Biomedical subjects

Linda S Aglio

Publications and source records attributed to Linda S Aglio.

4 recordsLinked to original sources

PubMed2005

Intraoperative awakening for vision examination during ophthalmic artery aneurysm clipping: technical case report.

OBJECTIVE AND IMPORTANCE: We present a case of a patient with an ophthalmic artery aneurysm in which the ophthalmic artery originated from the body of the aneurysm, requiring sacrifice of the ophthalmic artery to achieve complete aneurysm obliteration. We awakened the patient intraoperatively to assess optic nerve function after clipping and were able to confirm optic nerve function. Controlled intraoperative awakening proved a valuable adjunct to intraoperative angiography in determining the immediate consequences of sacrifice of the ophthalmic artery. CLINICAL PRESENTATION: The patient was a 55-year-old right-handed woman with a 3-month history of episodic blurriness in her left eye; imaging demonstrated an unruptured 5-mm left ophthalmic artery aneurysm in which the ophthalmic artery originated from the body of the aneurysm. INTERVENTION: Complete obliteration of the aneurysm required clip placement across the neck of the aneurysm, incorporating not only the aneurysm but also the ophthalmic artery. Aware that sacrifice of the ophthalmic artery was likely, we awakened the patient after clipping and before dural closure to evaluate her optic nerve function. Once fully awake, the patient was able to execute simple commands and conclusively confirm light perception in both of her eyes. She was then reanesthetized, and intraoperative angiography showed successful aneurysm obliteration and parent artery patency. CONCLUSION: The ophthalmic artery can be sacrificed during aneurysm clipping without loss of vision in many cases, most likely because of adequate collateral filling from the external carotid artery. Certainty about the visual consequences of sacrifice of the ophthalmic artery, however, is difficult to obtain preoperatively or intraoperatively. Intraoperative awakening for evaluation of optic nerve function served as a useful technique to assess the acute results of interruption of ophthalmic artery flow in this case.

Aneurysm↗

PubMed2004

Monitoring the electroencephalogram during bypass procedures.

Electroencephalographic monitoring has been performed since the early days of cardiopulmonary bypass. Despite this long experience, the technology has never been widely used for cardiac operations. This review examines the reasons for the limited use and describes technological advances that may alter this pattern.

Anesthesia, General↗

PubMed2002

Efficacious use of a cap shaped coil for transcranial magnetic stimulation of descending motor paths.

We report another technique of transcranial magnetic stimulation (TMS) for exciting the originating cells of the descending corticospinal tract. A cap shaped TMS coil has been described for simultaneously exciting muscles in all four extremities. This TMS coil is useful for monitoring the functional integrity of the descending motor paths during spinal cord surgery, because information regarding the integrity of both the left and right sides of the spinal cord motor paths can be obtained concurrently. Despite the improved design of the cap coil, careful placement is required for achieving bilateral spinal cord motor responses. Cortical mapping was used to identify the optimum scalp foci for the muscles studied. The cap coil must overlap these foci to simultaneously elicit compound muscle action potentials (CMAPs) in all four extremities. Increasing TMS stimulation intensity will increase the magnitude of the acquired CMAPs responses without significantly changing latency.

Action Potentials↗

PubMed2002

The use of transcranial magnetic stimulation for monitoring descending spinal cord motor function.

This report describes our initial clinical experience using transcranial magnetic stimulation for monitoring spinal cord motor function during surgical procedures. Motor evoked potentials were elicited using a cap shaped coil placed on the scalp of 27 patients while recording peripheral motor responses (compound muscle action potentials--CMAPs) from the upper (N = 1) or lower limbs (N = 26). Wherever possible, cortical somatosensory responses (SEPs) were also monitored by electrically stimulating the left and right posterior tibial nerve (N = 25) or the median nerve (N = 1). The judicious choice of anesthetic regimens resulted in successfully obtaining motor evoked responses (MEPs) in 21 of 27 patients and SEPs in 26 of 27 patients. Single pulse TMS resulted in peripheral muscle responses having large variability, whereas, the variability of SEPs was much less. Criteria based on response variability for assessing clinically significant changes in both MEPs and SEPs resulted in two false negative predictions for SEPs and none for MEPs when evaluating postoperative motor function. We recommend monitoring both sensory and motor pathways during procedures where placing the spinal cord at risk of damage.

Adult↗