E : An overview of electromagnetic safety considerations associated with magnetic resonance imaging . Ann N Y Acad Sci 649 : 204 – 224 , 1992 11 Mislow JMK , Golby AJ , Black PM : Origins of intraoperative MRI . Neurosurg Clin N Am 20 : 137 – 146 , 2009 12 Nuwer MR : Intraoperative Monitoring of Neural Function Handbook of Clinical Neurophysiology Amsterdam , Elsevier , 2008 13 Schmitz BL , Aschoff AJ , Hoffmann MHK , Grön G : Advantages and pitfalls in 3T MR brain

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Paul Park, Anthony C. Wang, Jaypal Reddy Sangala, Sung Moon Kim, Shawn Hervey-Jumper, Khoi D. Than, Amin Farokhrani and Frank LaMarca

I n the treatment of symptomatic kyphosis of the cervical or cervicothoracic spine, surgery is indicated for significant neurological symptoms and severe functional disability such as loss of horizontal gaze. 6 , 17 , 21 One of the major risks of deformity surgery, however, is the potential for neurological injury, with reported complication rates ranging from 4.8% to 62.5% including radiculopathy and/or spinal cord injury. 1 , 2 , 11 , 13 , 15 , 17 , 21 Intraoperative monitoring of SSEPs has been shown to decrease the rate of neurological complications

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Katsushige Watanabe, Takashi Watanabe, Akio Takahashi, Nobuhito Saito, Masafumi Hirato and Tomio Sasaki

Somatosensory evoked potential monitoring, although widely used, cannot provide direct and instantaneous information about motor pathway integrity. 14 Intraoperative MEP monitoring is valuable for identifying eloquent areas during surgical procedures, and thus allows the most extensive resection possible. 29 Intraoperative monitoring of pathways from the motor cortex to the peripheral muscles has been attempted by several methods. Stimulation can be delivered directly and electrically to the exposed cortical surface, or transcranially by using electrical or magnetic pulses

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Takahiro Ota, Kensuke Kawai, Kyousuke Kamada, Taichi Kin and Nobuhito Saito

during surgery 5 , 23 and that intraoperative VEP monitoring is currently not as widely used as monitoring of 2 other sensory responses. According to Cedzich et al., 5 who challenged the usefulness of intraoperative monitoring of flash-evoked visual potentials, the essential limitation of intraoperative VEP monitoring lay in the instability of the potentials while technical interferences, such as the effect of volatile anesthesia and the difference in visual stimuli, that is, LED flash and strobe flash versus pattern reversal, also influenced reliability. Most of

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Helmut Wiedemayer, Barbara Fauser, Ibrahim Erol Sandalcioglu, Heike Schäfer and Dietmar Stolke

Cereb Blood Flow Metab 4: 68–81, 1984 4. Daube JR : Intraoperative monitoring by evoked potentials for spinal cord surgery: the pros. Electroencephalogr Clin Neurophysiol 73 : 374 – 377 , 1989 Daube JR: Intraoperative monitoring by evoked potentials for spinal cord surgery: the pros. Electroencephalogr Clin Neurophysiol 73: 374–377, 1989 5. Dawson EG , Sherman JE , Kanim LEA , et al : Spinal cord monitoring. Results of the Scoliosis Research Society and the European Spinal Deformity Society

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Tatsuya Sasaki, Takeshi Itakura, Kyouichi Suzuki, Hiromichi Kasuya, Ryoji Munakata, Hiroyuki Muramatsu, Tsuyoshi Ichikawa, Taku Sato, Yuji Endo, Jun Sakuma and Masato Matsumoto

report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Acknowledgment We are grateful to Mr. Katsuhiko Kato (Gigatex, Osaki, Japan) for his technical support. References 1 Cedzich C , Schramm J , Fahlbusch R : Are flash-evoked visual potentials useful for intraoperative monitoring of visual pathway function? . Neurosurgery 21 : 709 – 715 , 1987 2 Chacko AG , Babu KS , Chandy MJ : Value of visual evoked potential monitoring during trans-sphenoidal pituitary

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Tomoyoshi Oikawa, Masato Matsumoto, Tatsuya Sasaki and Namio Kodama

T he medulla oblongata contains not only various important nuclei and pathways but also the vasomotor center, respiratory center, and brainstem reticular formation, which are essential to sustain life. 4, 15 Recent advances in neuroradiological imaging and microsurgical techniques have enabled neurosurgeons to locate lesions accurately 12, 23 and to perform surgery. 1, 2, 5, 17 Various methods of intraoperative monitoring have been applied with the intention of minimizing postoperative complications. During surgical treatment of the medulla oblongata

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, however, will require further assessment in a larger prospective cohort of patients. We read with great interest the article by Krassioukov and colleagues (Krassioukov AV, Sarjeant R, Arkia H, et al: Multimodality intraoperative monitoring during complex lumbosacral procedures: indications, techniques, and long-term follow-up review of 61 consecutive cases. J Neurosurg 1: 243-253, October, 2004). This represents an excellent, long-term follow-up study, which emphasizes the role of electrophysiological monitoring in increasing the safety of complex spinal

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You Gyoung Yi, Keewon Kim, Hyung-Ik Shin, Moon Suk Bang, Hee-Soo Kim, Jinwoo Choi, Kyu-Chang Wang, Seung-Ki Kim, Ji Yeoun Lee, Ji Hoon Phi and Han Gil Seo

N europhysiological intraoperative monitoring (IOM) of neural functions is an important surgical adjuvant in brain 1 , 31 and spine surgery 5 , 8 , 20 and is used to reduce the risk of injury by providing appropriate feedback to the neurosurgeon. 36 However, monitoring of somatosensory evoked potentials (SSEPs) alone is insufficient to detect injury to the corticospinal tract or nerve root so as to prevent postoperative weakness. 6 , 16 , 34 , 38 Monitoring motor evoked potentials (MEPs) during surgery through transcranial electrical stimulation (TES

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Daniel H. Fulkerson, Krishna B. Satyan, Lillian M. Wilder, James J. Riviello, Stephen A. Stayer, William E. Whitehead, Daniel J. Curry, Robert C. Dauser, Thomas G. Luerssen and Andrew Jea

report of the routine use of MEPs in this patient population. Methods All pediatric patients undergoing neurosurgical procedures with spinal cord monitoring between January 1, 2008, and May 1, 2010, at Texas Children's Hospital were studied. Over this time period, we performed a total of 81 cranial and 122 spinal procedures with intraoperative monitoring. Ten of the spinal surgeries were performed in children who were younger than 3 years of age. All underwent MEP monitoring. These 10 consecutive patients formed the basis for our study. Anesthesia Patients