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Journal articles on the topic 'Intraoperative electrophysiology'

Author: Grafiati

Published: 4 June 2021

Last updated: 11 February 2022

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1

Fekete, Gábor, László Bognár, Emanuel Gutema, and László Novák. "Intraoperative electrophysiology in children – Single institute experience of 96 examinations." Neurology India 68, no. 2 (2020): 407. http://dx.doi.org/10.4103/0028-3886.284352.

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2

Augoustides, John, D. Joshua Mancini, and Francis Marchilinski. "An unusual cause of intraoperative confusion in the electrophysiology laboratory." Journal of Cardiothoracic and Vascular Anesthesia 16, no. 3 (June 2002): 351–53. http://dx.doi.org/10.1053/jcan.2002.124147.

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3

Hariharan, Praveen, Jeffery R. Balzer, Katherine Anetakis, Donald J. Crammond, and Parthasarathy D. Thirumala. "Electrophysiology of Olfactory and Optic Nerve in Outpatient and Intraoperative Settings." Journal of Clinical Neurophysiology 35, no. 1 (January 2018): 3–10. http://dx.doi.org/10.1097/wnp.0000000000000416.

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Hariharan, Praveen, Jeffery R. Balzer, Katherine Anetakis, Donald J. Crammond, and Parthasarathy D. Thirumala. "Electrophysiology of Olfactory and Optic Nerve in Outpatient and Intraoperative Settings." Journal of Clinical Neurophysiology 35, no. 4 (July 2018): 355–56. http://dx.doi.org/10.1097/wnp.0000000000000478.

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5

Sener, Ugur, Aman Dabir, and Christopher Cifarelli. "RADI-08. Elucidating the Electrophysiology of Intraoperative Radiotherapy – Experience from Two Cases." Neuro-Oncology Advances 3, Supplement_3 (August 1, 2021): iii19. http://dx.doi.org/10.1093/noajnl/vdab071.078.

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Abstract Brain metastases require multimodality treatment, often combining surgical resection, radiation therapy, and individualized systemic pharmacotherapy based on oncogenic drivers. Intraoperative radiation therapy (IORT) is an emerging treatment option where radiation is delivered directly to the resection cavity at the time of surgery. We present two patients who underwent electrocorticography (ECoG) during IORT, providing information regarding electrophysiologic safety and tolerability of the technique. In the first case, a 65-year-old woman underwent resection of a hemorrhagic right occipital metastasis from non-small cell lung cancer. IORT was administered over sixteen minutes for a surface dose of 30 Gy. In the second case, a 73-year-old man with underwent resection of a right posterior frontal metastasis from non-small cell lung cancer. IORT was delivered over eleven minutes for a surface dose of 30 Gy. In both cases, a 1x6 contact array of subdural electrodes was placed adjacent to the planned field of radiation. Electrocortigraphy (HFF 70 Hz, TC 0.3 sec, sensitivity 150uV/mm) was obtained from the array two minutes prior to initiation of therapy, during therapy, and two minutes after completion of therapy in both cases. We found that IORT did not induce electrophysiological change in the tissue surrounding it in both cases with no epileptiform or ictal discharges during 20 minutes of ECoG recording around the time radiation therapy, nor did the patients have episodes suggestive of epileptic seizures in the acute post-operative period. One of the patients (case 1) experienced a single epileptic seizure 4 months after IORT, but this was temporally related to a new intraparenchymal hemorrhage and unlikely due to radiation therapy. These two cases illustrate the relative safety of IORT with respect to induction of immediate epileptiform changes within the brain parenchyma.

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De Vloo, Philippe, Terhi J. Huttunen, Dalila Forte, Ivana Jankovic, Amy Lee, Mark Hair, Stephanie Cawker, et al. "Intraoperative electrophysiology during single-level selective dorsal rhizotomy: technique, stimulation threshold, and response data in a series of 145 patients." Journal of Neurosurgery: Pediatrics 25, no. 6 (June 2020): 597–606. http://dx.doi.org/10.3171/2019.12.peds19372.

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OBJECTIVESelective dorsal rhizotomy (SDR) is effective at permanently reducing spasticity in children with spastic cerebral palsy. The value of intraoperative neurophysiological monitoring in this procedure remains controversial, and its robustness has been questioned. This study describes the authors’ institutional electrophysiological technique (based on the technique of Park et al.), intraoperative findings, robustness, value to the procedure, and occurrence of new motor or sphincter deficits.METHODSThe authors analyzed electrophysiological data of all children who underwent SDR at their center between September 2013 and February 2019. All patients underwent bilateral SDR through a single-level laminotomy at the conus and with transection of about 60% of the L2–S2 afferent rootlets (guided by intraoperative electrophysiology) and about 50% of L1 afferent roots (nonselectively).RESULTSOne hundred forty-five patients underwent SDR (64% male, mean age 6 years and 7 months, range 2 years and 9 months to 14 years and 10 months). Dorsal roots were distinguished from ventral roots anatomically and electrophysiologically, by assessing responses on free-running electromyography (EMG) and determining stimulation thresholds (≥ 0.2 mA in all dorsal rootlets). Root level was determined anatomically and electrophysiologically by assessing electromyographic response to stimulation. Median stimulation threshold was lower in sacral compared to lumbar roots (p < 0.001), and 16% higher on the first operated (right) side (p = 0.023), but unrelated to age, sex, or functional status. Similarly, responses to tetanic stimulation were consistent: 87% were graded 3+ or 4+, with similar distributions between sides. This was also unrelated to age, sex, and functional status. The L2–S2 rootlets were divided (median 60%, range 50%–67%), guided by response to tetanic stimulation at threshold amplitude. No new motor or sphincter deficits were observed, suggesting sparing of ventral roots and sphincteric innervation, respectively.CONCLUSIONSThis electrophysiological technique appears robust and reproducible, allowing reliable identification of afferent nerve roots, definition of root levels, and guidance for rootlet division. Only a direct comparative study will establish whether intraoperative electrophysiology during SDR minimizes risk of new motor or sphincter worsening and/or maximizes functional outcome.

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Chen, Jie, Lei Xu, and Dong Tian. "Intraoperative Electrophysiology Examination of Median Nerve Showed the Quick Outcome of Carpal Tunnel Release." HAND 11, no. 1_suppl (September 2016): 91S. http://dx.doi.org/10.1177/1558944716660555fs.

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8

Preul, Mark C., Richard Leblanc, Fernando Cendes, Francois Dubeau, David Reutens, Roberto Spreafico, Giorgio Battaglia, et al. "Function and organization in dysgenic cortex." Journal of Neurosurgery 87, no. 1 (July 1997): 113–21. http://dx.doi.org/10.3171/jns.1997.87.1.0113.

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✓ Cerebral dysgenesis is a subject of interest because of its relationship to cerebral development and dysfunction and to epilepsy. The authors present a detailed study of a 16-year-old boy who underwent surgery for a severe seizure disorder. This patient had dysgenesis of the right hemisphere, which was composed of a giant central frontoparietal nodular gray matter heterotopia with overlying large islands of cortical dysplasia around a displaced central fissure. Exceptional insight into the function, biochemistry, electrophysiology, and histological structure of this lesion was obtained from neurological studies that revealed complementary information: magnetic resonance (MR) imaging, [18]fluoro-2-deoxy-d-glucose positron emission tomography (PET), functional PET scanning, proton MR spectroscopic (1H-MRS) imaging, intraoperative cortical mapping and electrocorticography, in vitro electrophysiology, and immunocytochemistry. These studies demonstrated compensatory cortical reorganization and showed that large areas of heterotopia and cortical dysplasia in the central area may retain normal motor and sensory function despite strikingly altered cytoarchitectonic organization and neuronal metabolism. Such lesions necessitate appropriate functional imaging studies prior to surgery and cortical mapping to avoid creating neurological deficits. Integrated studies, such as PET, 1H-MRS imaging, cortical mapping, immunocytochemistry, and electrophysiology may provide information on the function of developmental disorders of cerebral organization.

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Makarin, Viktor, Anna Uspenskaya, Arseniy Semenov, Natalya Timofeeva, Roman Chernikov, Ilya Sleptsov, Igor Chinchuk, et al. "INTRAOPERATIVE CONTINUOUS NEUROMONITORING OF LARYNGEAL RECCURENT NERVES IN PATIENTS WITH THYROID CANCER." Problems in oncology 65, no. 3 (March 1, 2019): 342–48. http://dx.doi.org/10.37469/0507-3758-2019-65-3-342-348.

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Laryngeal muscles paresis ranks second in prevalence of postoperative complications after thyroid surgery. Intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) results in reduction of cases with dysphonia and prevents such severe complication as bilateral paresis. Currently there are two types of monitoring: intermittent and continual. When using intermittent IONM surgeon has no opportunity to control electrophysiology state of RLN during intervals between stimulations. In case of continual IONM date on amplitude and latency are available to surgeon in real time every second, allowing him instantly react to any disturbance of neural transmission to prevent its damage by changing surgical manipulation. This work presents the first experience of using continual neuromonitoring of RLN in Russia, the procedure is described in details its safety. It is represented the possibility of prevention of bilateral laryngeal muscles paresis.

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van Ouwerkerk, Willem J. R., Rob L. M. Strijers, Frederik Barkhof, Ulco Umans, and W. Peter Vandertop. "Detection of Root Avulsion in the Dominant C7 Obstetric Brachial Plexus Lesion: Experience with Three-dimensional Constructive Interference in Steady-state Magnetic Resonance Imaging and Electrophysiology." Neurosurgery 57, no. 5 (November 1, 2005): 930–40. http://dx.doi.org/10.1227/01.neu.0000180813.10843.d4.

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Abstract OBJECTIVE: Preoperative, reliable detection by ancillary investigations of spinal nerve root avulsions in infants with severe obstetric brachial plexus lesions to avoid ineffective operative repair from deceivingly intact but actually avulsed nerve roots. METHODS: Ten infants were selected with an infrequent, severe dominant C7 lesion, primarily because of the anatomically distinct supraclavicular course of this spinal nerve. Three-dimensional constructive interference in steady-state magnetic resonance imaging (3D CISS MRI) studies under mild sedation were performed and evaluated for detection of avulsed nerve roots by two experienced neuroradiologists. Preoperative electrodiagnostics (electromyography and somatosensory evoked potentials) as well as intraoperative somatosensory potentials and muscle contractions after electrostimulation were recorded. Preoperative and intraoperative ancillary investigations were correlated with intraoperative findings in eight patients and clinical status in two children who recovered spontaneously. RESULTS: Despite two minor motion artifacts, the quality of the 3D CISS MRI studies was good. In 8 of 10 patients, prediction of root continuity was consistent with operative or clinical findings, and 2 remained doubtful. Preoperative and intraoperative electrodiagnostics tended not to correlate with intraoperative findings in this small, selected group. CONCLUSION: 3D CISS MRI provides good images of anterior and posterior spinal roots in infants with obstetric brachial plexus lesions. Images seem to allow accurate prediction of root avulsion in the majority of patients. In this study, electrodiagnostics were of limited value.

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Smith, Adam P., and Roy A. E. Bakay. "Frameless deep brain stimulation using intraoperative O-arm technology." Journal of Neurosurgery 115, no. 2 (August 2011): 301–9. http://dx.doi.org/10.3171/2011.3.jns101642.

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Object Correct lead location in the desired target has been proven to be a strong influential factor for good clinical outcome in deep brain stimulation (DBS) surgery. Commonly, a surgeon's first reliable assessment of such location is made on postoperative imaging. While intraoperative CT (iCT) and intraoperative MR imaging have been previously described, the authors present a series of frameless DBS procedures using O-arm iCT. Methods Twelve consecutive patients with 15 leads underwent frameless DBS placement using electrophysiological testing and O-arm iCT. Initial target coordinates were made using standard indirect and direct assessment. Microelectrode recording (MER) with kinesthetic responses was performed, followed by microstimulation to evaluate the side-effect profile. Intraoperative 3D CT acquisitions obtained between each MER pass and after final lead placement were fused with the preoperative MR image to verify intended MER movements around the target area and to identify the final lead location. Tip coordinates from the initial plan, final intended target, and actual lead location on iCT were later compared with the lead location on postoperative MR imaging, and euclidean distances were calculated. The amount of radiation exposure during each procedure was calculated and compared with the estimated radiation exposure if iCT was not performed. Results The mean euclidean distances between the coordinates for the initial plan, final intended target, and actual lead on iCT compared with the lead coordinates on postoperative MR imaging were 3.04 ± 1.45 mm (p = 0.0001), 2.62 ± 1.50 mm (p = 0.0001), and 1.52 ± 1.78 mm (p = 0.0052), respectively. The authors obtained good merging error during image fusion, and postoperative brain shift was minimal. The actual radiation exposure from iCT was invariably less than estimates of exposure using standard lateral fluoroscopy and anteroposterior radiographs (p < 0.0001). Conclusions O-arm iCT may be useful in frameless DBS surgery to approximate microelectrode or lead locations intraoperatively. Intraoperative CT, however, may not replace fundamental DBS surgical techniques such as electrophysiological testing in movement disorder surgery. Despite the lack of evidence for brain shift from the procedure, iCT-measured coordinates were statistically different from those obtained postoperatively, probably indicating image merging inaccuracy and the difficulties in accurately denoting lead location. Therefore, electrophysiological testing may truly be the only means of precisely knowing the location in 3D space intraoperatively. While iCT may provide clues to electrode or lead location during the procedure, its true utility may be in DBS procedures targeting areas where electrophysiology is less useful. The use of iCT appears to reduce radiation exposure compared with the authors' traditional frameless technique.

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Suchyta, Marissa, Si-Gyun Roh, Diya Sabbagh, Mohammed Morsy, Huan Wang, and Samir Mardini. "4362 The Utilization of Polyethylene Glycol Fusion to Improve Facial Reanimation." Journal of Clinical and Translational Science 4, s1 (June 2020): 103. http://dx.doi.org/10.1017/cts.2020.319.

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OBJECTIVES/GOALS: This study’s goal is to determine whether intraoperative treatment of facial nerves with polyethylene glycol (PEG) fusion technology improves facial paralysis outcomes. Improved facial nerve regeneration in facial paralysis patients would lead to improved recovery time and effectiveness. METHODS/STUDY POPULATION: 30 rats were utilized; 15 underwent facial nerve regeneration without PEG fusion, and 15 with PEG fusion. Facial paralysis was initiated on the left by transection of the buccal and marginal mandibular branches of facial nerve. The buccal branch was repaired though microsuture technique. Neurorrhaphy sites of rats in the PEG group were exposed to calcium free saline, methylene blue, and polyethylene glycol. Nerve continuity was assessed post-operative in 5 animals in each group through electron microscopy. Functionality was assessed in the other 10 per group by EMG and whisker analysis after surgery, and weekly for 8 weeks. At 8 weeks, nerves and distal muscles were histologically analyzed. RESULTS/ANTICIPATED RESULTS: PEG fusion technology immediately restored axonal continuity following surgery, demonstrated by electron microscopy. Electrophysiology was also similarly restored across the site immediately, determined through intraoperative nerve stimulation, in the PEG fusion group. The nonintervention group showed dramatically reduced functional recovery than the PEG fusion group following surgery, shown by lower whisking activity and poor electrophysiology outcomes. Furthermore, the PEG fusion group showed statistically significant higher fascicle counts, myelination diameter, axonal diameter, and distal muscle fibers histologically. DISCUSSION/SIGNIFICANCE OF IMPACT: This study demonstrates that polyethylene fusion technology may improve facial reanimation outcomes. PEG is already a FDA-approved drug, and thus the pathway to translational clinical application of this work may thus be streamlined, bringing new options to patients with facial paralysis.

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Nevvazhay, Timofey, Katja Zeppenfeld, Charlotte Brouwer, and Mark Hazekamp. "Intraoperative cryoablation in late pulmonary valve replacement for tetralogy of Fallot." Interactive CardioVascular and Thoracic Surgery 30, no. 5 (April 24, 2020): 780–82. http://dx.doi.org/10.1093/icvts/ivaa013.

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Abstract Ventricular tachyarrhythmia (VT) is a major cause of late morbidity and mortality in patients who underwent surgical repair of tetralogy of Fallot. The majority of VTs are monomorphic macro-reentrant VT (MVT) and depend on slow conducting areas of diseased myocardium bordered by unexcitable tissue (anatomical isthmuses). Myocardial fibrosis due to surgical incisions, patch material and valve annuli are typical boundaries of anatomical isthmuses (AI). The conducting myocardium between the pulmonary valve and ventricular septum defect patch is called isthmus 3, and the majority of MVTs originate from this area. During pulmonary valve replacement, there is excellent exposure of isthmus 3. Importantly, after pulmonary valve replacement, the homograft may cover important parts of isthmus 3, which makes percutaneous catheter ablation at a later stage impossible. In all patients who need pulmonary valve replacement late after tetralogy of Fallot repair, preoperative electrophysiology study and electroanatomical mapping can identify patients with inducible MVT or slow conduction carrying high risk of MVT. In these patients, intraoperative cryoablation of isthmus 3 should be performed and bidirectional conduction block across the cryoablation line should be demonstrated by intraoperative differential pacing.

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Mammis, Antonios, and Alon Y. Mogilner. "The Use of Intraoperative Electrophysiology for the Placement of Spinal Cord Stimulator Paddle Leads Under General Anesthesia." Operative Neurosurgery 70, suppl_2 (August 19, 2011): ons230—ons236. http://dx.doi.org/10.1227/neu.0b013e318232ff29.

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ABSTRACT BACKGROUND: Placement of spinal cord stimulating paddle leads has traditionally been performed under local anesthesia with intravenous sedation to allow intraoperative confirmation of appropriate placement. It may be difficult to maintain appropriate sedation in certain patients because of medical comorbidities. Furthermore, patients undergoing lead revision frequently have extensive epidural scarring, requiring multilevel laminectomies to place the electrode appropriately. OBJECTIVE: To report our technique of neurophysiologic monitoring that allows these procedures to be performed under general anesthesia. METHODS: Data from 78 patients who underwent electromyography during laminectomy for paddle lead placement were retrospectively reviewed. Seventy patients presented for first-time permanent system placement after a successful trial, and 8 were referred for revision or replacement of previously functioning systems. Surgeries were performed under general anesthesia with fluoroscopic guidance. Electromyography was used to help define the physiological midline of the spinal cord and to guide appropriate lead placement. Somatosensory evoked potentials were used as an adjunct to minimize the possibility of neural injury. RESULTS: Immediately postoperatively, 75 of 78 patients reported that the paresthesia coverage was as good as (or better than) that of the spinal cord stimulation trial. At the long-term follow-up, 1 system was removed for infection, and 6 systems were explanted for lack of efficacy. A total of 64 of the 78 implanted patients reported continued pain relief with stimulator use. Revision surgery was performed in 9 patients. CONCLUSION: The use of intraoperative electrophysiology for the placement of spinal cord stimulation paddle leads under general anesthesia is a safe and efficacious alternative to awake surgery.

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Cagle, Jackson N., Michael S. Okun, Enrico Opri, Stephanie Cernera, Rene Molina, Kelly D. Foote, and Aysegul Gunduz. "Differentiating tic electrophysiology from voluntary movement in the human thalamocortical circuit." Journal of Neurology, Neurosurgery & Psychiatry 91, no. 5 (March 5, 2020): 533–39. http://dx.doi.org/10.1136/jnnp-2019-321973.

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ObjectivesTourette syndrome is a neurodevelopmental disorder commonly associated with involuntary movements, or tics. We currently lack an ideal animal model for Tourette syndrome. In humans, clinical manifestation of tics cannot be captured via functional imaging due to motion artefacts and limited temporal resolution, and electrophysiological studies have been limited to the intraoperative environment. The goal of this study was to identify electrophysiological signals in the centromedian (CM) thalamic nucleus and primary motor (M1) cortex that differentiate tics from voluntary movements.MethodsThe data were collected as part of a larger National Institutes of Health-sponsored clinical trial. Four participants (two males, two females) underwent monthly clinical visits for collection of physiology for a total of 6 months. Participants were implanted with bilateral CM thalamic macroelectrodes and M1 subdural electrodes that were connected to two neurostimulators, both with sensing capabilities. MRI scans were performed preoperatively and CT scans postoperatively for localisation of electrodes. Electrophysiological recordings were collected at each visit from both the cortical and subcortical implants.ResultsRecordings collected from the CM thalamic nucleus revealed a low-frequency power (3–10 Hz) increase that was time-locked to the onset of involuntary tics but was not present during voluntary movements. Cortical recordings revealed beta power decrease in M1 that was present during tics and voluntary movements.ConclusionWe conclude that a human physiological signal was detected from the CM thalamus that differentiated tic from voluntary movement, and this physiological feature could potentially guide the development of neuromodulation therapies for Tourette syndrome that could use a closed-loop-based approach.

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Lee, Darrin J., Christopher S. Lozano, Robert F. Dallapiazza, and Andres M. Lozano. "Current and future directions of deep brain stimulation for neurological and psychiatric disorders." Journal of Neurosurgery 131, no. 2 (August 2019): 333–42. http://dx.doi.org/10.3171/2019.4.jns181761.

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Deep brain stimulation (DBS) has evolved considerably over the past 4 decades. Although it has primarily been used to treat movement disorders such as Parkinson’s disease, essential tremor, and dystonia, recently it has been approved to treat obsessive-compulsive disorder and epilepsy. Novel potential indications in both neurological and psychiatric disorders are undergoing active study. There have been significant advances in DBS technology, including preoperative and intraoperative imaging, surgical approaches and techniques, and device improvements. In addition to providing significant clinical benefits and improving quality of life, DBS has also increased the understanding of human electrophysiology and network interactions. Despite the value of DBS, future developments should be aimed at developing less invasive techniques and attaining not just symptom improvement but curative disease modification.

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Patil, Parag G., Erin C. Conrad, J. Wayne Aldridge, Thomas L. Chenevert, and Kelvin L. Chou. "The Anatomical and Electrophysiological Subthalamic Nucleus Visualized by 3-T Magnetic Resonance Imaging." Neurosurgery 71, no. 6 (December 1, 2012): 1089–95. http://dx.doi.org/10.1227/neu.0b013e318270611f.

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ABSTRACT BACKGROUND: Accurate localization of the subthalamic nucleus (STN) is critical to the success of deep brain stimulation surgery for Parkinson disease. Recent developments in high-field-strength magnetic resonance imaging (MRI) have made it possible to visualize the STN in greater detail. However, the relationship of the MR-visualized STN to the anatomic, electrophysiological, or atlas-predicted STN remains controversial. OBJECTIVE: To evaluate the size of the STN visualized on 3-T MRI compared with anatomic measurements in cadaver studies and to compare the predictions of 3-T MRI and those of the Schaltenbrand-Wahren (SW) atlas for intraoperative STN microelectrode recordings. METHODS: We evaluated the STN by 3-T MRI and intraoperative microelectrode recordings in 20 Parkinson disease patients undergoing deep brain stimulation surgery. We compared our findings with anatomic cadaver studies and with the individually scaled SW atlas-based predictions for each patient. RESULTS: The dimensions of the 3-T MR-visualized STN were very similar to those of the largest anatomic study (MRI length, width, and height: 9.8 ± 1.6, 11.5 ± 1.6, and 3.7 ± 0.7 mm, respectively; n = 40; cadaver length, width, and height: 9.3 ± 0.7, 10.6 ± 0.9, and 3.1 ± 0.5 mm, respectively; n = 100). The amount of STN traversed during intraoperative microelectrode recordings was better correlated to the 3-T MR-visualized STN than the SW atlas-predicted STN (R = 0.38 vs R = −0.17). CONCLUSION: The STN as visualized on 3-T MRI corresponds well with cadaveric anatomic studies and intraoperative electrophysiology. STN visualization with 3-T MRI may be an improvement over SW atlas-based localization for STN deep brain stimulation surgery in Parkinson disease.

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Traynelis, Vincent C., Kingsley O. Abode-Iyamah, Katie M. Leick, Sarah M. Bender, and Jeremy D. W. Greenlee. "Cervical decompression and reconstruction without intraoperative neurophysiological monitoring." Journal of Neurosurgery: Spine 16, no. 2 (February 2012): 107–13. http://dx.doi.org/10.3171/2011.10.spine11199.

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Object The primary goal of this study was to review the immediate postoperative neurological function in patients surgically treated for symptomatic cervical spine disease without intraoperative neurophysiological monitoring. The secondary goal was to assess the economic impact of intraoperative monitoring (IOM) in this patient population. Methods This study is a retrospective review of 720 consecutively treated patients who underwent cervical spine procedures. The patients were identified and the data were collected by individuals who were not involved in their care. Results A total of 1534 cervical spine levels were treated in 720 patients using anterior, posterior, and combined (360°) approaches. Myelopathy was present preoperatively in 308 patients. There were 185 patients with increased signal intensity within the spinal cord on preoperative T2-weighted MR images, of whom 43 patients had no clinical evidence of myelopathy. Three patients (0.4%) exhibited a new neurological deficit postoperatively. Of these patients, 1 had a preoperative diagnosis of radiculopathy, while the other 2 were treated for myelopathy. The new postoperative deficits completely resolved in all 3 patients and did not require additional treatment. The Current Procedural Terminology (CPT) codes for IOM during cervical decompression include 95925 and 95926 for somatosensory evoked potential monitoring of the upper and lower extremities, respectively, as well as 95928 and 95929 for motor evoked potential monitoring of the upper and lower extremities. In addition to the charge for the baseline [monitoring] study, patients are charged hourly for ongoing electrophysiology testing and monitoring using the CPT code 95920. Based on these codes and assuming an average of 4 hours of monitoring time per surgical case, the savings realized in this group of patients was estimated to be $1,024,754. Conclusions With the continuing increase in health care costs, it is our responsibility as providers to minimize expenses when possible. This should be accomplished without compromising the quality of care to patients. This study demonstrates that decompression and reconstruction for symptomatic cervical spine disease without IOM may reduce the cost of treatment without adversely impacting patient safety.

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Hames, River, J. W. Awori Hayanga, Diane Schmidt-Krings, Timothy Goldhardt, John Bozek, Donald Siddoway, Stanley Schmidt, John Lobban, and Heather K. Hayanga. "Tricuspid Valve Replacement in a Patient with a Leadless Cardiac Pacemaker: Current Guidelines and Recommendations for Perioperative Management." Case Reports in Anesthesiology 2021 (July 1, 2021): 1–7. http://dx.doi.org/10.1155/2021/5559830.

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Leadless cardiac pacemakers were developed to reduce complications associated with conventional transvenous pacemakers. While this technology is still relatively new, devices are increasingly being implanted. The perioperative management of patients with these devices has been underreported; we thus seek to add to the limited body of knowledge of perioperative management of patients with leadless cardiac pacemakers. An elderly female patient with a Micra VR transcatheter pacing system leadless cardiac pacemaker placed for tachycardia-bradycardia syndrome with intermittent complete heart block was scheduled for elective tricuspid valve replacement for severe tricuspid regurgitation. Pacemaker interrogation was performed several hours prior to the scheduled surgery based on the electrophysiologist’s availability; the device was kept in its programmed VVIR mode, and the base rate was increased from 60 to 80 beats per minute in anticipation of the upcoming surgery. Upon preoperative evaluation, the anesthesiologist asked that the electrophysiology team be placed on standby intraoperatively due to the concern that either oversensing in the setting of pacemaker dependence and/or undesirable tachycardia from rate-responsive pacing could occur. The surgeon used monopolar electrocautery for the duration of the cardiac surgery. Despite the patient having evidence of pacemaker dependence in the intensive care unit preoperatively, no electromagnetic interference leading to oversensing nor rate modulation was detected during intraoperative electrocardiographic and intraarterial invasive monitoring. Evidence-based guidelines regarding perioperative management specifically of leadless cardiac pacemakers do not exist. As these devices become more prevalent, further evaluation will be paramount to determine whether existing guidelines for perioperative management of conventional transvenous pacemakers apply.

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Lepski, Guilherme, Jürgen Honegger, Marina Liebsch, Marília Grando Sória, Porn Narischat, Kristofer Fingerle Ramina, Thomas Nägele, Ulrike Ernemann, and Marcos Tatagiba. "Safe Resection of Arteriovenous Malformations in Eloquent Motor Areas Aided by Functional Imaging and Intraoperative Monitoring." Operative Neurosurgery 70, suppl_2 (September 23, 2011): ons276—ons289. http://dx.doi.org/10.1227/neu.0b013e318237aac5.

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ABSTRACT BACKGROUND: Arteriovenous malformations (AVMs) proximal to motor cortical areas or motor projection systems are challenging to manage because of the risk of severe sensory and motor impairment. Surgical indication in these cases therefore remains controversial. OBJECTIVE: To propose a standardized approach for centrally situated AVMs based on functional imaging and intraoperative electrophysiological evaluation. METHODS: We conducted a retrospective analysis of 15 patients who underwent surgical treatment for AVMs in motor cortical areas or proximal to motor projections. Preoperative assessment included functional magnetic resonance and 3-dimensional tractography. Operations were performed under continuous electrophysiological monitoring aided by direct brain stimulation. We identified critical bloody supply to the motor areas by temporary occluding the feeding vessels under electrophysiological monitoring. Clinical outcome was evaluated with the modified Rankin Scale. RESULTS: Total resection was achieved in 12 cases, whereas electrophysiology limited total extirpation in 3 cases. A significant reduction of motor evoked potentials by up to 15% of the initial values was associated with good recovery of motor function; in contrast, the disappearance of potentials correlated with long-term impairment. The mean follow-up time was 13 months, and clinical assessments revealed overall functional improvement (P < .05). After surgery, 11 patients were asymptomatic or presented with only minor neurological deficits. CONCLUSION: Surgical resection of AVMs in eloquent motor areas can be considered a safe option for selected cases when performed in conjunction with a detailed functional assessment. Possible selection criteria for surgical treatment are discussed in light of the presented clinical data.

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ReFaey, Karim, Kaisorn L. Chaichana, Anteneh M. Feyissa, Tito Vivas-Buitrago, Benjamin H. Brinkmann, Erik H. Middlebrooks, Jake H. McKay, et al. "A 360° electronic device for recording high-resolution intraoperative electrocorticography of the brain during awake craniotomy." Journal of Neurosurgery 133, no. 2 (August 2020): 443–50. http://dx.doi.org/10.3171/2019.4.jns19261.

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OBJECTIVEEpilepsy is common among patients with supratentorial brain tumors; approximately 40%–70% of patients with glioma develop brain tumor–related epilepsy (BTRE). Intraoperative localization of the epileptogenic zone during surgical tumor resection (real-time data) may improve intervention techniques in patients with lesional epilepsy, including BTRE. Accurate localization of the epileptogenic signals requires electrodes with high-density spatial organization that must be placed on the cortical surface during surgery. The authors investigated a 360° high-density ring-shaped cortical electrode assembly device, called the “circular grid,” that allows for simultaneous tumor resection and real-time electrophysiology data recording from the brain surface.METHODSThe authors collected data from 99 patients who underwent awake craniotomy from January 2008 to December 2018 (29 patients with the circular grid and 70 patients with strip electrodes), of whom 50 patients were matched-pair analyzed (25 patients with the circular grid and 25 patients with strip electrodes). Multiple variables were then retrospectively assessed to determine if utilization of this device provides more accurate real-time data and improves patient outcomes.RESULTSMatched-pair analysis showed higher extent of resection (p = 0.03) and a shorter transient motor recovery period during the hospitalization course (by approximately 6.6 days, p ≤ 0.05) in the circular grid patients. Postoperative versus preoperative Karnofsky Performance Scale (KPS) score difference/drop was greater for the strip electrode patients (p = 0.007). No significant difference in postoperative seizures between the 2 groups was present (p = 0.80).CONCLUSIONSThe circular grid is a safe, feasible tool that grants direct access to the cortical surgical surface for tissue resection while simultaneously monitoring electrical activity. Application of the circular grid to different brain pathologies may improve intraoperative epileptogenic detection accuracy and functional outcomes, while decreasing postoperative complications.

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Smith, Peter N., Patricia A. Schumitsch, Mary L. Seebandt, Cheryl J. Bores, Eugene T. Weiler, Jefferson F. Ray, William O. Myers, John W. E. Douglas-Jones, and Humberto J. Vidaillet. "Usefulness of placement of intraoperative epicardial wires during automatic implantable cardioverter-defibrillator insertion to preclude the need for transvenous catheters at the predischarge electrophysiology study." American Journal of Cardiology 68, no. 6 (September 1991): 679–81. http://dx.doi.org/10.1016/0002-9149(91)90366-s.

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Kindl, Radek P., Krunal Patel, and Rikin A. Trivedi. "Supraclavicular Brachial Plexus Approach for Excision of C8 Nerve Root Schwannoma: 3-Dimensional Operative Video." Operative Neurosurgery 16, no. 5 (August 8, 2018): 634–35. http://dx.doi.org/10.1093/ons/opy209.

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Abstract Brachial plexus tumors are uncommon lesions in young adults. The majority of these are benign peripheral sheath tumors. In this 3-dimensional video, we present a case of a 19-yr-old female who presented to the neurosurgical outpatients with an anterior neck lump. It has been present for months, causing occasional numbness and paraesthesia in the distribution of the left ring finger. There was no objective weakness in finger flexion with normal long flexors reflexes. The cervical spine and supraclavicular brachial plexus were investigated with a magnetic resonance imaging (Gadolinium) scan (Figure 1). It demonstrated 30 × 20 × 20 mm lesion adjacent to the C8 nerve arising from the neural foramen, however, mostly occupying the space lateral to it. The patient was consented for resection of the tumor. This was done via the supraclavicular brachial plexus approach. The brachial plexus nerves were macroscopically demonstrated lateral to the anterior scalene muscle. The intraoperative electrophysiology was used to directly stimulate the nerves, which aided in accurate tracking during the dissection. The tumor was exposed after tracing the C8 nerve deep and medial to the anterior scalene muscle. It was resected down to the foramen, reaching the level of the epidural venous plexus, while C8 was spared. The patient recovered with no neurological deficit. The histopathology confirmed grade 1 schwannoma. Subsequently, there was no radiological follow-up performed. This case demonstrates the surgical dissection of supraclavicular brachial plexus in 3-dimensions while describing the unusual dissection medial to scalenus anterior muscle.

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Slimp, Jefferson C. "Electrophysiologic intraoperative monitoring for spine procedures." Physical Medicine and Rehabilitation Clinics of North America 15, no. 1 (February 2004): 85–105. http://dx.doi.org/10.1016/s1047-9651(03)00106-2.

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Triepel, Caroline R., and L. Andrew Koman. "Intraoperative electrophysiologic aid to nerve repair." Operative Techniques in Orthopaedics 14, no. 3 (July 2004): 179–83. http://dx.doi.org/10.1053/j.oto.2004.06.008.

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Sloan, Tod B., Harvey L. Edmonds, and Antoun Koht. "Intraoperative Electrophysiologic Monitoring in Aortic Surgery." Journal of Cardiothoracic and Vascular Anesthesia 27, no. 6 (December 2013): 1364–73. http://dx.doi.org/10.1053/j.jvca.2012.09.027.

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Goodrich, James T. "Electrophysiologic Measurements: Intraoperative Evoked Potential Monitoring." Anesthesiology Clinics of North America 5, no. 3 (September 1987): 477–89. http://dx.doi.org/10.1016/s0889-8537(21)00328-x.

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Ashram, Yasmine A., Robert K. Jackler, Lawrence H. Pitts, and Charles D. Yingling. "Intraoperative Electrophysiologic Identification of the Nervus Intermedius." Otology & Neurotology 26, no. 2 (March 2005): 274–79. http://dx.doi.org/10.1097/00129492-200503000-00026.

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Midha, Rajiv, and Joey Grochmal. "Surgery for nerve injury: current and future perspectives." Journal of Neurosurgery 130, no. 3 (March 2019): 675–85. http://dx.doi.org/10.3171/2018.11.jns181520.

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In this review article, the authors offer their perspective on nerve surgery for nerve injury, with a focus on recent evolution of management and the current surgical management. The authors provide a brief historical perspective to lay the foundations of the modern understanding of clinical nerve injury and its evolving management, especially over the last century. The shift from evaluation of the nerve injury using macroscopic techniques of exploration and external neurolysis to microscopic interrogation, interfascicular dissection, and internal neurolysis along with the use of intraoperative electrophysiology were important advances of the past 50 years. By the late 20th century, the advent and popularization of interfascicular nerve grafting techniques heralded a major advance in nerve reconstruction and allowed good outcomes to be achieved in a large percentage of nerve injury repair cases. In the past 2 decades, there has been a paradigm shift in surgical nerve repair, wherein surgeons are not only directing the repair at the injury zone, but also are deliberately performing distal-targeted nerve transfers as a preferred alternative in an attempt to restore function. The peripheral rewiring approach allows the surgeon to convert a very proximal injury with long regeneration distances and (often) uncertain outcomes to a distal injury and repair with a greater potential of regenerative success and functional recovery. Nerve transfers, originally performed as a salvage procedure for severe brachial plexus avulsion injuries, are now routinely done for various less severe brachial plexus injuries and many other proximal nerve injuries, with reliably good to even excellent results. The outcomes from nerve transfers for select clinical nerve injury are emphasized in this review. Extension of the rewiring paradigm with nerve transfers for CNS lesions such as spinal cord injury and stroke are showing great potential and promise. Cortical reeducation is required for success, and an emerging field of rehabilitation and restorative neurosciences is evident, which couples a nerve transfer procedure to robotically controlled limbs and mind-machine interfacing. The future for peripheral nerve repair has never been more exciting.

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Niemczyk, Kazimierz, Krzysztof Morawski, Rafael Delgado, Maria Małkowska, Robert Bartoszewicz, Jacek Sokołowski, and Magdalena Lachowska. "Intraoperative hearing evaluation during tympanoplasty – surgical technique and measurement method using OssiMon LAIOM system." Polski Przegląd Otorynolaryngologiczny 7, no. 3 (September 30, 2018): 1–8. http://dx.doi.org/10.5604/01.3001.0012.6803.

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We present a surgical technique of closed tympanoplasty for chronic otitis, together with an intraoperative functional evaluation system with the OssiMon LAIOM software. The technique can be used in one or two steps for an intraoperative evaluation of the functional effect during ear operation. Using OssiMon LAIOM, we were able to simultaneously measure the auditory steady-state response (ASSR), as well as to perform laser dopler vibrometry (LDV). For electrophysiologic measurements, OssiMon LAIOM uses the Intelligent Hearing System platform, and the Polytec single-point laser to evaluate the ossicular mobility. The measurements can be conducted using both methods at the same time or separately, applying each method independently. The OssiMon LAIOM software records the ASSR response intraoperatively and marks it automatically on the audiogram with the preoperative hearing level. The ossicular vibration level is determined based on the measured LDV response. To the best of our knowledge, OssiMon LAIOM is the first solution allowing to objectively measure the effectiveness of tympanoplasty using two methods simultaneously, i.e. ASSR and LDV. The system could be widely applied in the functional evaluation of the middle ear and in clinical practice.

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Sugiura, Natsuki, Kentaro Ochi, Yasushi Komatsuzaki, Makoto Hyodo, Atsushi Okamoto, and Isao Kato. "Intraoperative Electrophysiologic Monitoring in Head and Neck Surgery." Nihon Kikan Shokudoka Gakkai Kaiho 51, no. 6 (2000): 436–38. http://dx.doi.org/10.2468/jbes.51.436.

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Padberg, Anne M., and Earl D. Thuet. "Intraoperative Electrophysiologic Monitoring: Considerations for Complex Spinal Surgery." Neurosurgery Clinics of North America 17, no. 3 (July 2006): 205–26. http://dx.doi.org/10.1016/j.nec.2006.05.008.

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Eisele, David W. "Intraoperative Electrophysiologic Monitoring of the Recurrent Laryngeal Nerve." Laryngoscope 106, no. 4 (April 1996): 443–49. http://dx.doi.org/10.1097/00005537-199604000-00010.

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Lessel, Manfred, Arnulf Thaler, Peter Heilig, Wolfgang Jantsch, and Viktor Scheiber. "Intraoperative retinal light damage reflected in electrophysiologic data." Documenta Ophthalmologica 76, no. 4 (1991): 323–33. http://dx.doi.org/10.1007/bf00142670.

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35

Lopez-Gonzalez, Miguel Angel, Xiaochun Zhao, Dinesh Ramanathan, Timothy Marc Eastin, and Song Minwoo. "High flow bypass for right giant cavernous internal carotid artery aneurysm with fibromuscular dysplasia of cervical internal carotid artery: microsurgical 2-D video." Surgical Neurology International 11 (July 4, 2020): 177. http://dx.doi.org/10.25259/sni_141_2020.

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Background: It is well known that intracranial aneurysms can be associated to fibromuscular dysplasia (FMD). Nevertheless, it is not clear the best treatment strategy when there is an association of giant symptomatic cavernous carotid aneurysm with extensive cervical internal carotid artery (ICA) FMD. Case Description: We present the case of 63 year-old right-handed female with hypothyroidism, 1 month history of right-sided pulsatile headache and visual disturbances with feeling of fullness sensation and blurry vision. Her neurological exam showed partial right oculomotor nerve palsy with mild ptosis, asymmetric pupils (right 5 mm and left 3mm, both reactive), and mild exotropia, normal visual acuity. Computed tomography angiogram and conventional angiogram showed 2.5 × 2.6 × 2.6 cm non-ruptured aneurysm arising from cavernous segment of the right ICA. She had right hypoplastic posterior communicant artery, and collateral flow through anterior communicant artery during balloon test occlusion and the presence of right cervical ICA FMD. The patient was started on aspirin. After lengthy discussion of treatment options in our neurovascular department, between observations, endovascular treatment with flow diverter device, or high flow bypass, recommendation was to perform high flow bypass and patient consented for the procedure. We performed right-sided pterional trans-sylvian microsurgical approach and right neck dissection at common carotid bifurcation under electrophysiology monitoring (somatosensory evoked potentials and electroencephalography); while vascular surgery department assisted with the radial artery graft harvesting. The radial artery graft was passed through preauricular tunnel, cranially was anastomosed at superior trunk of middle cerebral artery, and caudally at external carotid artery (Video). Intraoperative angiogram showed adequate bypass patency and lack of flow within aneurysm. The patient was extubated postoperatively and discharged home with aspirin in postoperative day 5. Improvement on oculomotor deficit was complete 3 weeks after surgery. Conclusion: Nowadays, endovascular therapy can manage small to large cavernous ICA aneurysms even if associated to FMD, although giant symptomatic cavernous carotid aneurysms impose a different challenge. Here, we present the management for the association of symptomatic giant cavernous ICA aneurysm and cervical ICA FMD with high flow bypass. We consider important to keep the skills in the cerebrovascular neurosurgeon armamentarium for the safe management of these lesions.

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Reddy, Kesava, Michael West, and Brian Anderson. "Carotid Endarterectomy Without Indwelling Shunts and Intraoperative Electrophysiologic Monitoring." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 14, no. 2 (May 1987): 131–35. http://dx.doi.org/10.1017/s031716710002624x.

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Abstract:Although carotid endarterectomy is a common surgical procedure in North America, controversies exist regarding the type of anesthesia, the use of indwelling shunts and the need for intraoperative cerebral monitoring. We present a prospective study of 100 carotid endarterectomies performed over a three year period by a single surgeon without the use of indwelling shunts, patch grafts, or EEG monitoring. The combined stroke and mortality rate was 1%. Our results confirm those of other authors; that indwelling shunts and EEG monitoring are not absolutely essential for a satisfactory outcome in carotid endarterectomies.

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LIPTON, RICHARD J., THOMAS V. MC CAFFREY, and WILLIAM J. LITCHY. "INTRAOPERATIVE ELECTROPHYSIOLOGIC MONITORING OF LARYNGEAL MUSCLE DURING THYROID SURGERY." Laryngoscope 98, no. 12 (December 1988): 1292???1296. http://dx.doi.org/10.1288/00005537-198812000-00003.

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38

Anderson, Richard C. E., Kathryn C. Dowling, Neil A. Feldstein, and Ronald G. Emerson. "Chiari I Malformation: Potential Role for Intraoperative Electrophysiologic Monitoring." Journal of Clinical Neurophysiology 20, no. 1 (February 2003): 65–72. http://dx.doi.org/10.1097/00004691-200302000-00009.

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39

Harper, C. Michel. "Preoperative and intraoperative electrophysiologic assessment of brachial plexus injuries." Hand Clinics 21, no. 1 (February 2005): 39–46. http://dx.doi.org/10.1016/j.hcl.2004.09.003.

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40

Vujaskovic, Zeljko, Sharon M. Gillette, Barbara E. Powers, Therese A. Stukel, Susan M. LaRue, Edward L. Gillette, Thomas B. Borak, Robert J. Scott, Julia Weiss, and Thomas A. Colacchio. "Effects of intraoperative irradiation and intraoperative hyperthermia on canine sciatic nerve: Neurologic and electrophysiologic study." International Journal of Radiation Oncology*Biology*Physics 34, no. 1 (January 1996): 125–31. http://dx.doi.org/10.1016/0360-3016(95)02097-7.

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41

Rhee, J. S., D. J. Weisz, M. B. Hirigoyen, U. Sinha, N. Alcaraz, and M. L. Urken. "Intraoperative Mapping of Sensate Flaps: Electrophysiologic Techniques and Neurosomal Boundaries." Archives of Otolaryngology - Head and Neck Surgery 123, no. 8 (August 1, 1997): 823–29. http://dx.doi.org/10.1001/archotol.1997.01900080055006.

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42

Mehall, John R., Robert M. Kohut, E. William Schneeberger, Tsuyoshi Taketani, Walter H. Merrill, and Randall K. Wolf. "Intraoperative Epicardial Electrophysiologic Mapping and Isolation of Autonomic Ganglionic Plexi." Annals of Thoracic Surgery 83, no. 2 (February 2007): 538–41. http://dx.doi.org/10.1016/j.athoracsur.2006.09.022.

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43

Kveton, John F., Edward C. Tarlov, Geralyn Drumheller, Fatti Katcher, and Cynthia Abbott. "Cochlear Nerve Conduction Block: An Explanation for Spontaneous Hearing Return after Acoustic Tumor Surgery." Otolaryngology–Head and Neck Surgery 100, no. 6 (June 1989): 594–601. http://dx.doi.org/10.1177/019459988910000613.

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In the presence of an Intact cochlear nerve, hearing loss has been attributed to either transection or spasm of the Internal auditory artery or direct mechanical trauma to the cochlear nerve during tumor manipulation. Such events have been correlated with changes in Intraoperative auditory evoked potentials. The possibility of a reversible conduction block in the cochlear nerve, however, has not been Investigated. Review of four cases of delayed spontaneous recovery of hearing several months after acoustic tumor resection suggests that a conduction block phenomenon may exist. By comparing recent pertinent animal data with clinical Intraoperative electrophysiologic data obtained during posterior fossa surgery in human subjects, we attempt to elucidate further the pathophysiology and Intraoperative predisposing factors to cochlear nerve Injury during hearing preservation procedures.

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44

Song, Phillip, and Larry Shemen. "Electrophysiologic Laryngeal Nerve Monitoring in High-Risk Thyroid Surgery." Ear, Nose & Throat Journal 84, no. 6 (June 2005): 378–81. http://dx.doi.org/10.1177/014556130508400621.

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We recently began performing intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve during high-risk thyroidectomies. Neuromonitoring can detect stimulation of these nerves and thereby prevent a mechanical or thermal injury that can result in neurapraxia or axonotmesis. Monitoring is also useful during dissection in an already operated-on field, when performing thyroidectomy on patients who depend on their voice for their livelihood, and when removing a large goiter or mediastinal mass.

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Shibata, Sumiya, Yukihiro Yamao, Takeharu Kunieda, Rika Inano, Takuro Nakae, Sei Nishida, Taku Inada, et al. "Intraoperative Electrophysiologic Mapping of Medial Frontal Motor Areas and Functional Outcomes." World Neurosurgery 138 (June 2020): e389-e404. http://dx.doi.org/10.1016/j.wneu.2020.02.129.

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Kawaguchi, Masahiko, Hideyuki Ohnishi, Takanori Sakamoto, Kiyoshi Shimizu, Hajime Touho, Tatsuhiko Monobe, and Jun Karasawa. "Intraoperative electrophysiologic monitoring of cranial motor nerves in skull base surgery." Surgical Neurology 43, no. 2 (February 1995): 177–81. http://dx.doi.org/10.1016/0090-3019(95)80131-y.

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Parney, Ian F., Stephan J. Goerss, Kiaran McGee, John Huston, William J. Perkins, and Frederic B. Meyer. "Awake Craniotomy, Electrophysiologic Mapping, and Tumor Resection With High-Field Intraoperative MRI." World Neurosurgery 73, no. 5 (May 2010): 547–51. http://dx.doi.org/10.1016/j.wneu.2010.02.003.

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Mittmann, Philipp, Arneborg Ernst, and Ingo Todt. "Intraoperative Electrophysiologic Variations Caused by the Scalar Position of Cochlear Implant Electrodes." Otology & Neurotology 36, no. 6 (July 2015): 1010–14. http://dx.doi.org/10.1097/mao.0000000000000736.

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Legatt, Alan D., Patrick A. Lasala, Robin J. Mitnick, Leon Zacharowicz, Josefina F. Llena, Cecile I. Fray, and Shlomo Shinnar. "Electrophysiologic Studies and Intraoperative Localization in a Child with Epilepsia Partialis Continua." Journal of Epilepsy 9, no. 3 (August 1996): 192–97. http://dx.doi.org/10.1016/0896-6974(96)00031-x.

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Legatt, A. D., L. Zacharowicz, P. A. LaSala, R. J. Mitnick, J. F. Llena, C. I. Fray, and S. Shinnar. "Electrophysiologic studies and intraoperative localization in a child with epilepsia partialis continua." Electroencephalography and Clinical Neurophysiology 95, no. 2 (August 1995): P37—P38. http://dx.doi.org/10.1016/0013-4694(95)98020-9.

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