Since the D-wave recording electrodes have 3 channels, it gives you 3 opportunities to record a response. Writing The D-Wave And Dorsal Column Mapping Program Both are very useful when stimulating over such a small area. The concentric probe eliminates this need and provides a very localized stimulation. You also need to monitor the surgeon to make sure they have the probe position correctly. If you were using a bipolar probe, then you would need to make sure the cathode is position correctly, depending on the dorsal column mapping technique you’re planning on using. No reference needed, like when using a monopolar probe. You will plug the anode and cathode into your stimulator box and do not have to worry which goes where. It looks like a monopolar probe at first. I would image it to be pretty difficult to get something reproducible.ĭon’t let the concentric bipolar probe fool you. I personally have never done percutaneous d-wave monitoring. There is a needle and tubing for fluid if you were going to place the electrode percutaneously. You’ll notice some other items in the box. The surgeon can then secure both with a loop tie. The second one should be placed caudal to the surgical area with the tip going towards the feet. The first should be placed rostral to the surgical area, with the tip going up towards the head. They should use 2 electrodes for the procedure. The surgeon can place it either epidural or subdural. The spinal recording electrode (on left) is meant to be placed on the spinal cord for d-wave recording. Conversations between the surgical neurophysiologist, the training neuromonitoring technician, the anesthesiologist and the surgeon are shown next to the cartoons.Ģ Spinal Electrodes And A Concentric Bipolar Probe Here we are going to walk through the case from the night before till the end of the case as it is likely to play out. (Going through these mental exercises is where I found it useful to take the position of different people in the OR, which is why I use the cartoon characters on my presentations and this website.) Case: Cervical Intramedullary Tumor There’s only so much you can learn at one time, so instead of asking Day 1 questions on Day 1 (like “what modalities should we run for this case?”) I was able to jump ahead of schedule.Įven though you might not see a D-wave and dorsal column mapping case on the schedule often, you should still go through the process. It took forever to do it, but I really think it cut my learning curve down significantly. common technical problems that could happen and how to troubleshoot them.alarm criteria for each modality as it pertains to that procedure.determine the parts of the surgery with higher risk and what modality would be affected.try to predict the conversions I would have with anesthesia and the surgeon as it pertained to that case.write a program for the case if I didn’t already have one.make a list of what modalities I would run.Here’s what that exercise would look like: One thing that helped me be able to quickly broaden my scope of neuromonitoring cases quickly was to look a the company schedule and prepare for every case we had on the board for that day. Part of that is going through textbooks and research articles, but there is more to it than that. That being said, there are ways to prepare that will shortcut your learning curve. You really need to be in there to train appropriately. It’s difficult to provide operating room experience from outside the operating room. Please do not attempt these cases if you’re experience level is not yet there. These are very high-risk surgeries where neuromonitoring and mapping play a crucial role in the surgical planning and outcomes. That means that you’re going to have to go in with a firm understanding of overall neuroanatomy and neurophysiology and be able to apply that knowledge to the case in front of you. Unless you are the exception and work at a facility that just knocks these out, you’re not going to get too many of these requested. Here’s the reality for people that want to get trained on doing d-wave and dorsal column mapping on spinal tumors… you most likely aren’t going to have the luxury of seeing 30 of these before you start doing these yourself.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |