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1/208. Intraoperative loss of auditory function relieved by microvascular decompression of the cochlear nerve.

    BACKGROUND: Brainstem auditory evoked potentials (BAEP) are useful indicators of auditory function during posterior fossa surgery. Several potential mechanisms of injury may affect the cochlear nerve, and complete loss of BAEP is often associated with postoperative hearing loss. We report two cases of intraoperative auditory loss related to vascular compression upon the cochlear nerve. methods: Intra-operative BAEP were monitored in a consecutive series of over 300 microvascular decompressions (MVD) performed in a recent twelve-month period. In two patients undergoing treatment for trigeminal neuralgia, BAEP waveforms suddenly disappeared completely during closure of the dura. RESULTS: The cerebello-pontine angle was immediately re-explored and there was no evidence of hemorrhage or cerebellar swelling. The cochlear nerve and brainstem were inspected, and prominent vascular compression was identified in both patients. A cochlear nerve MVD resulted in immediate restoration of BAEP, and both patients recovered without hearing loss. CONCLUSION: These cases illustrate that vascular compression upon the cochlear nerve may disrupt function, and is reversible with MVD. awareness of this event and recognition of BAEP changes alert the neurosurgeon to a potential reversible cause of hearing loss during posterior fossa surgery.
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2/208. Complete avulsion of the distal posterior interosseous nerve during wrist arthroscopy: a possible cause of persistent pain after arthroscopy.

    A case of avulsion of the distal posterior interosseous nerve during wrist arthroscopy is presented. Surgeons unaware of this entity may attribute persistent middorsal wrist pain to the underlying disease rather than to iatrogenic damage to the distal posterior interosseous nerve.
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keywords = nerve
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3/208. Difficult anesthetic management during pheochromocytoma surgery.

    The anesthetic management of two middle-aged patients having surgical removal of large pheochromocytomas is described. The same team of physicians was involved in the care of the patients, including an endocrinologist, who supervised their preoperative care. Although the preoperative care included pharmacologic adrenergic receptor blockade and fluid administration, guidelines for surgical readiness did not follow those recommended in our literature. Both patients experienced severe intraoperative hypotension after complete interruption of the tumors' venous drainage, and one patient suffered a cardiac arrest. Explanations for the occurrence of these problems are discussed, including factors relating to the complexity of the disease process. However, it is conceivable that appropriate input from the anesthesiologist during the preoperative preparation of these patients may have ameliorated, if not prevented, the encountered difficulties.
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keywords = block
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4/208. life-threatening haemorrhage following obturator artery injury during transurethral bladder surgery: a sequel of an unsuccessful obturator nerve block.

    In spite of prior blockade of the obturator nerve with 1% mepivacaine (8 ml) utilizing a nerve stimulator, violent leg jerking was evoked during transurethral electroresection of a bladder tumour approximately 1 h after the blockade in a 68-year-old man. The patient became severely hypotensive immediately following the jerking, and a large lower abdominal swelling concurrently developed. The urgent laparotomy indicated that the left obturator artery was severely injured by the resectoscope associated with the bladder perforation, causing acute massive haemorrhage. The patient recovered uneventfully after adequate surgery. Investigation of the literature suggested that both our nerve stimulation technique and anatomical approach were appropriate. It was therefore unlikely that our block resulted in failure because of an inappropriate site for deposition of the anaesthetic. However, consensus does not appear to have been obtained as to the concentration and volume of the anaesthetic necessary for prevention of the obturator nerve stimulation during the transurethral procedures. The concentration and volume of mepivacaine we used might have been too low and/or small, respectively, to profoundly block all the motor neuron fibres of the nerve. Alternatively, stimulation of the obturator nerve might occur because of the presence of some anatomical variant, such as the accessory obturator nerve or its abnormal branching. In conclusion, some uncertainty appears to exist in the effectiveness of the local anaesthetic blockade of the obturator nerve. In order to attain profound blockade of the motor neuron fibres of the obturator nerve and thereby prevent the thigh-adductor muscle contraction which can lead to life-threatening situations, we recommend, even with a nerve stimulator, to use a larger volume of a higher concentration of local anaesthetic with a longer duration in the obturator nerve block for the transurethral procedures.
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ranking = 4.7494616206511
keywords = nerve block, nerve, block
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5/208. Transient left vocal cord paralysis during laparoscopic surgery for an oesophageal hiatus hernia.

    A 45-year-old male, with symptoms of many years standing of gastro-oesophageal reflux disease, was subjected, under general anaesthesia, to laparoscopic fundoplication. Tracheal intubation yielded no problems but great difficulties were encountered during tube insertion into the oesophagus. After surgery, aphonia developed. Laryngological examination demonstrated paralysis of the left vocal cord. voice strength returned to the pre-operative status after 3 months, and laryngological examination confirmed normal mobility of both cords. The possible cause of the complication was damage to the left recurrent laryngeal nerve which occurred during insertion of the tube into the oesophagus. Gastro-oesophageal reflux disease causing 'acid laryngitis' can create conditions favouring this type of complication.
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keywords = nerve
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6/208. Traumatic aneurysm of the inferior lateral geniculate artery after total knee replacement.

    A 55-year old man incurred a false aneurysm of the inferior lateral geniculate artery after total knee replacement. The false aneurysm appeared as a pulsatile mass with compressive neuropathy of the posterior tibial nerve. The development of this complication and treatment are discussed.
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keywords = nerve
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7/208. A complication of intraoperative facial nerve monitoring: facial skin burns.

    OBJECTIVE: To report on three cases of severe facial skin burns resulting from intraoperative facial nerve monitoring in patients undergoing parotidectomies. STUDY DESIGN: This study is a retrospective case review. SETTING: A tertiary referral center. patients: This study includes three patients who underwent parotidectomies with concurrent facial nerve monitoring. RESULTS: Facial skin burns were proven to result from a technical defect of the intraoperative facial nerve monitoring device. burns were sustained at electrode insertion sites and their extent was related to the duration of monitoring. The most probable explanation of these burns is electrolysis. CONCLUSIONS: Successful retracing of technical defaults with biomedical engineers at the device manufacturer have led to the upgrade of the facial nerve monitor apparatus. The benefits of facial nerve monitoring largely outweigh the fortuitous occurrence of skin burns reported in this study. Therefore, this complication should not represent a drawback to the use of facial nerve monitoring.
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keywords = nerve
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8/208. bradycardia and asystole with the use of vagus nerve stimulation for the treatment of epilepsy: a rare complication of intraoperative device testing.

    PURPOSES: A 56-year-old man with mild mental retardation, right congenital hemiparesis, and refractory partial seizures was referred for vagus nerve stimulation (VNS). methods: Routine lead diagnostic testing during the surgical procedure (1.0 mA, 20 Hz, and 500 micros, for approximately 17 s) resulted, during the initial two stimulations, in a bradycardia of approximately 30 beats/min. A third attempt led to transient asystole that required atropine and brief cardiopulmonary resuscitation. RESULTS: The procedure was immediately terminated, the device removed, and the patient recovered completely. A postoperative cardiologic evaluation, including an ECG, 24-h Holter monitor, echocardiogram, and a tilt-table test, was normal. CONCLUSIONS: Possible mechanisms for the bradycardia/asystole include stimulation of cervical cardiac branches of the vagus nerve either by collateral current spread or directly by inadvertent placement of the electrodes on one of these branches; improper plugging of the electrodes into the pulse generator, resulting in erratic varying intensity of stimulation; reverse polarity; and idiosyncratic-type reaction in a hypersusceptible individual. The manufacturer reports the occurrence rate in approximately 3,500 implants for this intraoperative event to be approximately one in 875 cases or 0.1%.
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keywords = nerve
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9/208. Elicitation of the oculocardiac reflex during endoscopic forehead lift surgery.

    Elicitation of the oculocardiac reflex is a well-documented phenomenon encountered during ophthalmologic surgical procedures. Familiarity with and prompt recognition of this entity has significantly reduced the morbidity associated with it; however, potentially lethal arrhythmias and cardiac arrest still occur. We report elicitation of the reflex during manipulation of the supraorbital nerve during endoscopic forehead lift surgery. To our knowledge this is the first case of elicitation of the oculocardiac reflex reported during endoscopic forehead lift surgery.
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10/208. Evoked spinal cord potential monitoring reveals peroneal nerve ischemia during thoracoabdominal repair: a case report.

    An 82-year-old man underwent thoracoabdominal aortic replacement under cardiopulmonary bypass with left femoral artery cannulation. Lumber descending evoked spinal cord potentials and segmental evoked spinal cord potentials were monitored simultaneously for detecting spinal cord damage. When the cardiopulmonary bypass was terminated, a peripheral nerve ischemia pattern was evident. Left peroneal nerve paralysis was present at emergence from anesthesia. This monitoring system revealed that peroneal nerve paralysis can occur due to leg ischemia caused by femoral artery cannulation. This is, to our knowledge, the first report that segmental evoked spinal cord potential monitoring reveals peroneal nerve ischemia during thoracoabdominal surgery.
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ranking = 0.88888888888889
keywords = nerve
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