Intraoperative nerve action potential recordings: technical considerations, problems, and pitfalls

Neurosurgery
Everett G RobertD G Kline

Abstract

The purpose of this article is to provide our experience with intraoperative nerve action potential (NAP) recordings. In particular, we focus on a discussion of the technical considerations of intraoperative NAP with emphasis on identifying and remedying problems and pitfalls. We report, perhaps, the largest operative series of peripheral nerve lesions in continuity with intraoperative NAP recording derived from 1736 patients with 3459 lesions in continuity with operative outcomes. We pay special attention to patients for whom we felt that NAP recordings were either difficult or misleading. A positive NAP across a lesion resulting in neurolysis gave grade 3 or better function using the Louisiana State University Health Science Center grading system in 94.7% of neural elements. Differential fascicular recordings resulted in split repair in 62 nerves with recovery in 58. The absence of an NAP correlated histologically with a neurotmetic lesion. With resultant repair, 1111 of 1975 nerves recovered to grade 3 or better. Visual inspection of a nerve lesion in continuity can be misleading. Although there is no "head-to-head" comparison of our data with data obtained without the use of intraoperative NAP recordings, we feel strongly t...Continue Reading

References

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Citations

Sep 30, 2015·The European Journal of Neuroscience·Ruben EggersJoost Verhaagen
Oct 8, 2013·The Orthopedic Clinics of North America·Roongsak LimthongthangA Lee Osterman
Sep 2, 2015·Neurosurgical Focus·Thomas Anthony GallagherMichel Kliot
Nov 5, 2016·World Neurosurgery·R Shane TubbsRobert J Spinner
Jun 15, 2016·Muscle & Nerve·Jonathan K SmithMark E Landau
Dec 8, 2010·Neurosurgery·Jayme Augusto Bertelli, Marcos Flávio Ghizoni
Oct 3, 2018·The Journal of Trauma and Acute Care Surgery·Brandon W SmithThomas J Wilson
Jul 15, 2015·Neurosurgery·Franck Marie LeclèreEsther Vögelin
Apr 30, 2015·Journal of Neurology, Neurosurgery, and Psychiatry·Neil G SimonMichel Kliot
Jul 3, 2015·Journal of Neurology, Neurosurgery, and Psychiatry·Lisa KorusThomas A Miller
Mar 7, 2020·Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society·Lilia C De la Maza KrzeptowskyDavid J Anschel
May 22, 2021·Hand : Official Journal of the American Association for Hand Surgery·J Ryan HillChristopher J Dy
Sep 24, 2021·Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der Peripheren Nerven und Gefässe : Organ der Vereinigung der Deut·Florian Samuel FruehPietro Giovanoli
May 18, 2019·Operative Neurosurgery·Robert J SpinnerThomas J Wilson

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