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Published on: March 26, 2019
Neurophysiologic intraoperative monitoring of pediatric cerebrovascular surgery
1Department of Neurology, and Neurosurgery, Stanford University School of Medicine, Stanford, California 94305, USA. lopezjr@stanford.edu
Insights
Neurophysiologic monitoring can help prevent intraoperative cerebral ischemia during pediatric cerebrovascular disorder (CVD) treatments. This review explores techniques to identify, prevent, and reverse ischemia in children undergoing these procedures.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Neurosurgery
Background:
- Cerebrovascular disorders (CVDs) in children, including arteriovenous malformations, cavernous malformations, and moyamoya disease, are increasingly treated with surgical and endovascular methods.
- Intraoperative cerebral ischemia is a significant risk during these procedures, mirroring risks seen in adult populations.
Purpose of the Study:
- To review neurophysiologic techniques applicable to the intraoperative management of pediatric CVDs.
- To describe the rationale and physiologic basis for using these techniques.
- To present institutional experience and clinical utility in managing pediatric CVDs.
Main Methods:
- Review of existing neurophysiologic monitoring techniques.
- Application and adaptation of adult strategies to pediatric neurovascular surgery.
- Case management and outcome analysis.
Main Results:
- Neurophysiologic techniques offer potential for identifying and mitigating intraoperative cerebral ischemia in pediatric CVD treatment.
- Lack of published studies specifically addressing intraoperative neurophysiologic monitoring in pediatric neurovascular procedures.
- Demonstration of clinical utility through institutional experience and results.
Conclusions:
- Neurophysiologic monitoring is crucial for reducing cerebral ischemia risk in pediatric neurovascular surgery.
- Further research and standardized protocols are needed for intraoperative neurophysiologic monitoring in pediatric CVD treatment.
- Implementing these techniques can improve patient outcomes and safety during complex pediatric neurovascular interventions.
Abstract:
The surgical and endovascular treatment of cerebrovascular disorders (CVDs) in children, such as cerebral arteriovenous malformations, cavernous malformations, and moyamoya disease, have become commonplace and routine in many centers. As in the adult population, these procedures carry the risk of intraoperative cerebral ischemia. Therefore, similar strategies used to reduce the risk of cerebral ischemia in adults should be used in children. Unfortunately, there are no published studies on the intraoperative use of available techniques to identify, prevent, or potentially reverse cerebral ischemia. The goal of this article is to review the neurophysiologic techniques that may be useful and applicable in the surgical and endovascular treatment of pediatric CVDs, to describe the rationale and physiologic basis of their utility, to describe our experience in managing these cases, to present some of our results, and finally, to show the clinical utility of these techniques in the intraoperative management of CVDs.
