1
|
Mandeville R, Sanchez B, Johnston B, Bazarek S, Thum JA, Birmingham A, See RHB, Leochico CFD, Kumar V, Dowlatshahi AS, Brown J, Stashuk D, Rutkove SB. A scoping review of current and emerging techniques for evaluation of peripheral nerve health, degeneration, and regeneration: part 1, neurophysiology. J Neural Eng 2023; 20:041001. [PMID: 37279730 DOI: 10.1088/1741-2552/acdbeb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/06/2023] [Indexed: 06/08/2023]
Abstract
Peripheral neuroregeneration research and therapeutic options are expanding exponentially. With this expansion comes an increasing need to reliably evaluate and quantify nerve health. Valid and responsive measures that can serve as biomarkers of the nerve status are essential for both clinical and research purposes for diagnosis, longitudinal follow-up, and monitoring the impact of any intervention. Furthermore, such biomarkers can elucidate regeneration mechanisms and open new avenues for research. Without these measures, clinical decision-making falls short, and research becomes more costly, time-consuming, and sometimes infeasible. As a companion to Part 2, which is focused on non-invasive imaging, Part 1 of this two-part scoping review systematically identifies and critically examines many current and emerging neurophysiological techniques that have the potential to evaluate peripheral nerve health, particularly from the perspective of regenerative therapies and research.
Collapse
Affiliation(s)
- Ross Mandeville
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Benjamin Sanchez
- Department Electrical and Computer Engineering, University of Utah, Salt Lake City, UT 84112, United States of America
| | - Benjamin Johnston
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, United States of America
| | - Stanley Bazarek
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, United States of America
| | - Jasmine A Thum
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Austin Birmingham
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Reiner Henson B See
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Carl Froilan D Leochico
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Global City, Taguig, The Philippines
- Department of Rehabilitation Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, The Philippines
| | - Viksit Kumar
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Arriyan S Dowlatshahi
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Justin Brown
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Daniel Stashuk
- Department of Systems Design Engineering, University of Waterloo, Ontario N2L 3G1, Canada
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| |
Collapse
|
2
|
Orenga Orenga JV, Parra Escorihuela S, Barreda Altaba I, Estarelles Marco MJ, Ghinea AD, Leal Galicia DE, López García R. Iatrogenic lesions of the peripheral nervous system in orthopaedic surgery and traumatology procedures. ACTA ACUST UNITED AC 2021. [PMID: 34112446 DOI: 10.1016/j.recote.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe iatrogenic lesions of the peripheral nervous system and their relationship with different orthopaedic and traumatological procedures, through their assessment by means of electromyographic study. MATERIAL AND METHODS Retrospective descriptive study of the electromyographies performed in the clinical neurophysiology service of the Hospital General Universitari de Castelló between July 2015 and March 2019, recovering those in which the aetiology was diagnosed as iatrogenic in relation to surgical procedures and analysing those that were initiated after orthopaedic and traumatological procedures. RESULTS Of the total number of electromyographies reviewed, 1.37% corresponded to iatrogenic surgical lesions and 55.1% of these were secondary to orthopaedic surgery and traumatology procedures, the incidence in relation to the procedures performed was 0.65%. The most frequent locations related to injuries were the lumbar spine, hip and hand/wrist. Injuries due to postural causes not directly related to the surgical field are noteworthy. CONCLUSION Iatrogenic injuries to the peripheral nervous system after orthopaedic surgery and traumatology procedures are infrequent, but given their mechanism of injury and the high severity of most of them, it would be advisable to implement corrective mechanisms to reduce their incidence. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- J V Orenga Orenga
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain.
| | - S Parra Escorihuela
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
| | - I Barreda Altaba
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
| | - M J Estarelles Marco
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
| | - A D Ghinea
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
| | - D E Leal Galicia
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
| | - R López García
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
| |
Collapse
|
3
|
Vetrano IG, Acerbi F, Falco J, D'Ammando A, Devigili G, Nazzi V. High-Definition 4K 3D Exoscope (ORBEYETM) in Peripheral Nerve Sheath Tumor Surgery: A Preliminary, Explorative, Pilot Study. Oper Neurosurg (Hagerstown) 2021; 19:480-488. [PMID: 32357216 DOI: 10.1093/ons/opaa090] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/10/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Surgery for peripheral nerve sheath tumors aims to preserve functional fascicles achieving gross-total resection. Increasing the visualization of anatomic details helps to identify the different layers and the tumor-nerve interface. The traditional microscope can present some limitations in this type of surgery, such as its physical obstruction. OBJECTIVE To present a proof-of-concept study about exoscope-guided surgery for schwannomas of the lower limbs, to analyze the advantages and disadvantages of the 4K, high-quality, 3-dimensional (3D) imaging. METHODS We analyzed 2 consecutive surgical cases of suspected schwannomas of the lower limbs using the ORBEYE™ exoscope (Olympus). A standard operative microscope was also available in the operating room. All procedures were performed with neurophysiological monitoring, to identify functioning nerves and to localize the tumor capsule safest entry point. The cases are reported according to the PROCESS guidelines. RESULTS In both cases, we achieved a gross total resection of the schwannomas; the exoscope provided an excellent view of the anatomic details at tumor-nerve interface, as visible in intraoperative images and in the 3D-4K video supporting these findings. The surgeon's position was comfortable in both cases, although if the co-surgeon positioned himself in front of the first surgeon, the comfort was slightly reduced. The 4K monitor allowed a realistic, nontiring 3D vision for all the team. CONCLUSION The ORBEYETM, after an adequate learning curve, can represent a feasible and comfortable instrument for nerve tumor surgery, which is usually performed in a single horizontal plane. Further and wider clinical series are necessary to confirm this first impression.
Collapse
Affiliation(s)
- Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Antonio D'Ammando
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Grazia Devigili
- Neurological Unit 1, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vittoria Nazzi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| |
Collapse
|
4
|
Orenga Orenga JV, Parra Escorihuela S, Barreda Altaba I, Estarelles Marco MJ, Ghinea AD, Leal Galicia DE, López García R. Iatrogenic lesions of the peripheral nervous system in orthopaedic surgery and traumatology procedures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [PMID: 33714695 DOI: 10.1016/j.recot.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe iatrogenic lesions of the peripheral nervous system and their relationship with different orthopaedic and traumatological procedures, through their assessment by means of electromyographic study. MATERIAL AND METHODS Retrospective descriptive study of the electromyographies performed in the clinical neurophysiology service of the Hospital General Universitari de Castelló between July 2015 and March 2019, recovering those in which the aetiology was diagnosed as iatrogenic in relation to surgical procedures and analysing those that were initiated after orthopaedic and traumatological procedures. RESULTS Of the total number of electromyographies reviewed, 1.37% corresponded to iatrogenic surgical lesions and 55.1% of these were secondary to orthopaedic surgery and traumatology procedures, the incidence in relation to the procedures performed was 0.65%. The most frequent locations related to injuries were the lumbar spine, hip and hand/wrist. Injuries due to postural causes not directly related to the surgical field are noteworthy. CONCLUSION Iatrogenic injuries to the peripheral nervous system after orthopaedic surgery and traumatology procedures are infrequent, but given their mechanism of injury and the high severity of most of them, it would be advisable to implement corrective mechanisms to reduce their incidence. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- J V Orenga Orenga
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España.
| | - S Parra Escorihuela
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
| | - I Barreda Altaba
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
| | - M J Estarelles Marco
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
| | - A D Ghinea
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
| | - D E Leal Galicia
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
| | - R López García
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
| |
Collapse
|
5
|
Park D, Kim DY, Eom YS, Lee SE, Chae SB. Posterior interosseous nerve syndrome caused by a ganglion cyst and its surgical release with intraoperative neurophysiological monitoring: A case report. Medicine (Baltimore) 2021; 100:e24702. [PMID: 33663080 PMCID: PMC7909167 DOI: 10.1097/md.0000000000024702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/21/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Intraoperative neurophysiological monitoring (IONM) has been utilized not only for the rapid detection of neural insults during surgeries, but also to verify the neurophysiological integrity of nerve lesions in the surgical field. PATIENT CONCERNS A 32-year-old woman presented with a wrist and finger drop that had lasted about 3 months. DIAGNOSES The result of the initial electrodiagnostic test was consistent with posterior interosseous nerve (PIN) syndrome. Ultrasonography and magnetic resonance imaging of the proximal forearm showed a cystic mass at the anterolateral aspect of the radial head, which was diagnosed as a ganglion cyst. INTERVENTIONS Surgical release of the ganglion cyst with IONM was performed. During the surgery, we induced nerve action potentials and compound motor action potentials across the ganglion cyst, which demonstrated neural continuity. OUTCOMES Three months after the surgery, the patient showed partial recovery of wrist and finger extensor muscle power. An electrodiagnostic test conducted 3 months after the surgery showed reinnervation potentials in PIN-innervated muscles. LESSONS IONM during peripheral nerve surgeries can support surgical decisions and confirm the location and degree of nerve damage.
Collapse
Affiliation(s)
| | - Dong Young Kim
- Department of Orthopedic Surgery, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang
| | - Yoon Sik Eom
- Department of Orthopedic Surgery, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang
| | | | - Seung Bum Chae
- Department of Orthopedic Surgery, Daegu Catholic University Hospital, Daegu, Republic of Korea
| |
Collapse
|
6
|
Artifact reduction by using alternating polarity stimulus pairs in intraoperative peripheral nerve action potential recording. J Clin Monit Comput 2020; 35:1467-1475. [PMID: 33146861 DOI: 10.1007/s10877-020-00613-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
Intraoperative nerve action potential (NAP) recording permits direct study of an injured nerve for functional assessment of lesions in continuity. Stimulus artifact contamination often hampers NAP recording and interferes with its interpretation. In the present study, we evaluated the artifact reduction method using alternating polarity in peripheral nerve recording. Our study was conducted under controlled conditions in laboratory animals. NAPs were recorded from surgically exposed median or ulnar nerves. For the artifact reduction method with alternating polarity, two sequential recordings, one with normal and one with reversed stimulus polarity, were acquired and the signals from this recording pair were averaged. Simulation was also performed to further evaluate the effects of alternating polarity on the waveforms. The results are as follows: First, we found that this method worked for recordings with unsaturated electrical stimulus artifacts. Second, slightly unequal latencies occurred in an NAP pair, and this inequality contributed to a minimal loss of NAP amplitudes when averaging the two recordings. Third, perfect artifact cancelation and minimal signal loss were also demonstrated by simulation. Finally, we applied the method during nerve inching and demonstrated its usefulness in intraoperative NAP recordings as the method made the recording more resilient to short conduction distances. Thus, our findings demonstrate that this artifact reduction method can be used as a supplemental tool together with our previously described bridge grounding technique or the nonlifting nerve recording configuration to further improve intraoperative peripheral nerve recording. The method can be applied in clinical settings.
Collapse
|
7
|
Wu G, Belzberg A, Nance J, Gutierrez-Hernandez S, Ritzl EK, Ringkamp M. Solutions to the technical challenges embedded in the current methods for intraoperative peripheral nerve action potential recordings. J Neurosurg 2019; 133:884-893. [PMID: 31419790 PMCID: PMC7393774 DOI: 10.3171/2019.5.jns19146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/14/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intraoperative nerve action potential (NAP) recording is a useful tool for surgeons to guide decisions on surgical approaches during nerve repair surgeries. However, current methods remain technically challenging. In particular, stimulus artifacts that contaminate or mask the NAP and therefore impair the interpretation of the recording are a common problem. The authors' goal was to improve intraoperative NAP recording techniques by revisiting the methods in an experimental setting. METHODS First, NAPs were recorded from surgically exposed peripheral nerves in monkeys. For the authors to test their assumptions about observed artifacts, they then employed a simple model system. Finally, they applied their insights to clinical cases in the operating room. RESULTS In monkey peripheral nerve recordings, large stimulus artifacts obscured NAPs every time the nerve segment (length 3-5 cm) was lifted up from the surrounding tissue, and NAPs could not be recorded. Artifacts were suppressed, and NAPs emerged when "bridge grounding" was applied, and this allowed the NAPs to be recorded easily and reliably. Tests in a model system suggested that exaggerated stimulus artifacts and unmasking of NAPs by bridge grounding are related to a loop effect that is created by lifting the nerve. Consequently, clean NAPs were acquired in "nonlifting" recordings from monkey peripheral nerves. In clinical cases, bridge grounding efficiently unmasked intraoperative NAP recordings, validating the authors' principal concept in the clinical setting and allowing effective neurophysiological testing in the operating room. CONCLUSIONS Technical challenges of intraoperative NAP recording are embedded in the current methods that recommend lifting the nerve from the tissue bed, thereby exaggerating stimulus artifacts by a loop effect. Better results can be achieved by performing nonlifting nerve recording or by applying bridge grounding. The authors not only tested their findings in an animal model but also applied them successfully in clinical practice.
Collapse
Affiliation(s)
- Gang Wu
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Allan Belzberg
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jessica Nance
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Eva K. Ritzl
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Matthias Ringkamp
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|