OBJECTIVE: To analyse the Intraoperative neuromonitoring (IONM) data of patients with degenerative cervical myelopathy (DCM) undergoing cervical laminectomy and assess the incidence of signal drops and their risk factors.
METHODS: A retrospective observational study of patients with DCM who underwent cervical laminectomy with IONM between July 2018 to March 2023 were included. We analysed the signal changes for any correlation with the type of pathology (OPLL vs CSM), clinical(severity of myelopathy, duration of symptoms) and radiological parameters(length of cord signal changes and K-line).
RESULTS: Out of the 100 DCM cases, 55 were diagnosed with Ossified posterior longitudinal ligament (OPLL) and 45 as Cervical spondylotic myelopathy (CSM). Signal drops were recorded in 26 patients - 14 persistent drops and 12 transient drops. True positive drops were seen in 4 patients (2 OPLL and 2 CSM) out of which 3 had sustained bimodal drops(both SSEP and MEP). Incidence of signal drops were significantly higher with OPLL compared to CSM (p-value < 0.01). 10/14 persistent signal drops and 9/12 transient drops were seen in patients in OPLL. Continuous OPLL, negative K line, hill type OPLL, severity of myelopathy and longer duration of symptoms were risk factors for signal drops.
CONCLUSIONS: Patients with cervical OPLL have a higher incidence of false positive and transient signal drops after decompression compared to CSM. Longer duration of symptoms, high grade myelopathy, continuous OPLL, hill type lesion and negative K-line were risk factors for signal drops.

OBJECTIVE: Postoperative bowel and bladder dysfunction (BBD) poses a significant risk following surgery of the sacral spinal segments and sacral nerve roots, particularly in neuro-oncology cases. The need for more reliable neuromonitoring techniques to enhance the safety of spine surgery is evident.
METHODS: We conducted a case series comprising 60 procedures involving 56 patients, spanning from September 2022 to January 2024. We assessed the diagnostic accuracy of sacral reflexes (bulbocavernosus and external urethral sphincter reflexes) and compared them with transcranial motor evoked potentials (TCMEP) incorporating anal sphincter (AS) and external urethral sphincter (EUS) recordings, as well as spontaneous electromyography (s-EMG) with AS and EUS recordings.
RESULTS: Sacral reflexes demonstrated a specificity of 100% in predicting postoperative BBD, with a sensitivity of 73.33%. While sensitivity slightly decreased to 64.71% at the 1-month follow-up, it remained consistently high overall. TCMEP with AS/EUS recordings did not identify any instances of postoperative BBD, whereas s-EMG with AS/EUS recordings showed a sensitivity of 14.29% and a specificity of 97.14%.
CONCLUSIONS: Sacral reflex monitoring emerges as a robust adjunct to routine neuromonitoring, offering surgeons valuable predictive insights to potentially mitigate the occurrence of postoperative BBD.

BACKGROUND: Continuous bedside monitoring of brain tissue oxygen levels is a crucial component in the management of comatose patients suffering from acute brain injury on neurointensive care units. Ensuring sufficient brain oxygenation is recognized as an essential objective within neurocritical care, aimed at safeguarding patients from secondary ischemia. Hypoperfusion in occipital and the posterior watershed regions often remains undetected, as the placement of probes in these areas is challenging. A major concern is that patients would have to lie on the traditionally used implanted bolts due to the occipital entry point of the probes. Therefore, we present a novel technique compatible with magnetic resonance imaging that enables bedside placement of brain tissue oxygen probes without the use of a bolt in these areas.
METHODS: We conducted bedside implantations of Licox brain tissue oxygenation probes through Frazier\'s point utilizing peripheral venous cannulas on burr holes eliminating the need for bolts.
RESULTS: A novel approach was successfully established for the bedside implantation of a Licox brain tissue oxygenation probe for occipital regions.
CONCLUSIONS: This technical note describes the feasibility of a novel, simple, and straightforward bedside technique for boltless implantation of Licox brain tissue oxygen probes leading to rigid fixation and compatibility with magnetic resonance imaging.

After decades of bilateral \"subtotal\" and later \"total\" thyroidectomy, the extent of resection is now determined individually depending on the dominant thyroid condition. The leading indication by far in the study, documentation and quality center (StuDoQ) register of the Surgical Working Group Endocrinology (CAEK) is currently the suspicion of malignancy, which is followed by benign symptomatic nodular goiter, functional disorders and confirmed malignancy. The decision for an intervention as well as the extent of resection must be rigorously established. Aids for intraoperative nerve monitoring, vessel-sealing and parathyroid autofluorescence increase the safety of thyroid resections but also the complexity. The surgical technique of lobectomy using modern devices for vessel sealing is an intricate process in which the positioning, access to the neck and a modified sequence of dissection steps are equally important. While the usefulness of neuromonitoring is nowadays no longer in doubt, this is not yet so clear for other technologies. Above all, however, modern thyroid surgery is characterized by the knowledge of one\'s own results and a clear positioning to follow-ups. The selection of any surgical aid should be based on this knowledge.
UNASSIGNED: Nach Jahrzehnten der beidseitigen „subtotalen“ und später „totalen“ Thyreoidektomie wird heute das Resektionsausmaß individuell bestimmt. Die führende Indikation im StuDoQ(Studien‑, Dokumentations- und Qualitätszentrum)-Register der Chirurgischen Arbeitsgemeinschaft Endokrinologie (CAEK) ist derzeit der Verdacht auf Malignität deutlich vor der benignen, Symptome verursachenden Knotenstruma, den Funktionsstörungen und der gesicherten Malignität. Die Entscheidung für einen Eingriff und das Resektionsausmaß müssen streng begründet werden. Neuromonitoring, Gefäßversiegelung und Autofluoreszenz erhöhen die Sicherheit der resezierenden Eingriffe an der Schilddrüse, aber auch den Aufwand. Die operative Technik der Lobektomie mit modernen Devices zur Gefäßversieglung ist ein ineinandergreifender Prozess, bei dem Lagerung, Zugang zum Hals und eine veränderte Abfolge der Schritte der Präparation gleichermaßen wichtig sind. Während die Nützlichkeit des Neuromonitorings heute nicht mehr in Zweifel steht, ist dies für andere Technologien noch nicht so klar. V. a. aber ist eine moderne Schilddrüsenchirurgie durch das Wissen um die eigenen Ergebnisse und eine klare Positionierung zur Nachsorge gekennzeichnet. Die Auswahl jedweder Operationshilfen sollte auf der Basis dieser Erkenntnisse erfolgen.

Neuromonitoring has been widely accepted as an important part in neonatal care. Amplitude-integrated EEG (aEEG) and near-infrared spectroscopy (NIRS) are often mentioned in this context, though being only a part of the fully array of methods and examinations that could be considered neuromonitoring. Within the broad array of medical conditions that could be encountered in a neonatal patient, it is important to be aware of the indications for neuromonitoring and especially which neuromonitoring technique to use best for the individual condition. aEEG is now a widely accepted neuromonitor in neonatology with its value in hypoxic events and seizures only rarely questioned. Other methods like NIRS still have to prove themselves in the future. The SafeBoosC-III trial showed that it still remains difficult for some of these methods to prove their value for the improvement of outcome. Bute future developments such as multimodal neuromonitoring with data integration and artificial intelligence analysis could improve the value of these methods.

Neuro-monitoring is widely employed for the evaluation of intubated patients in the intensive care unit with stroke, severe head trauma, subarachnoid hemorrhage and/or hepatic encephalopathy. The present study reports the case of a patient with acute intracranial hemorrhage following the insertion of neuromonitoring catheters, which required surgical management. The patient was a 14-year-old male who sustained a severe traumatic brain injury and underwent a right-sided hemicraniectomy. During the installation of the neuromonitoring catheters, an acute hemorrhage was noted with a rapidly elevating intracranial pressure. A craniotomy was performed to identify and coagulate the injured cortical vessel. As demonstrated herein, the thorough evaluation of the clotting profile of the patient, a meticulous surgical technique and obtaining a post-insertion computed tomography scan may minimize the risk of any neuromonitoring-associated hemorrhagic complications.

Physical and chemical signals in the central nervous system yield crucial information that is clinically relevant under both physiological and pathological conditions. The emerging field of bioelectronics focuses on the monitoring and manipulation of neurophysiological signals with high spatiotemporal resolution and minimal invasiveness. Significant advances have been realized through innovations in materials and structural design, which have markedly enhanced mechanical and electrical properties, biocompatibility, and overall device performance. The diagnostic and therapeutic potential of soft bioelectronics has been corroborated across a diverse array of pre-clinical settings. This review summarizes recent studies that underscore the developments and applications of soft bioelectronics in neurological disorders, including neuromonitoring, neuromodulation, tumor treatment, and biosensing. Limitations and outlooks of soft devices are also discussed in terms of power supply, wireless control, biocompatibility, and the integration of artificial intelligence. This review highlights the potential of soft bioelectronics as a future platform to promote deciphering brain functions and clinical outcomes of neurological diseases.

Aging leads to anatomic and physiologic changes in the brain, making it more sensitive to the depressant effects of anesthetic medications and increasing the risk of postoperative neurocognitive complications such as postoperative delirium and postoperative cognitive dysfunction. This article explores the implications of anesthesia on elderly patients\' brain health, emphasizing the heightened risk of postoperative neurocognitive disorders, and describes the BIS™ Monitoring System as a neuromonitoring tool for anesthesia professionals to assess the depth of anesthesia. The integration of the BIS Monitoring System into clinical practice can contribute to a more tailored and patient-centered approach to anesthesia management, ultimately improving perioperative outcomes and safety.

BACKGROUND: Early diagnosis of acute brain injury (ABI) is critical for patients on veno-arterial extracorporeal membrane oxygenation (V-A ECMO) to guide anticoagulation strategy; however, neurological assessment in ECMO is often limited by patient sedation.
METHODS: In this pilot study of adults from June 2018 to May 2019, plasma samples of glial fibrillary acidic protein (GFAP), neurofilament light chain (NFL), and tubulin associated unit (Tau) were collected daily after V-A ECMO cannulation and measured using a multiplex platform. Primary outcomes were occurrence of ABI, assessed clinically, and neurologic outcome, assessed by modified Rankin Scale (mRS).
RESULTS: Of 20 consented patients (median age = 48.5°years; 55% female), 8 (40%) had ABI and 15 (75%) had unfavorable neurologic outcome at discharge. 10 (50%) patients were centrally cannulated. Median duration on ECMO was 4.5°days (IQR: 2.5-9.5). Peak GFAP, NFL, and Tau levels were higher in patients with ABI vs. without (AUC = 0.77; 0.85; 0.57, respectively) and in patients with unfavorable vs. favorable neurologic outcomes (AUC = 0.64; 0.59; 0.73, respectively). GFAP elevated first, NFL elevated to the highest degree, and Tau showed limited change regardless of ABI.
CONCLUSIONS: Further studies are warranted to determine how plasma biomarkers may facilitate early detection of ABIs in V-A ECMO to assist timely clinical decision-making.

Objective.The Root SedLine device is used for continuous electroencephalography (cEEG)-based sedation monitoring in intensive care patients. The cEEG traces can be collected for further processing and calculation of relevant metrics not already provided. Depending on the device settings during acquisition, the acquired traces may be distorted by max/min value cropping or high digitization errors. We aimed to systematically assess the impact of these distortions on metrics used for clinical research in the field of neuromonitoring.Approach.A 16 h cEEG acquired using the Root SedLine device at the optimal screen settings was analyzed. Cropping and digitization error effects were simulated by consecutive reduction of the maximum cEEG amplitude by 2µV or by reducing the vertical resolution. Metrics were calculated within ICM+ using minute-by-minute data, including the total power, alpha delta ratio (ADR), and 95% spectral edge frequency. Data were analyzed by creating violin- or box-plots.Main Results.Cropping led to a continuous reduction in total and band power, leading to corresponding changes in variability thereof. The relative power and ADR were less affected. Changes in resolution led to relevant changes. While the total power and power of low frequencies were rather stable, the power of higher frequencies increased with reducing resolution.Significance.Care must be taken when acquiring and analyzing cEEG waveforms from Root SedLine for clinical research. To retrieve good quality metrics, the screen settings must be kept within the central vertical scale, while pre-processing techniques must be applied to exclude unacceptable periods.