학술논문
Electromagnetic Navigation Systems and Intraoperative Neuromonitoring: Reliability and Feasibility Study
INSTRUMENTATION AND TECHNIQUE
INSTRUMENTATION AND TECHNIQUE
Document Type
Clinical report
Author
Source
Operative NeuroSurgery. April 2021, Vol. 20 Issue 4, p373, 10 p.
Subject
Language
English
ISSN
2332-4252
Abstract
In tumors close to eloquent regions, it is crucial to be able to preserve patient function in order to ultimately improve quality of life (1) as well as to maximize [...]
BACKGROUND: A recent influx of intraoperative technology is being used in neurosurgery, butfew reports investigate the accuracyand safety of these technologies when used simultaneously. OBJECTIVE: To assess the ability to use an electromagnetic navigation system alongside multimodal intraoperative neurophysiological monitoring (IONM). METHODS: Single-institution prospective cohort study of patients requiring craniotomy for brain tumor resection operated using an electromagnetic navigation system (AxiEM, Medtronic[C]). motor evoked potentials, somatosensory evoked potentials (SSEPs), electroencephalography, and electromyography were recorded and analyzed with AxiEM on (with/without filters) and off. The neurological outcomes of the patients were recorded. RESULTS: A total of 15 patients were included (8 males/7 females, mean age 52.13 yr). Even though the raw acquisition is affected by the electromagnetic field (particularly SSEPs), no significant difference was detected in the morphology, amplitude, and latency of the different monitoring modalities (AxiEM off vs on) after the appropriate software filter application. Adjustments to the frequency of SSEP stimulation and number of averages, and reductions to the low-pass filters were applied. Notch filters were used appropriately and changes to the physical setup of the IONM and electromagnetic navigation system equipment reduced noise. Postoperatively, none of the patients developed new focal deficits; 7 patients showed improvement in their motor deficit (4 recovered fully). CONCLUSION: The information provided by the IONM in intracranial neurosurgery patients whilst also using electromagnetic navigation systems is reliable for monitoring, mapping, and detecting intraoperative complications, provided that the appropriate software filters and tools are applied. KEYWORDS: Neuronavigation, Electromagnetic, Intraoperative Neuromonitoring, Neuro-Oncology DOI: 10.1093/ons/opaa407
BACKGROUND: A recent influx of intraoperative technology is being used in neurosurgery, butfew reports investigate the accuracyand safety of these technologies when used simultaneously. OBJECTIVE: To assess the ability to use an electromagnetic navigation system alongside multimodal intraoperative neurophysiological monitoring (IONM). METHODS: Single-institution prospective cohort study of patients requiring craniotomy for brain tumor resection operated using an electromagnetic navigation system (AxiEM, Medtronic[C]). motor evoked potentials, somatosensory evoked potentials (SSEPs), electroencephalography, and electromyography were recorded and analyzed with AxiEM on (with/without filters) and off. The neurological outcomes of the patients were recorded. RESULTS: A total of 15 patients were included (8 males/7 females, mean age 52.13 yr). Even though the raw acquisition is affected by the electromagnetic field (particularly SSEPs), no significant difference was detected in the morphology, amplitude, and latency of the different monitoring modalities (AxiEM off vs on) after the appropriate software filter application. Adjustments to the frequency of SSEP stimulation and number of averages, and reductions to the low-pass filters were applied. Notch filters were used appropriately and changes to the physical setup of the IONM and electromagnetic navigation system equipment reduced noise. Postoperatively, none of the patients developed new focal deficits; 7 patients showed improvement in their motor deficit (4 recovered fully). CONCLUSION: The information provided by the IONM in intracranial neurosurgery patients whilst also using electromagnetic navigation systems is reliable for monitoring, mapping, and detecting intraoperative complications, provided that the appropriate software filters and tools are applied. KEYWORDS: Neuronavigation, Electromagnetic, Intraoperative Neuromonitoring, Neuro-Oncology DOI: 10.1093/ons/opaa407