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Central Hypoventilation Following Pontomedullary Tumor Decompression - Is Routine Brainstem Monitoring Adequate?
Amit Goyal1, Bharath Srinivasaiah1, Mathangi K Kumar1
1Department of Neuroanaesthesia and Critical Care, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
Abstract:
Neurophysiological monitoring assesses the functional integrity of the brainstem by using monitoring and mapping techniques. We report an operated case of a pontomedullary lesion in a patient who developed central hypoventilation postoperatively. The intraoperative use of neurophysiological and cardiovascular monitoring was unable to predict/prevent this hypoventilation. We describe the inherent limitations of monitoring the respiratory system, including spontaneous respiration. Moreover, we suggest the novel application of diaphragmatic motor evoked potential for real-time monitoring of respiratory pathways during brainstem surgeries.
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