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Solutions to the technical challenges embedded in the current methods for intraoperative peripheral nerve action potential recordings.

Abstract：

OBJECTIVE:Intraoperative nerve action potential (NAP) recording is a useful tool for surgeons to guide decisions on surgical approaches during nerve repair surgeries. However, current methods remain technically challenging. In particular, stimulus artifacts that contaminate or mask the NAP and therefore impair the interpretation of the recording are a common problem. The authors' goal was to improve intraoperative NAP recording techniques by revisiting the methods in an experimental setting. METHODS:First, NAPs were recorded from surgically exposed peripheral nerves in monkeys. For the authors to test their assumptions about observed artifacts, they then employed a simple model system. Finally, they applied their insights to clinical cases in the operating room. RESULTS:In monkey peripheral nerve recordings, large stimulus artifacts obscured NAPs every time the nerve segment (length 3-5 cm) was lifted up from the surrounding tissue, and NAPs could not be recorded. Artifacts were suppressed, and NAPs emerged when "bridge grounding" was applied, and this allowed the NAPs to be recorded easily and reliably. Tests in a model system suggested that exaggerated stimulus artifacts and unmasking of NAPs by bridge grounding are related to a loop effect that is created by lifting the nerve. Consequently, clean NAPs were acquired in "nonlifting" recordings from monkey peripheral nerves. In clinical cases, bridge grounding efficiently unmasked intraoperative NAP recordings, validating the authors' principal concept in the clinical setting and allowing effective neurophysiological testing in the operating room. CONCLUSIONS:Technical challenges of intraoperative NAP recording are embedded in the current methods that recommend lifting the nerve from the tissue bed, thereby exaggerating stimulus artifacts by a loop effect. Better results can be achieved by performing nonlifting nerve recording or by applying bridge grounding. The authors not only tested their findings in an animal model but also applied them successfully in clinical practice.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Wu G,Belzberg A,Nance J,Gutierrez-Hernandez S,Ritzl EK,Ringkamp M

doi

10.3171/2019.5.JNS19146

subject

Has Abstract

pub_date

2019-08-16 00:00:00

pages

1-10

eissn

0022-3085

issn

1933-0693

pii

2019.5.JNS19146

pub_type

杂志文章

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Solutions to the technical challenges embedded in the current methods for intraoperative peripheral nerve action potential recordings.