Our Summary

This research paper discusses the importance of intraoperative monitoring during surgeries. This kind of monitoring is used to track a patient’s neurological function during an operation, to prevent any serious health issues from developing. However, there isn’t a one-size-fits-all method for this type of monitoring.

The paper mentions MEP, or Motor Evoked Potentials, as the most commonly used technique. It’s important to understand the differences when using MEP in brain surgeries versus spinal surgeries.

The paper also talks about the various methods used in spinal surgeries, each with its own set of challenges. It suggests that in some cases, a combination of different monitoring methods (multimodal monitoring) may be the best approach.

In simple terms, the paper emphasizes the need for customized monitoring methods during surgeries, to best protect the patient’s neurological health.

FAQs

  1. What is the purpose of intraoperative monitoring during surgery?
  2. What is the most common modality used in intraoperative monitoring and how does it differ in spinal and brain surgeries?
  3. What is multimodal monitoring and when should it be considered?

Doctor’s Tip

One helpful tip a doctor might tell a patient about brain surgery is to follow all pre-operative instructions carefully to ensure the best possible outcome. This may include avoiding certain medications, fasting before surgery, and stopping smoking or alcohol consumption. It is also important to discuss any concerns or questions with your healthcare team before the procedure. Following post-operative instructions, such as taking prescribed medications, attending follow-up appointments, and participating in rehabilitation, is also crucial for a successful recovery.

Suitable For

Patients who are typically recommended for brain surgery include those with:

  1. Brain tumors: Surgery may be recommended to remove tumors that are affecting brain function or causing symptoms.

  2. Epilepsy: Surgery may be recommended for patients with epilepsy that is not controlled with medication, in order to remove the seizure focus.

  3. Traumatic brain injury: Surgery may be recommended to remove blood clots or repair damage to the brain caused by a traumatic injury.

  4. Aneurysms or vascular malformations: Surgery may be recommended to repair or remove abnormal blood vessels in the brain that could potentially rupture and cause a stroke.

  5. Hydrocephalus: Surgery may be recommended to place a shunt to drain excess cerebrospinal fluid from the brain.

  6. Movement disorders: Surgery may be recommended for patients with movement disorders such as Parkinson’s disease or essential tremor, in order to implant deep brain stimulation electrodes.

  7. Chiari malformation: Surgery may be recommended to decompress the brainstem and spinal cord in patients with Chiari malformation.

It is important for patients to undergo thorough evaluation by a neurosurgeon to determine if brain surgery is the best treatment option for their specific condition.

Timeline

Before Brain Surgery:

  1. Consultation with a neurosurgeon to discuss the need for surgery and the potential risks and benefits.
  2. Pre-operative testing, such as MRI or CT scans, to assess the condition of the brain and identify the location of the problem.
  3. Pre-operative instructions, such as fasting before surgery and stopping certain medications.
  4. Admission to the hospital on the day of surgery.
  5. Anesthesia is administered before the surgery begins.

During Brain Surgery:

  1. The patient is positioned on the operating table and the surgeon makes an incision in the scalp to access the brain.
  2. The surgeon removes the part of the skull to expose the brain.
  3. The surgeon performs the necessary procedure, such as removing a tumor or repairing a blood vessel.
  4. Intraoperative monitoring, such as monitoring of brain activity and motor function, is used to ensure the safety of the patient during surgery.
  5. The surgeon closes the incision and the patient is taken to the recovery room.

After Brain Surgery:

  1. The patient is monitored closely in the recovery room for any complications.
  2. Pain medication and other medications are given to manage pain and prevent infection.
  3. The patient may stay in the hospital for a few days for observation and recovery.
  4. Follow-up appointments with the surgeon are scheduled to monitor the healing process and discuss any concerns.
  5. Rehabilitation may be recommended to help the patient regain cognitive and physical function.

What to Ask Your Doctor

  1. What specific type of brain surgery will I be undergoing?
  2. What are the potential risks and complications associated with this surgery?
  3. How will my neurological function be monitored during the surgery?
  4. What are the alarm criteria for detecting any neurological deterioration during the surgery?
  5. Will I need to be awake during any part of the surgery for monitoring purposes?
  6. What is the success rate of this type of brain surgery?
  7. What is the expected recovery time and rehabilitation process after the surgery?
  8. Will I need any additional treatments or therapies following the surgery?
  9. Are there any long-term effects or risks associated with this surgery?
  10. How can I best prepare for the surgery and optimize my chances for a successful outcome?

Reference

Authors: Matsuoka R, Ikeda K. Journal: No Shinkei Geka. 2021 Nov;49(6):1160-1170. doi: 10.11477/mf.1436204504. PMID: 34879337