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Gerald A. Grant, Donald Farrell, and Daniel L. Silbergeld

resonance imaging data in a neuronavigational system. Neurosurgery 49 : 1145 – 1157 , 2001 Roux FE, Ibarrola D, Tremoulet M, et al: Methodological and technical issues for integrating functional magnetic resonance imaging data in a neuronavigational system. Neurosurgery 49: 1145–1157, 2001 8. Rowed DW , Houlden DA , Basavakumar DG : Somatosensory evoked potential identification of sensorimotor cortex in removal of intracranial neoplasms. Can J Neurol Sci 24 : 116 – 120 , 1997 Rowed DW, Houlden DA

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Sumito Okuyama, Shinjitsu Nishimura, Yoshiharu Takahashi, Keiichi Kubota, Takayuki Hirano, Ken Kazama, Masato Tomii, Junko Matsuyama, Junichi Mizuno, Tadao Matsushima, Masataka Sato, and Kazuo Watanabe

C arotid endarterectomy (CEA) is a promising procedure for symptomatic and asymptomatic patients with severe carotid artery stenosis. 2 , 5 , 16 , 27 , 28 Median nerve somatosensory evoked potential (MNSSEP) monitoring during CEA is useful in identifying intraoperative cerebral hypoperfusion, which is related to the risk of perioperative stroke and deficits in cognitive performance. 4 , 8 , 19 , 22 , 24 Reported studies have investigated the limitations of MNSSEP monitoring during CEA. MNSSEP is less sensitive than electroencephalography in detecting carotid

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Mayumi Kitagawa, Jun-Ichi Murata, Haruo Uesugi, Ritsuko Hanajima, Yoshikazu Ugawa, and Hisatoshi Saito

example of SSEPs from the scalp and DBS electrode along the trajectory to the ZI in a patient with tremor-dominant PD (Case 7). Because a DBS electrode was implanted in the lateromedial direction, the atlases above and below the AC–PC line were designated 12.5 mm and 10.5 mm lateral to the midline, respectively. The contacts were 1.5-mm long and spaced 1.5-mm apart. The SSEP numbers (0-Fz, 1-Fz, 2-Fz, 3-Fz) are identical to the contact numbers (0, 1, 2, 3). Dotted lines show the latency period of P9, P13/14, N18 and N20. Somatosensory evoked potentials with a cephalic

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Xinyu Liu, Shunsuke Konno, Masabumi Miyamoto, Yoshikazu Gembun, Gen Horiguchi, and Hiromoto Ito

6 Chu NS : Somatosensory evoked potentials: correlations with height . Electroencephalogr Clin Neurophysiol 65 : 169 – 176 , 1986 7 Clinical Outcomes Committee of the Japanese Orthopaedic Association, Subcommittee on Evaluation of Back Pain and Cervical Myelopathy : Subcommittee on Low Back Pain and Cervical Myelopathy Evaluation of the Clinical Outcome Committe of the Japanese Orthopaedic Association, Fukui M, Chiba K, Kawakami M, Kikuchi S, Konno S, Miyamoto M, Seichi A, Shimamura T, Shirado O, Taguchi T, Takahashi K, Takeshita K, Tani T, Toyama Y

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Conducted somatosensory evoked potentials during spinal surgery

Part 1: Control conduction velocity measurements

James B. Macon and Charles E. Poletti

C ortical somatosensory evoked potentials (CSEP's) have been proposed as a means of monitoring spinal cord function intraoperatively. 10, 12 Measuring CSEP's, especially in response to peroneal stimulation, is limited by a number of factors, including: 1) marked variability of both latency and amplitude with changing levels of general anesthesia; 2) insensitivity to incomplete spinal cord lesions because of supraspinal polysynaptic components; 3) excessively long conduction distance masking the effects of spinal lesions; and 4) unreliability of responses from

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Dudley S. Dinner, Hans Lüders, Ronald P. Lesser, Harold H. Morris, Gene Barnett, and G. Klem

M onitoring of somatosensory evoked potentials (SEP's) to peripheral nerve stimulation (posterior tibial, peroneal, or median nerves) during spinal column or spinal cord surgery is commonplace. The detection of significant changes in the monitored potentials may indicate early spinal cord dysfunction and allow appropriate measures to be carried out to prevent irreversible spinal cord damage. The two basic types of spinal cord monitoring currently used employ noninvasive or invasive techniques. The noninvasive techniques 1, 2, 11, 27, 29, 31, 32, 34, 38, 39

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James B. Macon, Charles E. Poletti, William H. Sweet, Robert G. Ojemann, and Nicholas T. Zervas

I n the preceding paper, 4 we have described a technique for recording spinal somatosensory evoked potentials (SEP's) during spinal operations using bipolar epidural electrodes. Measurement of spinal conduction velocity (CV) across the operative field was proposed as a potentially safe, reliable, and sensitive means of intraoperatively monitoring spinal cord function. This paper addresses the question of whether permanent postoperative changes in neurological function, especially deterioration, can be predicted by intraoperative changes in spinal cord CV

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Stephen K. Powers, Catherine A. Bolger, and Michael S. B. Edwards

D espite a great deal of experimental and clinical research, a controversy exists concerning which spinal pathways mediate cortical somatosensory evoked potentials (SEP's). Several investigators 4, 8, 10, 17, 24, 36, 38 have concluded that the dorsal and dorsolateral columns contain the pathways that mediate the cortical SEP's. Early clinical investigations into SEP's in patients with dissociated sensory loss have shown that the integrity of the dorsal columns must be maintained for transmission of the cortical SEP's after stimulation of peripheral nerves. 25

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Jeffrey R. Balzer, Nestor D. Tomycz, Donald J. Crammond, Miguel Habeych, Parthasarathy D. Thirumala, Louisa Urgo, and John J. Moossy

estimating lead laterality but will not ultimately confirm if one or both sides of the spinal cord will receive clinically significant stimulation. Consequently, after the surgeon's best efforts to position a paddle electrode, there has been a need to develop a method to objectively confirm the location of cervical epidural electrodes without patient cooperation. Somatosensory evoked potentials have become the workhorse of neurophysiological monitoring in spine surgery due to their high sensitivity and specificity for identifying spinal cord injury and proven ability to

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Georg Neuloh and Johannes Schramm

ICA bifurcation aneurysm. Microvascular Doppler ultrasonography was also performed, whereas continuous MEP monitoring was not feasible due to a disturbing twitching artifact. No specific event was noted. Somatosensory evoked potentials remained stable throughout surgery, and MDU findings were normal. Right: There was a moderate postoperative hemiparesis that resolved after 3 weeks, and an early cerebral CT (CCT) scan demonstrated ischemia of the dorsal limb of the internal capsule (arrow) . For approximately 10 years, reliable intraoperative MEP monitoring