Safety, Utility, and Clinical Results of Continuous Intraoperative Electrophysiologic Monitoring in 1.5T iMRI-Guided Surgery

Breitkopf, Martin; Bisdas, Sotirios; Liebsch, Marina; Behling, Felix; Bender, Benjamín; Tatagiba, Marcos; Röder, Constantin

doi:10.1016/j.wneu.2017.06.054

Cited by 12 publications

(3 citation statements)

References 16 publications

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“…First, regarding the primary outcome of patient morbidity, the cumulative results are in keeping with literature on those patients undergoing resection of eloquently located glial neoplasms in the absence of awake craniotomy or I-MRI ( 17 , 18 , 47 – 49 ). Thus, from the 10 studies included within this review, the combined use of awake craniotomy techniques with I-MRI may not increase the post-operative transient and persistent neurological morbidity, with the range identified from 2.9 to 76.4% and 0 to 35.3%, for transient and persistent morbidity respectively.…”

Section: Discussionsupporting

confidence: 55%

The Role of Intraoperative MRI in Awake Neurosurgical Procedures: A Systematic Review

et al. 2018

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Background: Awake craniotomy for brain tumors remains an important tool in the arsenal of the treating neurosurgeon working in eloquent areas of the brain. Furthermore, with the implementation of intraoperative magnetic resonance imaging (I-MRI), one can afford the luxury of imaging to assess surgical resection of the underlying gross imaging defined neuropathology and the surrounding eloquent areas. Ideally, the combination of I-MRI and awake craniotomy could provide the maximal lesion resection with the least morbidity and mortality. However, more resection with the aid of real time imaging and awake craniotomy techniques might give opposite outcome results. The goal of this systematic review.is to identify the available literature on combined I-MRI and awake craniotomy techniques, to better understand the potential morbidity and mortality associated.Methods: MEDLINE, EMBASE, and CENTRAL were searched from inception up to December 2016. A total of 10 articles met inclusion in to the review, with a total of 324 adult patients.Results: All studies showed transient neurological deficits between 2.9 to 76.4%. In regards to persistent morbidity, the mean was ~10% (ranges from zero to 35.3%) with a follow up period between 5 days and 6 months.Conclusion: The preliminary results of this review also suggest this combined technique may impose acceptable post-operative complication profiles and morbidity. However, this is based on low quality evidence, and is therefore questionable. Further, well-designed future trials with the long-term follow-up are needed to provide various aspects of feasibility and outcome data for this approach.

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Section: Discussionsupporting

confidence: 55%

The Role of Intraoperative MRI in Awake Neurosurgical Procedures: A Systematic Review

et al. 2018

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“…The dose of propofol is 10 mg/kg/hour and fentanyl 0.25 mg/kg/minute has not been shown to affect the results of amplitude and latency of the MMEP and SSEP in IOM. 16 In Breitkopf et al, 17 the predictive value of IOM was shown in 9 of 17 cases with intraoperative worsening of IOM (in MEP and SEP, >50%). The positive and negative predictive values for IOM in the direct postoperative were 52.9% and 74.2%.…”

Section: Discussionmentioning

confidence: 94%

Retrospective Analysis on Intraoperative Neuromonitoring (IOM) of Potential Nerve Injury in Scoliosis Correction Surgery

Rachmat

Tobing²,

Fiddiyanti

et al. 2021

mkb

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Iatrogenic spinal injury resulting in paraplegia or paraparesis after surgical correction of scoliosis deformity is a rare complication but is very detrimental to the patient. Intraoperative Neuromonitoring (IOM) has become the gold standard to monitor surgical procedures which has potential risks to damage the spinal cord. This study aimed to retrospectively analyze the role of IOM in predicting the severity and extent of neurological injury during and after spinal correction surgery in adult idiopathic scoliosis cases related to surgical variables. This was a retrospective cohort study conducted at Dr. Cipto Mangunkusumo National Central Hospital, Fatmawati Central Hospital, and dr. Drajat Prawiranegara General Hospital during the period of 20 March 2018 to 20 August 2019. The primary outcomes were intraoperative monitoring status and post-operative neurological deficits status. Confounder data on scoliosis correction degree, intraoperative hemorrhage, and type of anesthesia used during surgery were retrieved. Chi-Square statistic was used in the analysis. Out of the ninety three patients eligible for this study, twenty two patients was detected as positive in IOM assessment. Four of the patients were found to be positive for post-operative neuromuscular defect. Thereby it can be concluded that IOM procedure can effectively prevent neurological deficits post-surgery with 81.8% specificity and 95.7% sensitivity among thosepositively detected by IOM. Some of the factors that could potentially influence false positive IOM results such as anesthetic used; dosage and administration procedures; magnitude of the scoliosis correction angle; and amount of bleeding during surgery have to be carefully analyzed.

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“…The loop formed by the MR conductor is especially dangerous. 105 It is also important to check the monitoring cables as care must be taken in order for it to not come into contact with each other or make loops, thus avoiding creation of eddy current. As the human body is a conductor, the patient’s body temperature increases due to the radiofrequency electromagnetic field, and in some cases, the induced eddy current can lead to burns.…”

Section: Safety In a Magnetic Fieldmentioning

confidence: 99%

Intraoperative MR Imaging during Glioma Resection

2022

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One of the major issues in the surgical treatment of gliomas is the concern about maximizing the extent of resection while minimizing neurological impairment. Thus, surgical planning by carefully observing the relationship between the glioma infiltration area and eloquent area of the connecting fibers is crucial. Neurosurgeons usually detect an eloquent area by functional MRI and identify a connecting fiber by diffusion tensor imaging. However, during surgery, the accuracy of neuronavigation can be decreased due to brain shift, but the positional information may be updated by intraoperative MRI and the next steps can be planned accordingly. In addition, various intraoperative modalities may be used to guide surgery, including neurophysiological monitoring that provides real-time information (e.g., awake surgery, motorevoked potentials, and sensory evoked potential); photodynamic diagnosis, which can identify high-grade glioma cells; and other imaging techniques that provide anatomical information during the surgery. In this review, we present the historical and current context of the intraoperative MRI and some related approaches for an audience active in the technical, clinical, and research areas of radiology, as well as mention important aspects regarding safety and types of devices.

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Safety, Utility, and Clinical Results of Continuous Intraoperative Electrophysiologic Monitoring in 1.5T iMRI-Guided Surgery

Cited by 12 publications

References 16 publications

The Role of Intraoperative MRI in Awake Neurosurgical Procedures: A Systematic Review

The Role of Intraoperative MRI in Awake Neurosurgical Procedures: A Systematic Review

Retrospective Analysis on Intraoperative Neuromonitoring (IOM) of Potential Nerve Injury in Scoliosis Correction Surgery

Intraoperative MR Imaging during Glioma Resection

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