Injury to the Recurrent Laryngeal Nerve (RLN) is a worrisome complication of a thyroidectomy. Intra-operative nerve monitoring (IONM) of the RLN has gained prevalence as an aid to prevent injury. We reviewed our serie...Injury to the Recurrent Laryngeal Nerve (RLN) is a worrisome complication of a thyroidectomy. Intra-operative nerve monitoring (IONM) of the RLN has gained prevalence as an aid to prevent injury. We reviewed our series and other studies in literature for insight. A chart review was carried out to identify all patients who underwent a thyroidectomy between 2005 and 2010. IONM was implemented by the Otolaryngology service in 2007. All identified patients were separated into three groups: 1) Otolaryngology service with IONM, 2) Otolaryngology service without IONM, and 3) General Surgery service without IONM. Several factors were noted, including age, sex, thyroid disease, extent of thyroidectomy, and RLN injury along with recovery. 230 patients underwent thyroidectomy from 2005-2010. 60 patients were isolated in the IONM-Otolaryngology group with 3 patients suffering injury. 109 patients underwent a thyroidectomy by the Otolaryngology service without IONM with 8 patients suffering nerve damage. In the third group, 61 patients underwent a thyroidectomy by General Surgery without IONM with 4 patients suffering damage. Of the thyroid pathology, 10 patients had Multinodular Goiter while 4 had Papillary Cancer and 1 had a Follicular Adenoma. The most severe complication of a thyroidectomy is RLN injury. In order to further decrease the risk of RLN injury, IONM has been employed. From our review and other studies, there does not appear to be a significant difference in rates of RLN injury with or without use of nerve monitoring. An interesting note is the increased prevalence of nerve injuries in Multinodular Goiter—a finding that merits further study to evaluate the role of IONM.展开更多
<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:""><span style="font-family:Verdana;">The surgery of cerebel...<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:""><span style="font-family:Verdana;">The surgery of cerebellopontine angle tumours has remarkably progressed over the last 2 decades due to improved microsurgical techniques. </span><span style="font-family:Verdana;">The primary operative goals are microscopic total removal of the tumour</span><span style="font-family:Verdana;"> while securing the adjacent cranial nerves. Facial Nerve plays a critical role in facial muscles function and one’s cosmetic appearance, and its weakness can have </span><span><span style="font-family:Verdana;">profound implications on a patient’s quality of life. </span><b><span style="font-family:Verdana;">Aim of the Study: </span></b><span style="font-family:Verdana;">To </span></span><span style="font-family:Verdana;">assess </span><span style="font-family:Verdana;">the impact of monitoring techniques on the preservation of facial nerve</span><span style="font-family:Verdana;"> function during cerebellopontine angle tumours surgery. </span><b><span style="font-family:Verdana;">Patients and Methods: </span></b><span style="font-family:Verdana;">This is a prospective study. This study was conducted on 30 cases (2 groups, </span><span style="font-family:Verdana;">each had 15 patients) with CPA lesions that had undergone surgical exci</span><span style="font-family:Verdana;">sion of these lesions performed by retrosigmoid approach (Group A: the</span><span style="font-family:Verdana;"> pa</span><span style="font-family:Verdana;">tients were operated under continuous intraoperative facial nerve</span><span style="font-family:Verdana;"> monitoring</span> <span style="font-family:Verdana;">(IOFNM) and Group B: the patients were operated without IOFNM). They</span> <span style="font-family:Verdana;">were operated upon in neurosurgery departments at Al-Azhar university</span><span style="font-family:Verdana;"> hosp</span><span><span style="font-family:Verdana;">itals between August 2019 and August 2021. </span><b><span style="font-family:Verdana;">Results: </span></b></span></span><span style="font-family:Verdana;">This study sho</span><span style="font-family:Verdana;">wed that </span><span style="font-family:Verdana;">excellent facial nerve function (HB Grade I and II) was higher in group A</span><span style="font-family:""><span style="font-family:Verdana;"> than group B, immediately and at 6-month post op (80% and 93% VS 53.3% and 66.7%). Intermediate (HB Grade III and VI) and Poor (HB Grade V and </span><span style="font-family:Verdana;">VI) facial nerve function was higher in group B than group A;both</span><span style="font-family:Verdana;"> immediately and 6-month postop (46.7% and 33.3% VS 20% and 6.6%). However, </span><span><span style="font-family:Verdana;">no statistically significant P-Value between both groups. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">We</span></span><span style="font-family:Verdana;"> concluded that IOFNM can help, but cannot guarantee, the preservation of facial </span><span style="font-family:Verdana;">nerve. Furthermore, it is merely a technical adjunct and does not replace</span><span style="font-family:Verdana;"> surgical skills, knowledge of anatomy and experience.展开更多
Objective:To present our classification for peripheral nerve schwannomas as well as explore the surgical strategies and operative management of peripheral nerve schwannomas based on the intraoperative neurophysiologic...Objective:To present our classification for peripheral nerve schwannomas as well as explore the surgical strategies and operative management of peripheral nerve schwannomas based on the intraoperative neurophysiological monitoring(INM)technique and to decrease the risk of postoperative neurological deficits in the management of these schwannomas.Materials and methods:A retrospective study was conducted on 92 cases of peripheral nerve microsurgery performed,using the INM technique.We also made the classification for peripheral nerve schwannomas into two types according to operative findings and proceeded corresponding surgical strategies.Results:All tumors were removed completely under microscopy and INM.Three patients developed residual neurological deficits at final follow-up.There were different results about temporary(18/92,19.6%)and permanent(3/92,3.3%)neurological deficits.The incidence of temporary and permanent neurological deficits in type II group was significantly higher than that in type I group(p<0.01).The incidence of permanent neurological deficits in larger size tumors was significantly higher than that of smaller size(p<0.01).Conclusions:We made the classification for peripheral nerve schwannomas according to operative findings based on INM that is helpful to our surgical strategies.Intracapsular enucleation was the preferred strategy with satisfactory results and low risk of nerve injury.The size and location of tumors seem to be related to the risk of fascicular injury.展开更多
In the surgery of lumbar disc herniation(LDH),the nerve root retractor is used to pull the nerve root to prevent damage.The traditional medical nerve root retractor cannot quantify the force on the nerve root.In order...In the surgery of lumbar disc herniation(LDH),the nerve root retractor is used to pull the nerve root to prevent damage.The traditional medical nerve root retractor cannot quantify the force on the nerve root.In order to improve the nerve root retractor,this paper proposes an intraoperative lumbar neurological force monitoring system.The core module of this system is the improved nerve root retractor equipped with the high density flexible pressure sensor array.The high density microneedle array and multiple pressure detection units are used in the pressure sensor to realise sensitive pressure monitoring in a narrow surgical operation area.The sensing area is 4 mm×17 mm,including 6 detection units.The sensitivity of sensor is 67.30%/N in the range of 0-5 N.This system is used for in vitro animal experiments,which can continuously detect pressure.展开更多
BACKGROUND Neuromonitoring in medical intensive care units is challenging as most patients are unfit for invasive intracranial pressure(ICP)modalities or unstable to transport for imaging.Ultrasonography-based optic n...BACKGROUND Neuromonitoring in medical intensive care units is challenging as most patients are unfit for invasive intracranial pressure(ICP)modalities or unstable to transport for imaging.Ultrasonography-based optic nerve sheath diameter(ONSD)is an attractive option as it is reliable,repeatable and easily performed at the bedside.It has been sufficiently validated in traumatic brain injury(TBI)to be incorporated into the guidelines.However,currently the data for non-TBI patients is inconsistent for a scientific recommendation to be made.AIM To compile the existing evidence for understanding the scope of ONSD in measuring ICP in adult non-traumatic neuro-critical patients.METHODS PubMed,Google Scholar and research citation analysis databases were searched for studies in adult patients with non-traumatic causes of raised ICP.Studies from 2010 to 2024 in English languages were included.RESULTS We found 37 articles relevant to our search.The cutoff for ONSD in predicting ICP varied from 4.1 to 6.3 mm.Most of the articles used cerebrospinal fluid opening pressure followed by raised ICP on computed tomography/magnetic resonance imaging as the comparator parameter.ONSD was also found to be a reliable outcome measure in cases of acute ischaemic stroke,intracerebral bleeding and intracranial infection.However,ONSD is of doubtful utility in septic metabolic encephalopathy,dysnatremias and aneurysmal subarachnoid haemorrhage.CONCLUSION ONSD is a useful tool for the diagnosis of raised ICP in non-traumatic neuro-critically ill patients and may also have a role in the prognostication of a subset of patients.展开更多
Background:Even though the use of nerve monitoring during parotid gland surgery is not the gold standard to prevent damage to the nerve,it surely offers some advantages over the traditional approach.Different from thy...Background:Even though the use of nerve monitoring during parotid gland surgery is not the gold standard to prevent damage to the nerve,it surely offers some advantages over the traditional approach.Different from thyroid surgery,where a series of steps in intraoperative nerve monitoring have been described to confirm not only the integrity but—most importantly—the function of the recurrent laryngeal nerve,in parotid gland surgery,a formal guideline to follow while dissecting the facial nerve has yet to be described.Methods:A five‐year retrospective study was done reviewing the intraoperative records of patients who underwent parotid gland surgery under neural monitoring.The operative findings regarding the neuromonitoring process,particularly in regard to the amplitude of two main branches,were revised.A literature search was done to search for guidelines to follow when a facial nerve loss of signal is encountered.Results:Fifty‐five patients were operated on using the Nim 3 Nerve Monitoring System(Medtronic);31 were female patients,and 47 patients had benign lesions.Minimum changes were observed in the amplitude records after a comparison was made between the first and the last stimulation.There were only three articles discussing the term loss of signal during parotid gland surgery.Conclusion:Today,no sufficient attention has been given to the facial nerve monitoring process during parotidectomy.This study proposes a formal guideline to follow during this procedure as well as an instruction to consider when a loss of signal is observed to develop a uniform technique of facial nerve stimulation.展开更多
Intraoperative nerve monitoring(IONM)has evolved into an objective tool not only for the identification but also for the preservation and prognostication of function of the recurrent laryngeal nerve in thyroid surgeri...Intraoperative nerve monitoring(IONM)has evolved into an objective tool not only for the identification but also for the preservation and prognostication of function of the recurrent laryngeal nerve in thyroid surgeries.Technical improvements have resulted in the increasing incorporation of IONM into operating rooms around the world.The importance of adherence to recommended standards is also recognized as being vital in optimizing the efficacy of IONM.The advent of continuous IONM has made real-time nerve monitoring possible,thus providing the surgeon with an ally in difficult surgeries.Additionally,as thyroid surgeries are evolving into remote access and minimally invasive procedures,so also is the applicability of IONM.This review focuses on the use of IONM for nerve monitoring in thyroidectomies for neoplastic conditions while discussing the rationale,technique,and interpretation of findings and their implications.展开更多
Epilepsy is a severe,relapsing,and multifactorial neurological disorder.Studies regarding the accurate diagnosis,prognosis,and in-depth pathogenesis are crucial for the precise and effective treatment of epilepsy.The ...Epilepsy is a severe,relapsing,and multifactorial neurological disorder.Studies regarding the accurate diagnosis,prognosis,and in-depth pathogenesis are crucial for the precise and effective treatment of epilepsy.The pathogenesis of epilepsy is complex and involves alterations in variables such as gene expression,protein expression,ion channel activity,energy metabolites,and gut microbiota composition.Satisfactory results are lacking for conventional treatments for epilepsy.Surgical resection of lesions,drug therapy,and non-drug interventions are mainly used in clinical practice to treat pain associated with epilepsy.Non-pharmacological treatments,such as a ketogenic diet,gene therapy for nerve regeneration,and neural regulation,are currently areas of research focus.This review provides a comprehensive overview of the pathogenesis,diagnostic methods,and treatments of epilepsy.It also elaborates on the theoretical basis,treatment modes,and effects of invasive nerve stimulation in neurotherapy,including percutaneous vagus nerve stimulation,deep brain electrical stimulation,repetitive nerve electrical stimulation,in addition to non-invasive transcranial magnetic stimulation and transcranial direct current stimulation.Numerous studies have shown that electromagnetic stimulation-mediated neuromodulation therapy can markedly improve neurological function and reduce the frequency of epileptic seizures.Additionally,many new technologies for the diagnosis and treatment of epilepsy are being explored.However,current research is mainly focused on analyzing patients’clinical manifestations and exploring relevant diagnostic and treatment methods to study the pathogenesis at a molecular level,which has led to a lack of consensus regarding the mechanisms related to the disease.展开更多
文摘Injury to the Recurrent Laryngeal Nerve (RLN) is a worrisome complication of a thyroidectomy. Intra-operative nerve monitoring (IONM) of the RLN has gained prevalence as an aid to prevent injury. We reviewed our series and other studies in literature for insight. A chart review was carried out to identify all patients who underwent a thyroidectomy between 2005 and 2010. IONM was implemented by the Otolaryngology service in 2007. All identified patients were separated into three groups: 1) Otolaryngology service with IONM, 2) Otolaryngology service without IONM, and 3) General Surgery service without IONM. Several factors were noted, including age, sex, thyroid disease, extent of thyroidectomy, and RLN injury along with recovery. 230 patients underwent thyroidectomy from 2005-2010. 60 patients were isolated in the IONM-Otolaryngology group with 3 patients suffering injury. 109 patients underwent a thyroidectomy by the Otolaryngology service without IONM with 8 patients suffering nerve damage. In the third group, 61 patients underwent a thyroidectomy by General Surgery without IONM with 4 patients suffering damage. Of the thyroid pathology, 10 patients had Multinodular Goiter while 4 had Papillary Cancer and 1 had a Follicular Adenoma. The most severe complication of a thyroidectomy is RLN injury. In order to further decrease the risk of RLN injury, IONM has been employed. From our review and other studies, there does not appear to be a significant difference in rates of RLN injury with or without use of nerve monitoring. An interesting note is the increased prevalence of nerve injuries in Multinodular Goiter—a finding that merits further study to evaluate the role of IONM.
文摘<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:""><span style="font-family:Verdana;">The surgery of cerebellopontine angle tumours has remarkably progressed over the last 2 decades due to improved microsurgical techniques. </span><span style="font-family:Verdana;">The primary operative goals are microscopic total removal of the tumour</span><span style="font-family:Verdana;"> while securing the adjacent cranial nerves. Facial Nerve plays a critical role in facial muscles function and one’s cosmetic appearance, and its weakness can have </span><span><span style="font-family:Verdana;">profound implications on a patient’s quality of life. </span><b><span style="font-family:Verdana;">Aim of the Study: </span></b><span style="font-family:Verdana;">To </span></span><span style="font-family:Verdana;">assess </span><span style="font-family:Verdana;">the impact of monitoring techniques on the preservation of facial nerve</span><span style="font-family:Verdana;"> function during cerebellopontine angle tumours surgery. </span><b><span style="font-family:Verdana;">Patients and Methods: </span></b><span style="font-family:Verdana;">This is a prospective study. This study was conducted on 30 cases (2 groups, </span><span style="font-family:Verdana;">each had 15 patients) with CPA lesions that had undergone surgical exci</span><span style="font-family:Verdana;">sion of these lesions performed by retrosigmoid approach (Group A: the</span><span style="font-family:Verdana;"> pa</span><span style="font-family:Verdana;">tients were operated under continuous intraoperative facial nerve</span><span style="font-family:Verdana;"> monitoring</span> <span style="font-family:Verdana;">(IOFNM) and Group B: the patients were operated without IOFNM). They</span> <span style="font-family:Verdana;">were operated upon in neurosurgery departments at Al-Azhar university</span><span style="font-family:Verdana;"> hosp</span><span><span style="font-family:Verdana;">itals between August 2019 and August 2021. </span><b><span style="font-family:Verdana;">Results: </span></b></span></span><span style="font-family:Verdana;">This study sho</span><span style="font-family:Verdana;">wed that </span><span style="font-family:Verdana;">excellent facial nerve function (HB Grade I and II) was higher in group A</span><span style="font-family:""><span style="font-family:Verdana;"> than group B, immediately and at 6-month post op (80% and 93% VS 53.3% and 66.7%). Intermediate (HB Grade III and VI) and Poor (HB Grade V and </span><span style="font-family:Verdana;">VI) facial nerve function was higher in group B than group A;both</span><span style="font-family:Verdana;"> immediately and 6-month postop (46.7% and 33.3% VS 20% and 6.6%). However, </span><span><span style="font-family:Verdana;">no statistically significant P-Value between both groups. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">We</span></span><span style="font-family:Verdana;"> concluded that IOFNM can help, but cannot guarantee, the preservation of facial </span><span style="font-family:Verdana;">nerve. Furthermore, it is merely a technical adjunct and does not replace</span><span style="font-family:Verdana;"> surgical skills, knowledge of anatomy and experience.
基金This work was supported by the Natural Science Foundation of Zhejiang Province of China(LY14H160025)the National Natural Science Foundation of China(81402044)the Natural Science Foundation of Zhejiang Province of China(LY14H160017).
文摘Objective:To present our classification for peripheral nerve schwannomas as well as explore the surgical strategies and operative management of peripheral nerve schwannomas based on the intraoperative neurophysiological monitoring(INM)technique and to decrease the risk of postoperative neurological deficits in the management of these schwannomas.Materials and methods:A retrospective study was conducted on 92 cases of peripheral nerve microsurgery performed,using the INM technique.We also made the classification for peripheral nerve schwannomas into two types according to operative findings and proceeded corresponding surgical strategies.Results:All tumors were removed completely under microscopy and INM.Three patients developed residual neurological deficits at final follow-up.There were different results about temporary(18/92,19.6%)and permanent(3/92,3.3%)neurological deficits.The incidence of temporary and permanent neurological deficits in type II group was significantly higher than that in type I group(p<0.01).The incidence of permanent neurological deficits in larger size tumors was significantly higher than that of smaller size(p<0.01).Conclusions:We made the classification for peripheral nerve schwannomas according to operative findings based on INM that is helpful to our surgical strategies.Intracapsular enucleation was the preferred strategy with satisfactory results and low risk of nerve injury.The size and location of tumors seem to be related to the risk of fascicular injury.
基金the National Key Technologies R&D Program(No.2016YFC0105604)the National Natural Science Foundation of China(No.61474107).
文摘In the surgery of lumbar disc herniation(LDH),the nerve root retractor is used to pull the nerve root to prevent damage.The traditional medical nerve root retractor cannot quantify the force on the nerve root.In order to improve the nerve root retractor,this paper proposes an intraoperative lumbar neurological force monitoring system.The core module of this system is the improved nerve root retractor equipped with the high density flexible pressure sensor array.The high density microneedle array and multiple pressure detection units are used in the pressure sensor to realise sensitive pressure monitoring in a narrow surgical operation area.The sensing area is 4 mm×17 mm,including 6 detection units.The sensitivity of sensor is 67.30%/N in the range of 0-5 N.This system is used for in vitro animal experiments,which can continuously detect pressure.
文摘BACKGROUND Neuromonitoring in medical intensive care units is challenging as most patients are unfit for invasive intracranial pressure(ICP)modalities or unstable to transport for imaging.Ultrasonography-based optic nerve sheath diameter(ONSD)is an attractive option as it is reliable,repeatable and easily performed at the bedside.It has been sufficiently validated in traumatic brain injury(TBI)to be incorporated into the guidelines.However,currently the data for non-TBI patients is inconsistent for a scientific recommendation to be made.AIM To compile the existing evidence for understanding the scope of ONSD in measuring ICP in adult non-traumatic neuro-critical patients.METHODS PubMed,Google Scholar and research citation analysis databases were searched for studies in adult patients with non-traumatic causes of raised ICP.Studies from 2010 to 2024 in English languages were included.RESULTS We found 37 articles relevant to our search.The cutoff for ONSD in predicting ICP varied from 4.1 to 6.3 mm.Most of the articles used cerebrospinal fluid opening pressure followed by raised ICP on computed tomography/magnetic resonance imaging as the comparator parameter.ONSD was also found to be a reliable outcome measure in cases of acute ischaemic stroke,intracerebral bleeding and intracranial infection.However,ONSD is of doubtful utility in septic metabolic encephalopathy,dysnatremias and aneurysmal subarachnoid haemorrhage.CONCLUSION ONSD is a useful tool for the diagnosis of raised ICP in non-traumatic neuro-critically ill patients and may also have a role in the prognostication of a subset of patients.
文摘Background:Even though the use of nerve monitoring during parotid gland surgery is not the gold standard to prevent damage to the nerve,it surely offers some advantages over the traditional approach.Different from thyroid surgery,where a series of steps in intraoperative nerve monitoring have been described to confirm not only the integrity but—most importantly—the function of the recurrent laryngeal nerve,in parotid gland surgery,a formal guideline to follow while dissecting the facial nerve has yet to be described.Methods:A five‐year retrospective study was done reviewing the intraoperative records of patients who underwent parotid gland surgery under neural monitoring.The operative findings regarding the neuromonitoring process,particularly in regard to the amplitude of two main branches,were revised.A literature search was done to search for guidelines to follow when a facial nerve loss of signal is encountered.Results:Fifty‐five patients were operated on using the Nim 3 Nerve Monitoring System(Medtronic);31 were female patients,and 47 patients had benign lesions.Minimum changes were observed in the amplitude records after a comparison was made between the first and the last stimulation.There were only three articles discussing the term loss of signal during parotid gland surgery.Conclusion:Today,no sufficient attention has been given to the facial nerve monitoring process during parotidectomy.This study proposes a formal guideline to follow during this procedure as well as an instruction to consider when a loss of signal is observed to develop a uniform technique of facial nerve stimulation.
文摘Intraoperative nerve monitoring(IONM)has evolved into an objective tool not only for the identification but also for the preservation and prognostication of function of the recurrent laryngeal nerve in thyroid surgeries.Technical improvements have resulted in the increasing incorporation of IONM into operating rooms around the world.The importance of adherence to recommended standards is also recognized as being vital in optimizing the efficacy of IONM.The advent of continuous IONM has made real-time nerve monitoring possible,thus providing the surgeon with an ally in difficult surgeries.Additionally,as thyroid surgeries are evolving into remote access and minimally invasive procedures,so also is the applicability of IONM.This review focuses on the use of IONM for nerve monitoring in thyroidectomies for neoplastic conditions while discussing the rationale,technique,and interpretation of findings and their implications.
基金supported by the National Natural Science Foundation of China,No.32130060(to XG).
文摘Epilepsy is a severe,relapsing,and multifactorial neurological disorder.Studies regarding the accurate diagnosis,prognosis,and in-depth pathogenesis are crucial for the precise and effective treatment of epilepsy.The pathogenesis of epilepsy is complex and involves alterations in variables such as gene expression,protein expression,ion channel activity,energy metabolites,and gut microbiota composition.Satisfactory results are lacking for conventional treatments for epilepsy.Surgical resection of lesions,drug therapy,and non-drug interventions are mainly used in clinical practice to treat pain associated with epilepsy.Non-pharmacological treatments,such as a ketogenic diet,gene therapy for nerve regeneration,and neural regulation,are currently areas of research focus.This review provides a comprehensive overview of the pathogenesis,diagnostic methods,and treatments of epilepsy.It also elaborates on the theoretical basis,treatment modes,and effects of invasive nerve stimulation in neurotherapy,including percutaneous vagus nerve stimulation,deep brain electrical stimulation,repetitive nerve electrical stimulation,in addition to non-invasive transcranial magnetic stimulation and transcranial direct current stimulation.Numerous studies have shown that electromagnetic stimulation-mediated neuromodulation therapy can markedly improve neurological function and reduce the frequency of epileptic seizures.Additionally,many new technologies for the diagnosis and treatment of epilepsy are being explored.However,current research is mainly focused on analyzing patients’clinical manifestations and exploring relevant diagnostic and treatment methods to study the pathogenesis at a molecular level,which has led to a lack of consensus regarding the mechanisms related to the disease.
