IONM in Vascular Surgery - Revision history

Wdoyon: /* Introduction and Anatomy */

2020-02-24T03:02:11Z

Introduction and Anatomy

← Older revision		Revision as of 22:02, 23 February 2020
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	1. The vertical blood supply arises from the vertebral arteries. The subclavian artery gives rise to the vertebral arteries, which run bilaterally through the transverse foraminal processes of C1-C6 towards the brain. The right and left vertebral artery then join together (anastomose) to form the basilar artery, which continues into the skull via the magnus foramen (see below). The vertebral artery branches into two posterior spinal arteries and one anterior spinal artery, and these arteries run the length of the spinal cord.		1. The vertical blood supply arises from the vertebral arteries. The subclavian artery gives rise to the vertebral arteries, which run bilaterally through the transverse foraminal processes of C1-C6 towards the brain. The right and left vertebral artery then join together (anastomose) to form the basilar artery, which continues into the skull via the magnus foramen (see below). The vertebral artery branches into two posterior spinal arteries and one anterior spinal artery, and these arteries run the length of the spinal cord.

	2. The segmental spinal arteries supply each segment of the spinal cord and arise from different vessels along the spine. Along the cervical spine, the vertebral artery and the deep cervical artery give off segmental arteries. Along the thoracic spine, the posterior intercostal arteries give off segmental arteries. Along the abdomen, the lumbar and sacral arteries give off the segmental arteries. Each segmental artery also gives rise to other smaller arteries of the spinal cord, including the anterior and posterior radicular arteries, which supply the nerve roots. At some spinal levels, there ~~is an~~ additional ~~artery~~ that ~~branches~~ off the segmental spinal artery called the segmental medullary artery. The ~~largest of these~~ segmental medullary arteries is the artery of Adamkiewicz, ~~which~~ typically ~~occurs~~ between T9-T12.		2. The segmental spinal arteries supply each segment of the spinal cord and arise from different vessels along the spine. Along the cervical spine, the vertebral artery and the deep cervical artery give off segmental arteries. Along the thoracic spine, the posterior intercostal arteries give off segmental arteries. Along the abdomen, the lumbar and sacral arteries give off the segmental arteries. Each segmental artery also gives rise to other smaller arteries of the spinal cord, including the anterior and posterior radicular arteries, which supply the nerve roots. At some spinal levels, there are additional arteries that branch off the segmental spinal artery called the segmental medullary artery. The segmental medullary arteries feed into the anterior and posterior spinal arteries. There about 6-10 segmental medullary arteries along the spine in an adult, the largest of which is the artery of Adamkiewicz, typically found between T9-T12.

	==Carotid endarterectomy ==		==Carotid endarterectomy ==

Wdoyon: /* Introduction */

2020-02-23T23:54:27Z

Introduction

← Older revision		Revision as of 18:54, 23 February 2020
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	==Introduction==		==Introduction and Anatomy==

			'''Blood supply to the spinal cord.'''
			The spinal cord is supplied by blood flow from two major sources: vertical arteries and segmental spinal arteries.

			1. The vertical blood supply arises from the vertebral arteries. The subclavian artery gives rise to the vertebral arteries, which run bilaterally through the transverse foraminal processes of C1-C6 towards the brain. The right and left vertebral artery then join together (anastomose) to form the basilar artery, which continues into the skull via the magnus foramen (see below). The vertebral artery branches into two posterior spinal arteries and one anterior spinal artery, and these arteries run the length of the spinal cord.

			2. The segmental spinal arteries supply each segment of the spinal cord and arise from different vessels along the spine. Along the cervical spine, the vertebral artery and the deep cervical artery give off segmental arteries. Along the thoracic spine, the posterior intercostal arteries give off segmental arteries. Along the abdomen, the lumbar and sacral arteries give off the segmental arteries. Each segmental artery also gives rise to other smaller arteries of the spinal cord, including the anterior and posterior radicular arteries, which supply the nerve roots. At some spinal levels, there is an additional artery that branches off the segmental spinal artery called the segmental medullary artery. The largest of these segmental medullary arteries is the artery of Adamkiewicz, which typically occurs between T9-T12.

	==Carotid endarterectomy ==		==Carotid endarterectomy ==

Wdoyon: /* Carotid endarterectomy */

2020-02-15T22:48:27Z

Carotid endarterectomy

← Older revision		Revision as of 17:48, 15 February 2020
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	EEG and SSEPs are the most common modalities used to monitor ischemic events in the brain during a carotid endarterectomy. EEG measures the spontaneous electrical activity of the brain. Changes in the alpha and beta band frequencies of the EEG are an indicator of changes in cerebral blood flow and ischemia (Visser et al. J Clin Neurophysiol, 2001;18:169-77).		EEG and SSEPs are the most common modalities used to monitor ischemic events in the brain during a carotid endarterectomy. EEG measures the spontaneous electrical activity of the brain. Changes in the alpha and beta band frequencies of the EEG are an indicator of changes in cerebral blood flow and ischemia (Visser et al. J Clin Neurophysiol, 2001;18:169-77).

	The N20 generator for the median nerve SSEP lies within the cortical region perfused by the middle cerebral artery. Therefore, monitoring the median nerve SSEP provides an indication of ischemia within the region perfused by the middle cerebral artery. By contrast, the P37 generator for the tibial nerve SSEP lies within the cortical region perfused by the anterior cerebral artery, making the tibial nerve SSEP a good indicator of ischemia within the region perfused by the anterior cerebral artery.		The N20 generator for the median nerve SSEP lies within the cortical region perfused by the middle cerebral artery. Therefore, monitoring the median nerve SSEP provides an indication of ischemia within the region perfused by the middle cerebral artery. By contrast, the P37 generator for the posterior tibial nerve SSEP lies within the cortical region perfused by the anterior cerebral artery, making the tibial nerve SSEP a good indicator of ischemia within the region perfused by the anterior cerebral artery.

	==Microvascular decompression==		==Microvascular decompression==

Wdoyon: /* Carotid endarterectomy */

2020-02-05T18:39:42Z

Carotid endarterectomy

← Older revision		Revision as of 13:39, 5 February 2020
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	EEG and SSEPs are the most common modalities used to monitor ischemic events in the brain during a carotid endarterectomy. EEG measures the spontaneous electrical activity of the brain. Changes in the alpha and beta band frequencies of the EEG are an indicator of changes in cerebral blood flow and ischemia (Visser et al. J Clin Neurophysiol, 2001;18:169-77).		EEG and SSEPs are the most common modalities used to monitor ischemic events in the brain during a carotid endarterectomy. EEG measures the spontaneous electrical activity of the brain. Changes in the alpha and beta band frequencies of the EEG are an indicator of changes in cerebral blood flow and ischemia (Visser et al. J Clin Neurophysiol, 2001;18:169-77).

	The N20 generator for the median nerve SSEP lies within the cortical region perfused by the middle cerebral artery. Therefore, monitoring the median nerve SSEP provides an indication of ischemia within the region perfused by the middle cerebral artery. By contrast, the ~~N37~~ generator for the tibial nerve SSEP lies within the cortical region perfused by the anterior cerebral artery, making the tibial nerve SSEP a good indicator of ischemia within the region perfused by the anterior cerebral artery.		The N20 generator for the median nerve SSEP lies within the cortical region perfused by the middle cerebral artery. Therefore, monitoring the median nerve SSEP provides an indication of ischemia within the region perfused by the middle cerebral artery. By contrast, the P37 generator for the tibial nerve SSEP lies within the cortical region perfused by the anterior cerebral artery, making the tibial nerve SSEP a good indicator of ischemia within the region perfused by the anterior cerebral artery.

	==Microvascular decompression==		==Microvascular decompression==

Wdoyon: /* Carotid endarterectomy */

2020-02-05T17:56:09Z

Carotid endarterectomy

← Older revision		Revision as of 12:56, 5 February 2020
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	EEG and SSEPs are the most common modalities used to monitor ischemic events in the brain during a carotid endarterectomy. EEG measures the spontaneous electrical activity of the brain. Changes in the alpha and beta band frequencies of the EEG are an indicator of changes in cerebral blood flow and ischemia (Visser et al. J Clin Neurophysiol, 2001;18:169-77).		EEG and SSEPs are the most common modalities used to monitor ischemic events in the brain during a carotid endarterectomy. EEG measures the spontaneous electrical activity of the brain. Changes in the alpha and beta band frequencies of the EEG are an indicator of changes in cerebral blood flow and ischemia (Visser et al. J Clin Neurophysiol, 2001;18:169-77).

	The N20 generator for the median nerve SSEP lies within the cortical region perfused by the middle cerebral artery. Therefore, monitoring the median nerve SSEP provides an indication of ischemia within the region perfused by the middle cerebral artery. By contrast, the N37 generator for the tibial nerve SSEP lies within the cortical region perfused by the anterior cerebral artery, making the tibial nerve SSEP a good indicator ~~for~~ ischemia within the region perfused by the anterior cerebral artery.		The N20 generator for the median nerve SSEP lies within the cortical region perfused by the middle cerebral artery. Therefore, monitoring the median nerve SSEP provides an indication of ischemia within the region perfused by the middle cerebral artery. By contrast, the N37 generator for the tibial nerve SSEP lies within the cortical region perfused by the anterior cerebral artery, making the tibial nerve SSEP a good indicator of ischemia within the region perfused by the anterior cerebral artery.

	==Microvascular decompression==		==Microvascular decompression==

Wdoyon: /* Microvascular decompression */

2020-02-05T17:21:24Z

Microvascular decompression

← Older revision		Revision as of 12:21, 5 February 2020
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	==Microvascular decompression==		==Microvascular decompression==
	Disorders, such as trigeminal or glossopharyngeal neuralgia, can cause blood vessels in the brain to compress the cranial nerves, resulting in chronic pain and muscle spasms. A microvascular decompression is a procedure to relieve vascular pressure on these nerves. The vascular compression often occurs at the level of the nerve roots. The majority of trigeminal neuralgia cases arise from compression of the trigeminal nerve root, and Multiple Sclerosis is associated with a higher incidence of trigeminal neuralgia (Putzki et al. Eur J Neurol, 2009;16:262–7). Hemifacial spasms are caused by vascular compression of the facial nerve roots in the brainstem. Neuromonitoring of ~~this procedure and others~~ involves the use of brainstem auditory evoked ~~potentials~~, free-running EMG, and facial motor-evoked potentials.		Disorders, such as trigeminal or glossopharyngeal neuralgia, can cause blood vessels in the brain to compress the cranial nerves, resulting in chronic pain and muscle spasms. A microvascular decompression is a procedure to relieve vascular pressure on these nerves. The vascular compression often occurs at the level of the nerve roots. The majority of trigeminal neuralgia cases arise from compression of the trigeminal nerve root, and Multiple Sclerosis is associated with a higher incidence of trigeminal neuralgia (Putzki et al. Eur J Neurol, 2009;16:262–7). Hemifacial spasms are caused by vascular compression of the facial nerve roots in the brainstem.

			Neuromonitoring of microvascular decompression involves the use of brainstem auditory evoked responses (BAERs), free-running EMG, and facial motor-evoked potentials. BAERs are used to monitor the auditory nerve (CN VIII), which is at risk for injury due to the surgical manipulations.

	==Cardiac procedures==		==Cardiac procedures==

Wdoyon: /* Microvascular decompression */

2020-01-28T21:28:49Z

Microvascular decompression

← Older revision		Revision as of 16:28, 28 January 2020
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	==Microvascular decompression==		==Microvascular decompression==
	Disorders, such as trigeminal or glossopharyngeal neuralgia, can cause blood vessels in the brain to compress the cranial nerves~~. This compression can result~~ in pain and muscle spasms. A microvascular decompression is a procedure to relieve pressure on ~~a cranial nerve caused by an artery or vein compressing~~ the nerve. The majority of trigeminal neuralgia cases arise from compression of the trigeminal nerve root. Multiple Sclerosis is associated with a higher incidence of trigeminal neuralgia (Putzki et al. Eur J Neurol, 2009;16:262–7).		Disorders, such as trigeminal or glossopharyngeal neuralgia, can cause blood vessels in the brain to compress the cranial nerves, resulting in chronic pain and muscle spasms. A microvascular decompression is a procedure to relieve vascular pressure on these nerves. The vascular compression often occurs at the level of the nerve roots. The majority of trigeminal neuralgia cases arise from compression of the trigeminal nerve root, and Multiple Sclerosis is associated with a higher incidence of trigeminal neuralgia (Putzki et al. Eur J Neurol, 2009;16:262–7). Hemifacial spasms are caused by vascular compression of the facial nerve roots in the brainstem. Neuromonitoring of this procedure and others involves the use of brainstem auditory evoked potentials, free-running EMG, and facial motor-evoked potentials.

	==Cardiac procedures==		==Cardiac procedures==

Wdoyon: /* Microvascular decompression */

2020-01-24T21:43:16Z

Microvascular decompression

← Older revision		Revision as of 16:43, 24 January 2020
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	==Microvascular decompression==		==Microvascular decompression==
	Disorders, such as trigeminal or glossopharyngeal neuralgia, can cause blood vessels in the brain to compress the cranial nerves. This compression can result in pain and muscle spasms. A microvascular decompression is a procedure to relieve pressure on a cranial nerve caused by an artery or vein compressing the nerve. The majority of trigeminal neuralgia cases arise from compression of the trigeminal nerve root. Multiple Sclerosis is associated with a higher incidence of trigeminal neuralgia (Putzki et al. Eur J Neurol. 2009;16:262–7).		Disorders, such as trigeminal or glossopharyngeal neuralgia, can cause blood vessels in the brain to compress the cranial nerves. This compression can result in pain and muscle spasms. A microvascular decompression is a procedure to relieve pressure on a cranial nerve caused by an artery or vein compressing the nerve. The majority of trigeminal neuralgia cases arise from compression of the trigeminal nerve root. Multiple Sclerosis is associated with a higher incidence of trigeminal neuralgia (Putzki et al. Eur J Neurol, 2009;16:262–7).

	==Cardiac procedures==		==Cardiac procedures==

Wdoyon: /* Microvascular decompression */

2020-01-24T16:57:12Z

Microvascular decompression

← Older revision		Revision as of 11:57, 24 January 2020
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	==Microvascular decompression==		==Microvascular decompression==
	Disorders, such as trigeminal or glossopharyngeal neuralgia, can cause blood vessels in the brain to compress the cranial nerves. This compression can result in pain and muscle spasms. A microvascular decompression is a procedure to relieve pressure on a cranial nerve caused by an artery or vein. The majority of trigeminal neuralgia cases arise from compression of the trigeminal nerve root.		Disorders, such as trigeminal or glossopharyngeal neuralgia, can cause blood vessels in the brain to compress the cranial nerves. This compression can result in pain and muscle spasms. A microvascular decompression is a procedure to relieve pressure on a cranial nerve caused by an artery or vein compressing the nerve. The majority of trigeminal neuralgia cases arise from compression of the trigeminal nerve root. Multiple Sclerosis is associated with a higher incidence of trigeminal neuralgia (Putzki et al. Eur J Neurol. 2009;16:262–7).

	==Cardiac procedures==		==Cardiac procedures==

Wdoyon: /* Microvascular decompression */

2020-01-23T03:33:57Z

Microvascular decompression

← Older revision		Revision as of 22:33, 22 January 2020
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	==Microvascular decompression==		==Microvascular decompression==
			Disorders, such as trigeminal or glossopharyngeal neuralgia, can cause blood vessels in the brain to compress the cranial nerves. This compression can result in pain and muscle spasms. A microvascular decompression is a procedure to relieve pressure on a cranial nerve caused by an artery or vein. The majority of trigeminal neuralgia cases arise from compression of the trigeminal nerve root.

	==Cardiac procedures==		==Cardiac procedures==