Modified Auditory Brainstem Responses (MABR) Part 2 - Studies in Patients with Intracranial Lesions

Ghaly, Ramsis F.; Stone, James L.; Subramanian, K. S.; Roccaforte, Peter; Hughes, John R.

doi:10.1177/155005948801900211

Cited by 6 publications

(5 citation statements)

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“…27 This led us to modify the BAEP in the hope of increasing the sensitivity of the test, utilizing a rapid binaural stimulation rate and diminishing intensity levels in 106 patients with a symptomatic cerebral lesion. 17,28 That study detected absolute wave V latency or amplitude abnormalities in 88% of patients, whereas the standard BAEP performed at 2 different stimulus intensities was nonspecifically abnormal in under 50% of patients. About two thirds of operated patients showed improvement or normalization of the modified BAEP after surgical decompression.…”

Section: Introductionmentioning

confidence: 92%

“…A number of animal studies, in addition to clinical reports and reviews of patients with large supratentorial intracranial lesions or hydrocephalus, demonstrated BAEP wave V changes and correlations, at times reversible between wave V and transtentorial herniation (TH), increased intracranial pressure (ICP), and reduced auditory nerve, cochlear, or brain perfusion. 11 –26 Our previous work in a primate TH model disclosed that attenuation of the V-Vn waveform complex was a better predictor ½ hour before TH than ICP. 27 This led us to modify the BAEP in the hope of increasing the sensitivity of the test, utilizing a rapid binaural stimulation rate and diminishing intensity levels in 106 patients with a symptomatic cerebral lesion.…”

Section: Introductionmentioning

confidence: 99%

“…About two thirds of operated patients showed improvement or normalization of the modified BAEP after surgical decompression. 17 In addition to the click stimulus (2.5 kHz frequency maxima), our modified BAEP (MBP) now also includes a 1000-Hz pure tone BAEP stimulus currently used in audiology, which activates a more apical cochlear region. 3 –5 This MBP has been studied in a series of normal volunteers, 5 and we now present preliminary experience using the MBP in 27 symptomatic patients with non–brain stem or auditory nerve compressive cerebral lesions accompanied by significant radiological mass effects.…”

Section: Introductionmentioning

confidence: 99%

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Modified Brain Stem Auditory Evoked Potentials in Patients With Intracranial Mass Lesions

et al. 2012

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The authors report their experience utilizing a recently described rapid rate, binaural click and 1000-Hz tone burst modification of the brain stem auditory evoked potentials (BAEP), modified (MBP), in 27 symptomatic patients with non-brain stem compressive space-taking cerebral lesions (22), hydrocephalus (4), and pseudotumor cerebri (1). Many presented with clinical signs suggestive of increased intracranial pressure (ICP) and focal neurological deficits. The cerebral lesions, mostly large tumors with edema, had very substantial radiological signs of mass effect. Fourteen patients were also studied following surgical decompression. A number of significant changes in the wave V and Vn latency/intensity and less so amplitude/intensity function was found in the 27 patients, compared to normal volunteers, as well as those studied pre- and postoperatively. Similar MBP changes had been noted in normal volunteers placed in a dependent head position. Possible mechanisms to explain these findings are discussed. The MBP methodology shows promise and further development could make neuro-intensive care unit monitoring practical.

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Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Modified Brain Stem Auditory Evoked Potentials in Patients With Intracranial Mass Lesions

et al. 2012

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“…I have done extensive research and pioneer work in neuroscience including neuromonitoring, motor-evoked potentials, and neurotrauma. [15161718192021222324252627] I continue to practice and learn about the five specialties in neuroscience till today. I was granted professorship in 2011 in both neurological surgery and anesthesiology.…”

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confidence: 99%

Do neurosurgeons need Neuroanesthesiologists? Should every neurosurgical case be done by a Neuroanesthesiologist?

Ghaly¹

2014

Surg Neurol Int

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Neuroscience is exponentially growing and accompanied with everyday innovations and intriguing developments. There are new branches of science that are being developed within neuroscience. For instance, the fields of computer interface nanotechnology, molecular biology, ultra cellular, and gene therapy. The neuroscience programs have been established nationwide and worldwide. There is strong belief that better patient care is obtained through high volume and specialty physicians and hospitals. In fact, there are new subspecialties that already developed from within the specialty itself. Neuroanesthesia is one of the specialties that has contributed tremendously over the years to neuroscience yet it remained non-accredited and supported. In fact, there is a discouraging trend to pursue advocating the necessity of neurosurgery cases to be done by neuroanesthesiologists. It is one of the specialties that is lagging behind compared with other specialties and subspecialties in neuroscience. There is an ongoing debate within the neuroanesthesia society about the role of neuroanesthesiologists in neurosurgery. The author, being a neurosurgeon, neuroanesthesiologist, and neurointensivist, is presenting the topic, the views and expressing his opinion.

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“…This may be especially important in unconscious patients given barbiturates or therapeutically paralyzed to control increased ICP. [42][43][44][45] Another new practical method performed at the bedside is transcranial ultrasonic Doppler, which fairly reliably yields a middle cerebral arterial velocity waveform. Transcranial Doppler, like CBF measurements, has shown utility in demonstrating cerebral vasospasm usually associated with a ruptured cerebral aneurysm.…”

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confidence: 99%

Nonsurgical Management of Increased Intracranial Pressure

Stone

1989

Semin Neurol

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CPP reflects perfusion problems related to increased ICP or inadequate MAP. CPP is a most helpful and practical management tool. The relationship of CBF and CPP depends on cerebral vascular resistance (flow equals pressure divided by resistance). At present, we do not have a practical method to measure vascular resistance or CBV. A close relationship between an increase in CBV and increase in ICP exists. However, the relationship between CBF and ICP is more complex. Whereas CBV is strongly dependent on vasodilation and venous return, CBF is influenced by CPP, vascular resistance, viscosity changes, and focally or diffusely increased ICP. For instance, in hypotensive shock one finds a low CBF with an elevated CBV (and ICP) from vasodilation related to hypercapnia, anoxia, or acidosis. Nevertheless, about two thirds of patients with increased ICP after head injury have increased CBF (hyperemia) and increased CBV. This frequent hyperemia is one rationale for the wide usage of hyperventilation to treat increased ICP. It must be recognized that a group of patients may have ischemia caused by excessive hyperventilation therapy for increased ICP. The PaCO2 must not be allowed to decrease to 20 mmHg or lower, but in some patients a PaCO2 level of 21 to 25 may be predisposing to ischemia. Strong consideration is thus given to monitoring CBF and cerebral oxygen metabolism (arteriovenous oxygen content difference [AVDO2], CMRO2) in states of coma and increased ICP. In such patients, continuous infusion of mannitol may result in improved CBF, and hyperventilation therapy can be less aggressive.(ABSTRACT TRUNCATED AT 250 WORDS)

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Modified Auditory Brainstem Responses (MABR) Part 2 - Studies in Patients with Intracranial Lesions

Cited by 6 publications

References 47 publications

Modified Brain Stem Auditory Evoked Potentials in Patients With Intracranial Mass Lesions

Modified Brain Stem Auditory Evoked Potentials in Patients With Intracranial Mass Lesions

Do neurosurgeons need Neuroanesthesiologists? Should every neurosurgical case be done by a Neuroanesthesiologist?

Nonsurgical Management of Increased Intracranial Pressure

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