상단 PDF Artifacts and Troubleshooting in Intraoperative Neurophysiological Monitoring

Artifacts and Troubleshooting in Intraoperative Neurophysiological Monitoring

Artifacts and Troubleshooting in Intraoperative Neurophysiological Monitoring

The types of artifacts that are observed in intraoperative neurophysiological monitoring (INM) is truly diverse. The removal of artifacts that interfere with the examination is essential. In addition, improving the quality of the examination by removing artifacts is a reflection of the competency of the examiner and is also the best way to ensure patient safety. However, if knowledge of the equipment or anesthesia in the operating room is insufficient due to lack of experience, artifacts cannot be removed even with a method appropriate to the situation. If artifacts are not separated and removed, the reading of the examination results in confusion in the operation process. This can be a fatal problem in neurosurgery that requires rapid and sophisticated procedures. In this paper, the causes of artifacts that occur during surgery are classified into electrical factors, non-electrical factors, and other factors, and a method and examination method for removing artifacts according to the specific situation is mentioned. Although the operating room environment is a very critical place to simultaneously consider various scenarios, we hope that a stable and optimal INM will play a role by knowing the types and causes of various artifacts and how to tackle them.
더 보기

9 더 읽기

Suggestions for the Effective Intraoperative Neurophysiological Monitoring in Microvascular Decompression Surgery of Hemifacial Spasm

Suggestions for the Effective Intraoperative Neurophysiological Monitoring in Microvascular Decompression Surgery of Hemifacial Spasm

임성혁 삼성서울병원 신경과 Hemifacial spasm is a disease caused by involuntary facial muscles with repeated unilateral convulsive spasms. It involves contraction of multiple muscles at the same time (synkinesia). The pathogenesis appears to be the pressure on the vessel by the facial nerve. This study included hemifacial spasm patients, who received microvascular decompression surgery. Brainstem auditory evoked potential and the examination time were carefully noted when using brain surgical retractor. The facial nerve electromyography tests for the identification of artifacts and EMG waveform when the facial nerve damage, about the importance of the maintenance of anesthesia in the lateral spread response and in a somatosensory evoked potential propose a new method.
더 보기

7 더 읽기

Intraoperative Neurophysiological Monitoring and  Neuromuscular Anesthesia Depth Monitoring

Intraoperative Neurophysiological Monitoring and Neuromuscular Anesthesia Depth Monitoring

수술 중 신경손상을 최소화하고, 감각신경과 운동신경에 영 향을 주지 않으면서 수술이 진행되도록 수술하는 동안 유발전 위, 근전도, 뇌파, 뇌혈류 등의 검사를 진행하면서 환자의 상태를 감시하는 신경계 추적감시(intraoperative neurophysiological monitoring, INM)검사는 마취에 의한 영향을 많이 받는다. 그 중에서도 근 이완제의 영향을 가장 많이 받는다. 하지만 수술 중 근 이완제를 사용하여야 하는 정도에 대한 표준 기준이 없고, 수 술이 종료되었을 때 환자의 체내에서 근 이완제가 모두 대사되 었는지 유무를 평가하는 신경근 감시에 대한 표준도 없는 실정 이다. 환자의 연령, 성별, 체중 등 환자의 상태에 따라서 마취제 또는 근 이완제를 적정량 투여하면 마취가 투여량만큼 마취 심 도가 유지되는 것이 아니고 환자마다 체내에서 약물을 대사 시 키는 대사능력이 다르고 약리 기전의 시간이 다르므로 마취제의 용량을 정량화시킬 수 없는 어려운 점이 있다. 그러므로 마취과 에서 수술 중 근 이완의 정도를 측정하는 신경근 감시는 어떻게 하고 있는지 그리고 신경근 감시에 대하여 국내 상황뿐만 아니 라 국제적으로 어떠한 기준들이 있는 살펴보아서 수술 중 근 이 완 상태가 적절하게 유지되고, 수술 후 잔류 근 이완제가 남지 않 도록 하며 수술 중 신경손상 유무를 정확하게 파악할 수 있도록 도움을 주고자 한다.
더 보기

10 더 읽기

Intraoperative Neurophysiological Monitoring in Cerebello Pontine Angle Tumor

Intraoperative Neurophysiological Monitoring in Cerebello Pontine Angle Tumor

Department of Neurology Laboratory, Samsung Medical Center, Seoul 135-710, Korea Intraoperative Neurophysiological Monitoring (INM) inspection has a very important role. While preserving the patient's neurological function be sure to safe surgery, neurological examination should thank. Cerebello pontine angle tumor surgery, especially in the nervous system is more important to the meaning of INM. In cochlear nerve, facial nerve, trigeminal nerve, which are intricate brain surgery, doctors are only human eye and brain to the brain that it is virtually impossible to distinguish the nervous system. They receives a lot of help from INM. In this paper, we examined six kinds broadly. First, the methods of spontaneous EMG and Free-running EMG, which can instantly detect a damage inflicted on a nerve during surgery. Second, methods of triggered EMG and direct nerve electrical stimulation, which directly stimulate a nerve using electricity to distinguish between nerves and brain tumors. Third, the method of knowing a more accurate neurologic status by informing neurological surgeons about Free-running EMG wave forms that are segmetalized into four. Fourth, three ways of knowing when a patient will be awaken from intraoperative anesthesia, which happens due to a weak anesthetic. Fifth, a method of understanding the structures of a brain tumor and a facial nerve as five dividend segments. Sixth, comparisons between cases normal facial nerve recovery and occurrence of a facial nerve paralysis during the postoperative course.
더 보기

8 더 읽기

Intraoperative Neurophysiological Monitoring in Cerebello Pontine Angle Tumor

Intraoperative Neurophysiological Monitoring in Cerebello Pontine Angle Tumor

Department of Neurology Laboratory, Samsung Medical Center, Seoul 135-710, Korea Intraoperative Neurophysiological Monitoring (INM) inspection has a very important role. While preserving the patient's neurological function be sure to safe surgery, neurological examination should thank. Cerebello pontine angle tumor surgery, especially in the nervous system is more important to the meaning of INM. In cochlear nerve, facial nerve, trigeminal nerve, which are intricate brain surgery, doctors are only human eye and brain to the brain that it is virtually impossible to distinguish the nervous system. They receives a lot of help from INM. In this paper, we examined six kinds broadly. First, the methods of spontaneous EMG and Free-running EMG, which can instantly detect a damage inflicted on a nerve during surgery. Second, methods of triggered EMG and direct nerve electrical stimulation, which directly stimulate a nerve using electricity to distinguish between nerves and brain tumors. Third, the method of knowing a more accurate neurologic status by informing neurological surgeons about Free-running EMG wave forms that are segmetalized into four. Fourth, three ways of knowing when a patient will be awaken from intraoperative anesthesia, which happens due to a weak anesthetic. Fifth, a method of understanding the structures of a brain tumor and a facial nerve as five dividend segments. Sixth, comparisons between cases normal facial nerve recovery and occurrence of a facial nerve paralysis during the postoperative course.
더 보기

8 더 읽기

Intraoperative Neurophysiological Monitoring for Optimal Brain Mapping

Intraoperative Neurophysiological Monitoring for Optimal Brain Mapping

1 Department of Neurology Laboratory, Kang Nam Cha Medical Center, Seoul 135-913, Korea 2 Department of Neurology Laboratory, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea There is a correct way to avoid any sequale in the central motor area during neurosurgery procedures. A clear way to find the circumference of the central sulcus, central motor, and sensory areas by giving cortical electrical stimulation to the central motor area immediate after surgery is proposed. Looking at patients who underwent brain surgery September 2009 to July 2013, the central sulcus and speech areas around the central area of the brain was investigated, using the practices of either a localized brain map check or a direct cortical electrical stimulation test. Brain maps localized around the surgical site through functional movement or speech areas were identified. Accurate tests done during surgery without damage to motor neurons or after surgery were conducted smoothly. Although successful brain map test localization can be accomplished, there are some factors that can interfere. The following phenomena can reverse the phase: (1) the first sensory / motor in the case of patients severe nerve damage; (2) placement of the electrode on top of the vessel; (3) presence of a brain tumor near the brain cortex; (4) use of anesthesia if patient cooperation is difficult; and (5) location of the electrode position and stimulus is inappropriate.
더 보기

10 더 읽기

Principles of Intraoperative Neurophysiological Monitoring with Insertion and Removal of Electrodes

Principles of Intraoperative Neurophysiological Monitoring with Insertion and Removal of Electrodes

재료 및 방법 수술 중 신경계 감시 검사는 운동유발전위검사(motor evoked potential, MEP), 체성감각유발전위검사(somato- sensory evoked potential, SSEP), 청각유발전위검사 (brainstem auditory evoked potential, BAEP), 시각유발전 위검사(visual evoked potential, VEP), 자유진행 및 유발근 전도검사(free-running and triggered EMG)로 크게 분류할 수 있다[4, 5]. 이 검사 방법들은 수술의 종류 및 부위에 따라 적 용이 달라질 수 있다. 현재 우리나라에 수입된 장비중 the Xltek_ Protektor IOM system (Natus Medical Incorporated, Pleasanton, CA, USA)을 이용하여 각 검사마다 자극부위 (stimulation site)와 기록부위(recording site)에 대하여 해부 학적으로 알아보고 실제환자에 침 전극(Xi'an Friendship Medical Electronics Co., No. 9 Gao Xin 1st Road, Hi-Tech Development Zone, Xi'an, Shaanxi, China)을 삽입하는 과정도 자세히 언급하였다. 본 연구의 환자들은 수술 전 의료진에게 수술동의서를 작성하였으며, 수술동의서에 따라 수술 중 유발전위검사를 시행하였다. 신경계 검사자는 수술장 에서 파형 측정이 원활하지 않은 경우, 의사의 지도 하에 유발전 위의 검사 술기를 효율적으로 제안 및 개선하여 수행하였다.
더 보기

9 더 읽기

Principles of Intraoperative Neurophysiological Monitoring with Insertion and Removal of Electrodes

Principles of Intraoperative Neurophysiological Monitoring with Insertion and Removal of Electrodes

재료 및 방법 수술 중 신경계 감시 검사는 운동유발전위검사(motor evoked potential, MEP), 체성감각유발전위검사(somato- sensory evoked potential, SSEP), 청각유발전위검사 (brainstem auditory evoked potential, BAEP), 시각유발전 위검사(visual evoked potential, VEP), 자유진행 및 유발근 전도검사(free-running and triggered EMG)로 크게 분류할 수 있다[4, 5]. 이 검사 방법들은 수술의 종류 및 부위에 따라 적 용이 달라질 수 있다. 현재 우리나라에 수입된 장비중 the Xltek_ Protektor IOM system (Natus Medical Incorporated, Pleasanton, CA, USA)을 이용하여 각 검사마다 자극부위 (stimulation site)와 기록부위(recording site)에 대하여 해부 학적으로 알아보고 실제환자에 침 전극(Xi'an Friendship Medical Electronics Co., No. 9 Gao Xin 1st Road, Hi-Tech Development Zone, Xi'an, Shaanxi, China)을 삽입하는 과정도 자세히 언급하였다. 본 연구의 환자들은 수술 전 의료진에게 수술동의서를 작성하였으며, 수술동의서에 따라 수술 중 유발전위검사를 시행하였다. 신경계 검사자는 수술장 에서 파형 측정이 원활하지 않은 경우, 의사의 지도 하에 유발전 위의 검사 술기를 효율적으로 제안 및 개선하여 수행하였다.
더 보기

9 더 읽기

Surgical Outcomes of Thalamic Tumors in Children: The Importance of Diffusion Tensor Imaging, Neuro-Navigation and Intraoperative Neurophysiological Monitoring

Surgical Outcomes of Thalamic Tumors in Children: The Importance of Diffusion Tensor Imaging, Neuro-Navigation and Intraoperative Neurophysiological Monitoring

logical status worsened in only 5 cases (19%), similar to results from recent studies [5,16,21]. In addition, there was a statisti- cally significant difference in the extent of resection between the group that employed DTI, neuro-navigation and IOM and the group that did not employ at least one of the aforementioned measures. Nevertheless, there was no statistically significant difference in postoperative neurological status between the two groups. The lack of difference in morbidity may be attrib- uted to a more conservative surgical approach employed to minimize neurological deficits in the latter group. This is also reflected in the difference in the extent of resection, because extent of tumor resection could be maximized to the where crucial structures were not injured with application of these aforementioned technologies.
더 보기

8 더 읽기

Effects of intravenous methylprednisolone on intraoperative neurophysiological monitoring during spinal cord tumor surgery: a case report

Effects of intravenous methylprednisolone on intraoperative neurophysiological monitoring during spinal cord tumor surgery: a case report

ABSTRACT In spinal cord tumor surgery, muscle motor-evoked potentials (mMEPs) and direct wave (D-wave) have been used to predict neurological outcomes. A severe deterioration of mMEPs in the presence of intact D-wave may indicate temporary postoperative weakness. A 58-year-old man complaining of lower extremities’ weakness was diagnosed as cavernous malformation at T3/T4 level. During removal surgery, the amplitudes of mMEPs were reduced more than 80% in the right tibialis anterior and abductor halluces compared to the baseline in the absence of a change in D-wave.
더 보기

5 더 읽기

Intraoperative Neurophysiologic Monitoring: Basic Principles and Recent Update

Intraoperative Neurophysiologic Monitoring: Basic Principles and Recent Update

commonly observed during IOM by electrocautery, hammer- ing, electrical stimulation, electrical artifact of the heart (elec- trocardiography artifact), movement of respiratory muscles of patients, contact of cable with operating table, influence of elec- trical power lines or plug, or diverse surgical procedures. Though automated filters and artifact rejection program can be partly useful in reducing artifacts, the role of neurophysiologist is still crucial in discriminating such artifact from real IOM changes and also in reducing it. For this reason, it is essential that the clinical neurophysiologist is trained in basic electrophysiologi- cal principles and gains experience in IOM.
더 보기

9 더 읽기

Clinical practice guidelines for intraop-erative neurophysiological monitoring: 2020 update

Clinical practice guidelines for intraop-erative neurophysiological monitoring: 2020 update

technologist. 2 As a supervising physician, the neurophysi- ologist should be familiar with a wide range of monitoring techniques, know which is the most appropriate to obtain the required waveforms during a particular type of surgery, recognize the meaning behind any changes in those wave- forms and be able to reduce any artifacts, and be able to supervise and guide the medical technologist in the perfor- mance of these monitoring techniques. In this setting, neu- rophysiologists should also be able to not only properly and clearly report waveforms or waveform changes observed on a monitor to the operating surgeon, but should also be able to interpret their clinical significance. They should not only have a good understanding of neurophysiology, but should also have received full-time training on the methods of electrophysiological testing including generation of evoked potentials (EPs), EMG, EEG, nerve conduction studies (NCS), and ultrasonography. In South Korea, board-certified neurol- ogists or rehabilitation medicine physicians would qualify as neurophysiologists based on the training that they receive.
더 보기

11 더 읽기

Technical Instructions for Continuous Intraoperative Neural Monitoring in Thyroid Surgery

Technical Instructions for Continuous Intraoperative Neural Monitoring in Thyroid Surgery

CIONM requires exact calibration of VN stimulation amplitude and latency at the beginning of surgery. To achieve net benefit, it is important to recruit an experienced surgeon who adheres to the strict standardization guidelines and a cooperate anesthesiologist. Additionally, if the surgeon has competence in troubleshooting algorithms and knowledge of monitoring limits, if they can implement training and experience and continuous audit, this would be beneficial in the future review of CIONM (1,13). Obtaining a baseline amplitude >500 mcV is the prerequisite for the diagnosis, interpretation, and verification of a functional intact RLN, an LOS, to monitor significant modification of EMG profile, and signal reentry or recovery. The observed increased
더 보기

18 더 읽기

Intraoperative monitoring of somatosensory and visual evoked potentials for detecting posterior cerebral artery infarction during anteromesial temporal resection

Intraoperative monitoring of somatosensory and visual evoked potentials for detecting posterior cerebral artery infarction during anteromesial temporal resection

Suyeon Seo 1 , Dong Jun Kim 2 , Chae Young Lee 2 1 Wonkwang University School of Medicine, Iksan, Korea 2 Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea We performed intraoperative neurophysiological monitoring (INM) during anteromesial temporal resection (AMTR) in a patient with lesional temporal lobe epilepsy. INM revealed a sudden decrease in N20 waves in somatosensory evoked potentials (SSEPs) and poor P100 waves in visual evoked potentials (VEPs). These changes developed after applying electroco- agulation in the right mesial temporal areas. Postoperative brain magnetic resonance imaging demonstrated right thalamic and medial occipital infarctions. SSEPs and VEPs monitoring can be useful for detecting posterior cerebral artery infarction in AMTR.
더 보기

5 더 읽기

Basic Techniques of Intraoperative Neurophysiological Monitoring

Basic Techniques of Intraoperative Neurophysiological Monitoring

Keywords: Intraoperative neurophysiological monitoring, Brainstem auditory evoked potentials, Motor evoked potentials, Somato-sensory evoked potentials, Visual evoked potentials.. Corre[r]

9 더 읽기

Basic Techniques of Intraoperative Neurophysiological Monitoring

Basic Techniques of Intraoperative Neurophysiological Monitoring

Keywords: Intraoperative neurophysiological monitoring, Brainstem auditory evoked potentials, Motor evoked potentials, Somato-sensory evoked potentials, Visual evoked potentials.. Corre[r]

9 더 읽기

Intraoperative Neural Monitoring in Thyroid Surgery: Role and Responsibility of Surgeon

Intraoperative Neural Monitoring in Thyroid Surgery: Role and Responsibility of Surgeon

E. Total thyroidectomy as planned for advanced thyroid carcinomas (including undifferenti- ated thyroid carcinomas) with the aim of immediate postoperative radiotherapy. IONM technology has undergone rapid growth in the thyroid surgical field. In clinical practice, failure of IONM procedures mainly results from a surgeon's inability or to a device malfunction. According to data from the literature, device malfunction or false IONM results are rare (<1%) (19). High false-positive rates should give reason to critically review the clinic-internal standards in order to avoid unnecessary double-stage thyroidectomy. A possible intraoperative recovery of the EMG signal and its importance for the progress of the operation should be the subject of further studies using continuous neuromonitoring. We believe it is important to explain to the patient, as with all the technologies used in surgery, that the IONM can fail or give unreliable results.
더 보기

12 더 읽기

Intraoperative Neurophysiologic Monitoring and Functional Outcome in Cerebellopontine Angle Tumor Surgery

Intraoperative Neurophysiologic Monitoring and Functional Outcome in Cerebellopontine Angle Tumor Surgery

Object of this study is to the correlation between the changes of intraoperative monitoring modalities during cere- bellopontine angle tumor surgery and post-operative functional outcome[r]

8 더 읽기

The Consistency of Intraoperative Neural Monitoring in Thyroid Surgery

The Consistency of Intraoperative Neural Monitoring in Thyroid Surgery

The rationale and indications for IONM have substantially changed in the last 5 years. Methodologies have to some extent evolved, although the basic principles of monitoring and mapping techniques remain the same. Nevertheless, IONM has undoubtedly become more and more accessible and extensively used than it has been in the past. The growing interest for this discipline is well documented by the increasing number of publications in this field, both in the form of peer-reviewed papers and edited books as well as by the number of scientific meetings dedicated to intraoperative neurophysiologic monitoring (4,5).
더 보기

7 더 읽기

Tableting Technology and Its Troubleshooting

Tableting Technology and Its Troubleshooting

流動性이 나쁜 분넣은 vibrator를 움직 인다... 生產性에 부합되지 않는다.[r]

7 더 읽기

Show all 10000 documents...

관련 주제