International journal of advanced smart convergence

The Institute of Internet, Broadcasting and Communication (한국인터넷방송통신학회)
권호 표지
DOI QR코드

DOI QR Code

Motor and Somato Sensory Evoked Potentials During Intraoperative Surveillance Testing in Patients with Diabetes

  • Lee, Kyuhyun (Department of Health Sciences, Dankook University) ;
  • Kim, Jaekyung (Department of Health Sciences, Dankook University)
  • Received : 2019.12.21
  • Accepted : 2019.12.29
  • Published : 2020.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

Cerebral vascular surgery can damage patients' motor and sensory nerves; therefore, neuromonitoring is performed intraoperatively. Patients with diabetes often have peripheral neuropathy and may be prone to nerve damage during surgery. This study aimed to identify factors that should be considered when diabetic patients undergo intraoperative neuromonitoring during brain vascular surgery and to present new criteria. Methods: In patients with and without diabetes who underwent cerebrovascular surgery (n = 30/group), we compared the intraoperative stimulation intensity, postoperative motor power and sensory, glycated hemoglobin (HbA1c) and glucose levels, and imaging findings. Results: Fasting glucose, blood glucose, and HbA1c levels were 10%, 12.1%, and 9.7%, respectively; they were higher in patients with than in patients without diabetes. Two patients with diabetes had weakness, and 10 required increased Somato sensory evoked potential (SSEP) stimulation, while in 16, motor power recovered over time rather than immediately. The non-diabetic group had no weakness after surgery, but 10 patients required more increased SSEP stimulation. The diabetic group showed significantly more abnormal test results than the non-diabetic group. Conclusion: For patients with diabetes undergoing surgery with intraoperative neuromonitoring, whether diabetic peripheral neuropathy is present, their blood glucose level and the anesthetic used should be considered.

Keywords

References

  1. K.M. Scheufler and J. Zentner, Total Intravenous Anesthesia for Intraoperative Monitoring of the Motor Pathways: An Integral View Combining Clinical and Experimental Data, Journal of Neurosurgery, Vol. 96, No. 3, pp. 571-579, Mar 2002. DOI: https://doi.org/10.3171/jns.2002.96.3.0571
  2. B.S. Galer, A. Gianas, and M.P. Jensen, Painful Diabetic Polyneuropathy: Epidemiology, Pain Description, and Quality Of Life, Diabetes Research and Clinical Practice, Vol. 47, No. 2, pp. 123-128, Feb 2000. DOI: https://doi.org/10.1016/s0168-8227(99)00112-6
  3. K. Lorenz, C. Sekulla, J. Schelle, B. Schmeiss, M. Brauckhoff, and H. Dralle, What Are Normal Quantitative Parameters of Intraoperative Neuromonitoring (IONM) in Thyroid Surgery? Langenbeck's Archives of Surgery, Vol. 395, No. 7, pp. 901-909, Sep 2010. DOI: https://doi.org/10.1007/s00423-010-0691-5
  4. P.J. Dyck, J. Karnes, P. O'Brien, P. Thomas, A. Asbury, A. Winegrad, et al., Diabetic Neuropathy. 1987. DOI: https://doi.org/10.1212/wnl.37.9.1569-a
  5. D. Sea, et al., Care Guidelines for Non-Destructive Brain Aortic Flows. 2011. www.the-jcen.org > archive > paper_file_download
  6. M.W. Stolar, Atherosclerosis in Diabetes: The Role of Hyperinsulinemia, Metabolism, Vol. 37, No. 2, pp. 1-9, Feb 1988. DOI: https://doi.org/10.1016/0026-0495(88)90180-1
  7. T. Dumont, A. Rughani, J. Silver, and B.I. Tranmer, Diabetes Mellitus Increases Risk of Vasospasm Following Aneurysmal Subarachnoid Hemorrhage Independent of Glycemic Control, Neurocritical Care, Vol. 11, No. 2, pp. 183-189, Oct 2009. DOI: https://doi.org/10.1007/s12028-009-9232-x
  8. S.D. Lavine, L.S. Masri, M.L. Levy, and S.L. Giannotta, Temporary Occlusion of the Middle Cerebral Artery in Intracranial Aneurysm Surgery: Time Limitation and Advantage of Brain Protection, Journal of Neurosurgery, Vol. 87, No. 6, pp. 817-824, Dec 1997. DOI: https://doi.org/10.3171/jns.1997.87.6.0817
  9. Karunanithi, K., Computational Analysis of Hemodynamic Parameters in the Management of Cerebrovascular Diseases (Intracranial Aneurysms and Moyamoya Disease), Ph.D. Thesis. Macquarie University, Sydney, Australia, 2016. http://www.researchonline.mq.edu.au/www.researchonline.mq.edu.au > vital > Repository
  10. N. Sanai, Z. Zador, and M.T. Lawton, Bypass Surgery for Complex Brain Aneurysms: An Assessment of Intracranial-Intracranial Bypass, Neurosurgery, Vol. 65, No. 4, pp. 670-683, Oct 2009. DOI: https://doi.org/10.1227/01.neu.0000348557.11968.f1
  11. O. Ates, A.S. Ahmed, D. Niemann, and M.K. Baskaya, The Occipital Artery for Posterior Circulation Bypass: Microsurgical Anatomy, Neurosurgical Focus, Vol. 24, No. 2, p. E9, Feb 2008. DOI: https://doi.org/10.3171/foc/2008/24/2/e9
  12. S.J. Peerless, G.G. Ferguson, and C.G. Drake, Extracranial-Intracranial (EC/IC) Bypass in the Treatment of Giant Intracranial Aneurysms, Neurosurgical Review, Vol. 5, No. 3, pp. 77-81, Sep 1982. DOI: https://doi.org/10.1007/bf01743477
  13. M. Ottenhausen, S.M. Krieg, B. Meyer, and F. Ringel, Functional Preoperative and Intraoperative Mapping and Monitoring: Increasing Safety and Efficacy in Glioma Surgery, Neurosurgical Focus, Vol. 38, No. 1, p. E3, Jan 2015. DOI: https://doi.org/10.3171/2014.10.focus14611
  14. M.S. Cho, M.S. Kim, C.H. Chang, S.W. Kim, S.H. Kim, and B.Y. Choi, Analysis of Clip-Induced Ischemic Complication of Anterior Choroidal Artery Aneurysms, Journal of Korean Neurosurgical Society, Vol. 43, No. 3, pp. 131-134, Mar 2008. DOI: https://doi.org/10.3340/jkns.2008.43.3.131
  15. L. Nannetti, M. Paci, M. Baccini, L.A. Rinaldi, and P.G. Taiti, Recovery from Stroke in Patients with Diabetes Mellitus, Journal of Diabetes and Its Complications, Vol. 23, No. 4, pp. 249-254, Jul 2009. DOI: https://doi.org/10.1016/j.jdiacomp.2008.02.008
  16. H. Daikun, Z. Jihong, and C. Xiaoli, A Study of the Relationship Between the Level of Blood Glucose and the Clinical In Acute Cerebral Infarction in Aged Diabetic Patients, Clinical Medicine of China, Vol. 5, 2000. http://en.cnki.com.cn/Article_en/CJFDTotal-ZHLC200005027.htm
  17. J.M. Seelig, D.P. Becker, J.D. Miller, R.P. Greenberg, J.D. Ward, and S.C. Choi, Traumatic Acute Subdural Hematoma: Major Mortality Reduction in Comatose Patients Treated Within Four Hours, New England Journal of Medicine, Vol. 304, No. 25, pp. 1511-1518, Jun 1981. DOI: https://doi.org/10.1056/nejm198106183042503
  18. A.I. Vinik, Diabetic Neuropathies, In: Controversies in Treating Diabetes, Humana Press, pp. 135-156, 2008. DOI: https://doi.org/10.1007/978-1-59745-572-5_8
  19. C.Z. Zhu and R.N. Auer, Optimal Blood Glucose Levels While Using Insulin to Minimize the Size of Infarction in Focal Cerebral Ischemia, Journal of Neurosurgery, Vol. 101, No. 4, pp. 664-668, Oct 2004. DOI: https://doi.org/10.3171/jns.2004.101.4.0664
  20. C. Ahn, J.H. Kang, and E.B. Jeung, Calcium Homeostasis in Diabetes Mellitus, Journal of Veterinary Science, Vol. 18, no. 3, pp. 261-266, Sep 2017. DOI: https://doi.org/10.4142/jvs.2017.18.3.261
  21. V.M. Sandler and J.G. Barbara, Calcium-Induced Calcium Release Contributes to Action Potential-Evoked Calcium Transients in Hippocampal CA1 Pyramidal Neurons, Journal of Neuroscience, Vol. 19, No. 11, pp. 4325-4336, Jun 1999. DOI: https://doi.org/10.1523/jneurosci.19-11-04325.1999
  22. J. Mitri, B. Dawson-Hughes, F.B. Hu, and A.G. Pittas, Effects of Vitamin D and Calcium Supplementation on Pancreatic Β Cell Function, Insulin Sensitivity, and Glycemia in Adults at High Risk of Diabetes: The Calcium and Vitamin D for Diabetes Mellitus (Caddm) Randomized Controlled Trial, American Journal of Clinical Nutrition, Vol. 94, No. 2, pp. 486-494, 2011. DOI: https://doi.org/10.3945/ajcn.111.011684
  23. J. Huguenard, Low-Threshold Calcium Currents in Central Nervous System Neurons, Annual Review of Physiology, Vol. 58, No. 1, pp. 329-348, 1996. DOI: https://doi.org/10.1146/annurev.ph.58.030196.001553
  24. P. Dandona, I.M. James, P.A. Newbury, M.L. Woollard, and A.G. Beckett, Cerebral Blood Flow in Diabetes Mellitus: Evidence of Abnormal Cerebrovascular Reactivity, British Medical Journal, Vol. 2, No. 6133, pp. 325-326, Jul 1978. DOI: https://doi.org/10.1136/bmj.2.6133.325
  25. A.S. Dumont, R.J. Dumont, J.H. McNeill, N.F. Kassell, G.R. Sutherland, and S. Verma, Chronic Endothelin Antagonism Restores Cerebrovascular Function in Diabetes, Neurosurgery, Vol. 52, No. 3, pp. 653-660, Mar 2003. DOI: https://doi.org/10.1227/01.neu.0000048187.74897.7e
  26. G. Assmann and H. Schulte, The Prospective Cardiovascular Münster (PROCAM) Study: Prevalence of Hyperlipidemia in Persons With Hypertension and/or Diabetes Mellitus and the Relationship to Coronary Heart Disease, American Heart Journal, Vol. 116, No. 6, pp. 1713-1724, Dec 1988. DOI: https://doi.org/10.1016/0002-8703(88)90220-7
  27. C.S. Ogilvy, B.S. Carter, S. Kaplan, C. Rich, and R.M. Crowell, Temporary Vessel Occlusion for Aneurysm Surgery: Risk Factors for Stroke in Patients Protected by Induced Hypothermia and Hypertension and Intravenous Mannitol Administration, Journal of Neurosurgery, Vol. 84, No. 5, pp. 785-791, May 1996. DOI: https://doi.org/10.3171/jns.1996.84.5.0785
  28. B. Ljunggren, H. Saveland, L. Brandt, E. Kagstrom, S. Rehncrona, and P.E. Nilsson, Temporary Clipping During Early Operation for Ruptured Aneurysm: Preliminary Report, Neurosurgery, Vol. 12, No. 5, pp. 525-530, May 1983. DOI: https://doi.org/10.1227/00006123-198305000-00008
  29. K. Kothbauer, V. Deletis, and F.J. Epstein, Intraoperative Spinal Cord Monitoring for Intramedullary Surgery: An Essential Adjunct, Pediatric Neurosurgery, Vol. 26, No. 5, pp. 247-254, Aug 1997. DOI: https://doi.org/10.1159/000121199
  30. Y .Kim, HS. Son, H. Kim. Disease risk prediction system using correlated health indexes. International Journal. Vol.7 No.4 1-9, Jan 2018. DOI: http://dx.doi.org/10.7236/IJASC.2018.7.4.1