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Langeloo, Danielle D.; Lelivelt, Arjan; Journée, H. L.; Slappendel, R.; Kleuver, Marinus de

doi:10.1097/00007632-200305150-00017

Cited by 27 publications

(37 citation statements)

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“…The anesthetic agent was ketamine, 200 mg/hr via infusion during these experiments. The most commonly used criteria for alerting to a clinically relevant event during MEP monitoring is either a 100% or 80% loss of signal 28 . Therefore, the time for DCS to detect a 50% drop in blood flow from baseline was compared with the time for motor evoked potential (MEP) signals to drop by 80% from baseline upon performing an aortic clamping in three sheep.…”

Section: Methodsmentioning

confidence: 99%

Fiber-optic Monitoring of Spinal Cord Hemodynamics in Experimental Aortic Occlusion

et al. 2015

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BACKGROUND Spinal cord ischemia occurs frequently during thoracic aneurysm repair. Current methods to detect ischemia, based upon electrophysiology techniques, are indirect, non-specific, and temporally slow. Here we report the testing of a spinal cord blood flow and oxygenation monitor, based on Diffuse Correlation and Optical Spectroscopies, during aortic occlusion in a sheep model. METHODS Testing was carried out in sixteen Dorset sheep. Sensitivity in detecting spinal cord blood flow and oxygenation changes during aortic occlusion, pharmacologically induced hypotension and hypertension, and physiologically induced hypoxia/hypercarbia were assessed. Accuracy of the Diffuse Correlation Spectroscopy measurements was determined via comparison to microsphere blood flow measurements. Precision was assessed through repeated measurements in response to pharmacologic interventions. RESULTS The fiber optic probe can be placed percutaneously, and is capable of continuously measuring spinal cord blood flow and oxygenation preoperatively, intraoperatively, and postoperatively. The device is sensitive to spinal cord blood flow and oxygenation changes associated with aortic occlusion, immediately detecting a fall in blood flow (−65 ± 32%, n=32) and blood oxygenation (−17 ± 13%, n=11) in 100% of trials. Comparison of spinal cord blood flow measurements by the device with microsphere measurements led to a correlation of R2=0.49, p<0.01 and the within-sheep coefficient of variation was 9.69%. Finally, Diffuse Correlation Spectroscopy is temporally more sensitive to ischemic interventions than motor evoked potentials. CONCLUSIONS The first generation spinal fiber optic monitoring device offers a novel and potentially important step forward in the monitoring of spinal cord ischemia.

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Section: Methodsmentioning

confidence: 99%

Fiber-optic Monitoring of Spinal Cord Hemodynamics in Experimental Aortic Occlusion

et al. 2015

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“…that an 80% reduction in amplitude was significant in spinal surgery. [11] The relative amplitude indexes with and without CMAP compensation were calculated at the beginning of the operative procedure (at the introduction of the microscope after craniotomy in a cranial operation) and at the end of the procedure (just before dural closure in a cranial operation). [29] The alarm-point amplitude reduction rate of postoperative motor palsy was determined according to the sensitivity and specificity of each amplitude reduction.…”

Section: Methodsmentioning

confidence: 99%

Sensitivity and specificity in transcranial motor-evoked potential monitoring during neurosurgical operations

Tanaka¹,

Tashiro²,

Gomi³

et al. 2011

Surg Neurol Int

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Background:Intraoperative transcranial motor-evoked potential (TCMEP) monitoring is widely performed during neurosurgical operations. Sensitivity and specificity in TCMEP during neurosurgical operations were examined according to the type of operation.Methods:TCMEP monitoring was performed during 283 neurosurgical operations for patients without preoperative motor palsy, including 121 spinal operations, 84 cerebral aneurysmal operations, and 31 brain tumor operations. Transcranial stimulation at 100–600 V was applied by screw electrodes placed in the scalp and electromyographic responses were recorded with surface electrodes placed on the affected muscles. To exclude the effects of muscle relaxants on TCMEP, compound muscle action potential (CMAP) by supramaximal stimulation of the peripheral nerve immediately after transcranial stimulation was used for compensation of TCMEP.Results:In spinal operations, with an 80% reduction in amplitude as the threshold for motor palsy, the sensitivity and specificity with CMAP compensation were 100% and 96.4%, respectively. In aneurysmal operations, with a 70% reduction in amplitude as the threshold for motor palsy, the sensitivity and specificity with CMAP compensation were 100% and 94.8%, respectively. Compensation by CMAP was especially useful in aneurysmal operations. In all neurosurgical operations, with a 70% reduction in amplitude as the threshold for motor palsy, the sensitivity and specificity with CMAP compensation were 95.0% and 90.9%, respectively.Conclusions:Intraoperative TCMEP monitoring is a significantly reliable method for preventing postoperative motor palsy in both cranial and spinal surgery. A 70% reduction in the compensated amplitude is considered to be a suitable alarm point in all neurological operations.

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“…LR between 1 and 2 and between 0.5-1 rarely alter pretest probability. 6 Despite traditional spinal IOM literature suggests that NIOM is effective in identifying patients at a high risk for sustaining new spinal cord injuries [7][8][9][10][11][12][13][14][15] as well as animal research has supported human experience, [16][17][18] there is a heterogeneity in IOM services and this should be reviewed to see what accounts for the difference in false-positive and false-negative cases in the literature.…”

Section: Resultsmentioning

confidence: 99%

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2014

Arq Bras Neurocir

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Cited by 27 publications

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Fiber-optic Monitoring of Spinal Cord Hemodynamics in Experimental Aortic Occlusion

Fiber-optic Monitoring of Spinal Cord Hemodynamics in Experimental Aortic Occlusion

Sensitivity and specificity in transcranial motor-evoked potential monitoring during neurosurgical operations

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