Intraoperative Neurophysiological Monitoring (IONM) for Adolescent Brainstem Tumor Surgeries
By Admin | May 04, 2021
The brain is the most complex part of the human body. This three-pound organ is the seat of intelligence, interpreter of the senses, initiator of body movement, and controller of behavior. It’s the centralized hub of everything that makes us who we are. Therefore, when a tumor develops on the brainstem, the risks of removal are endless, and the risks of not removing such a formation are often significantly greater.
Potential complications for brainstem surgeries become even more complicated when the brain is still undergoing development. While much is said about how puberty affects the adolescent body, it also alters their brain chemistry. Changes in hormones that attach to your brain cells change how the brain learns and grows. This shift in hormone balance makes tumor growth on young brains even more terrifying for patients and parents alike, making what we do at Axis Neuromonitoring that much more important.
“Our jobs don’t start and stop in the operating room. There is an entire team of dedicated people working behind the scenes to give you the optimum care you deserve,” said Dr. Faisal R. Jahangiri of Axis Neuromonitoring in Richardson, Texas.
Surgical treatment was performed on a 13-year-old patient who presented with pilocytic astrocytoma (a benign brain tumor). Resection of the pilocytic astrocytoma means operating dangerously close to the structure responsible for so many of our involuntary behaviors. (swallow, breathing, etc.) Complications during this procedure could result in lifelong challenges for our 13-year-old patient.
Surgeries on the brainstem are inherently dangerous. The proximity to dense clusters of nerves makes operating on this area a perfect candidate for neuromonitoring. For this 13-year-old, upper and lower Somatosensory Evoked Potentials (SSEP), upper and lower Motor Evoked Potentials (MEP), Brainstem Auditory Evoked Potentials (BAEP), Train of Four (TOF), and Cranial Nerves VII, IX, and X Electromyography (CN-EMG) were all used to monitor the patient’s nerve response.
Near the end of this resection, the Axis neuromonitoring technician noted a decrement in the left auditory nerve responses from the brainstem. Upon immediately alerting the surgeon, they removed the retractor on the brainstem, resulting in an instantaneous improvement of the patient’s auditory responses. The surgeon safely removed the brainstem tumor without changes in the neurophysiological status of the patient.
“Axis Neuromonitoring maintains a professional, experienced staff focused on avoiding obstacles and anticipating problems,” said Dr. Jahangiri.
Identification of the changes in the left auditory response was made possible by intraoperative neuromonitoring. Without neuromonitoring, this change may have gone unnoticed and resulted in damage to the auditory nerve (CN-VIII). Hence, the patient would have postoperative hearing loss ranging anywhere from minor to complete.