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  1. Article ; Online: Letter of response to "Letter-to-the Editor BRS-D-23-00557".

    Szelényi, Andrea / Fava, Enrica

    Brain stimulation

    2023  Volume 16, Issue 5, Page(s) 1555

    Language English
    Publishing date 2023-11-01
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 2394410-9
    ISSN 1876-4754 ; 1935-861X
    ISSN (online) 1876-4754
    ISSN 1935-861X
    DOI 10.1016/j.brs.2023.10.004
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  2. Article ; Online: Long latency responses in tongue muscle elicited by various stimulation sites in anesthetized humans - New insights into tongue-related brainstem reflexes.

    Szelényi, Andrea / Fava, Enrica

    Brain stimulation

    2022  Volume 15, Issue 3, Page(s) 566–575

    Abstract: Background: Long Latency Responses (LLR) in tongue muscles are a scarcely described phenomenon, the physiology of which is uncertain.: Objectives: The aim of this exploratory, observational study was to describe tongue-LLR elicited by direct ... ...

    Abstract Background: Long Latency Responses (LLR) in tongue muscles are a scarcely described phenomenon, the physiology of which is uncertain.
    Objectives: The aim of this exploratory, observational study was to describe tongue-LLR elicited by direct trigeminal nerve (DTNS), dorsal column (DoColS), transcranial electric (TES) and peripheral median nerve (MNS) stimulation in a total of 93 patients undergoing neurosurgical procedures under general anesthesia.
    Methods: Bilateral tongue responses were derived concurrently after each of the following stimulations: (1) DTNS applied with single monophasic or train-of-three pulses, ≤5 mA; (2) DoColS applied with a train-of-three pulses, ≤10 mA; (3) TES consisting of an anodal train-of-five stimulation, ≤250 mA; (4) MNS at wrist consisting of single or train-of-three monophasic pulses, ≤50 mA. Polyphasic tongue muscle responses exceeding the latencies of tongue compound muscle action potentials or motor evoked potentials were classified as LLR.
    Results: Tongue-LLR were evoked from all stimulation sites, with latencies as follows: (1) DTNS: solely ipsilateral 20.2 ± 3.3 msec; (2) DoColS: ipsilateral 25.9 ± 1.6 msec, contralateral 25.1 ± 4.2 msec; (3) TES: contralateral 55.3 ± 10.2 msec, ipsilateral 54.9 ± 12.0 msec; (4) MNS: ipsilateral 37.8 ± 4.7 msec and contralateral 40.3 ± 3.5 msec.
    Conclusion: The tongue muscles are a common efferent in brainstem pathways targeted by trigeminal and cervical sensory fibers. DTNS can elicit the "trigemino-hypoglossal-reflex". For the MNS elicited tongue-LLR, we propose the term "somatosensory-evoked tongue-reflex". Although the origin of the TES related tongue-LLR remains unclear, these data will help to interpret intraoperative tongue recordings.
    MeSH term(s) Brain Stem ; Electric Stimulation/methods ; Evoked Potentials, Motor/physiology ; Humans ; Muscles/physiology ; Reaction Time/physiology ; Tongue/innervation ; Tongue/physiology
    Language English
    Publishing date 2022-03-24
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 2394410-9
    ISSN 1876-4754 ; 1935-861X
    ISSN (online) 1876-4754
    ISSN 1935-861X
    DOI 10.1016/j.brs.2022.03.003
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  3. Book ; Thesis: Selektivität der Bahnung motorisch evozierter Potentiale nach transkranieller Kortexstimulation bei Patienten mit Läsionen des oberen motorischen Neurons

    Szelényi, Andrea

    1993  

    Author's details vorgelegt von Andrea Szelényi
    Language German
    Size 92 Bl. : Ill., graph. Darst.
    Document type Book ; Thesis
    Thesis / German Habilitation thesis Düsseldorf, Univ., Diss., 1993
    HBZ-ID HT006221903
    Database Catalogue ZB MED Medicine, Health

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  4. Article: Establishment of Different Intraoperative Monitoring and Mapping Techniques and Their Impact on Survival, Extent of Resection, and Clinical Outcome in Patients with High-Grade Gliomas-A Series of 631 Patients in 14 Years.

    Staub-Bartelt, Franziska / Suresh Babu, Marian Preetham / Szelényi, Andrea / Rapp, Marion / Sabel, Michael

    Cancers

    2024  Volume 16, Issue 5

    Abstract: Background: The resection of brain tumors can be critical concerning localization, but is a key point in treating gliomas. Intraoperative neuromonitoring (IONM), awake craniotomy, and mapping procedures have been incorporated over the years. Using these ...

    Abstract Background: The resection of brain tumors can be critical concerning localization, but is a key point in treating gliomas. Intraoperative neuromonitoring (IONM), awake craniotomy, and mapping procedures have been incorporated over the years. Using these intraoperative techniques, the resection of eloquent-area tumors without increasing postoperative morbidity became possible. This study aims to analyze short-term and particularly long-term outcomes in patients diagnosed with high-grade glioma, who underwent surgical resection under various technical intraoperative settings over 14 years.
    Methods: A total of 1010 patients with high-grade glioma that underwent resection between 2004 and 2018 under different monitoring or mapping procedures were screened; 631 were considered eligible for further analyses. We analyzed the type of surgery (resection vs. biopsy) and type of IONM or mapping procedures that were performed. Furthermore, the impact on short-term (The National Institute of Health Stroke Scale, NIHSS; Karnofsky Performance Scale, KPS) and long-term (progression-free survival, PFS; overall survival, OS) outcomes was analyzed. Additionally, the localization, extent of resection (EOR), residual tumor volume (RTV), IDH status, and adjuvant therapy were approached.
    Results: In 481 patients, surgery, and in 150, biopsies were performed. The number of biopsies decreased significantly with the incorporation of awake surgeries with bipolar stimulation, IONM, and/or monopolar mapping (
    Conclusion: Based on the present analysis using data from 14 years and more than 600 patients, we observed that through the implementation of various monitoring and mapping techniques, a significant decrease in biopsies and an increase in the resection of eloquent tumors was achieved. With that, the operability of eloquent tumors without a negative influence on neurological outcomes is suggested by our data. However, a statistical effect of monitoring and mapping procedures on long-term outcomes such as PFS and OS could not be shown.
    Language English
    Publishing date 2024-02-25
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2527080-1
    ISSN 2072-6694
    ISSN 2072-6694
    DOI 10.3390/cancers16050926
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  5. Article ; Online: Feasibility of multimodal intraoperative neurophysiological monitoring for extramedullary spinal cord tumor surgery in elderly patients.

    Siller, Sebastian / Sixta, Akela / Tonn, Joerg-Christian / Szelenyi, Andrea

    Acta neurochirurgica

    2023  Volume 165, Issue 8, Page(s) 2089–2099

    Abstract: Background/purpose: Extramedullary spinal cord tumors (EMSCTs) are mostly benign tumors which are increasingly diagnosed and operatively treated in the elderly. While there are hints that multimodal intraoperative neurophysiological monitoring (IONM) ... ...

    Abstract Background/purpose: Extramedullary spinal cord tumors (EMSCTs) are mostly benign tumors which are increasingly diagnosed and operatively treated in the elderly. While there are hints that multimodal intraoperative neurophysiological monitoring (IONM) could be influenced by age and age-related comorbidities, no study has ever systematically evaluated its feasibility and value for EMSCT surgery in elderly patients.
    Methods: We retrospectively evaluated all patients with microsurgical EMSCT resection under continuous multimodal IONM with SSEPs, MEPs and electromyography between 2016 and 2020. Epidemiological, clinical, imaging and operative/IONM records as well as detailed individual outcomes were analyzed and compared for the cohort < / ≥ 65 years.
    Results: Mean age was 45 years in cohort < 65 years (n = 109) and 76 years in cohort ≥ 65 years (n = 64), while baseline/operative characteristics did not significantly differ. Mean baseline SSEPs' latencies (left-right average) were significantly higher in the cohort ≥ 65 years for both median (20.9 ms vs. 22.1 ms; p < 0.01) and tibial nerve (42.9 ms vs. 46.1 ms; p < 0.01) without significant differences for SSEPs' amplitudes. Stimulation intensity to elicit intraoperative MEPs was significantly higher in the cohort ≥ 65 years (surrogate-marker: left-right-averaged quotient ID1-muscle/abductor-hallucis-muscle; 1.6 vs. 2.1; p < 0.001). Intraoperatively, SSEP and MEP monitoring were feasible in 99%/100% and 99%/98% for the cohort < / ≥ 65 years without significant differences in rates for significant IONM changes during surgery or postoperatively new sensorimotor deficits. Sensitivity of IONM was 29%/43%, specificity 99%/98%, positive and negative predictive values 67%/75% and 95%/93% for the cohort < / ≥ 65 years. Overall, age was no risk factor for IONM feasibility or rate of significant IONM changes.
    Discussion: Multimodal IONM is feasible/reliable for EMSCT surgery in elderly patients. An age-related prolongation of SSEPs' latencies and demand for higher stimulation intensities for MEPs' elicitation has to be considered.
    MeSH term(s) Humans ; Aged ; Middle Aged ; Evoked Potentials, Motor/physiology ; Evoked Potentials, Somatosensory/physiology ; Intraoperative Neurophysiological Monitoring/methods ; Retrospective Studies ; Feasibility Studies ; Spinal Cord Neoplasms/diagnostic imaging ; Spinal Cord Neoplasms/surgery
    Language English
    Publishing date 2023-06-24
    Publishing country Austria
    Document type Journal Article
    ZDB-ID 80010-7
    ISSN 0942-0940 ; 0001-6268
    ISSN (online) 0942-0940
    ISSN 0001-6268
    DOI 10.1007/s00701-023-05682-8
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  6. Article: Intraoperative mapping and monitoring during brain tumor surgeries.

    Seidel, Kathleen / Szelényi, Andrea / Bello, Lorenzo

    Handbook of clinical neurology

    2022  Volume 186, Page(s) 133–149

    Abstract: Many different methodologies and paradigms are available to guide surgery of supratentorial tumors with the aim to preserve quality of life of the patients and to increase the extent of tumor resection. Neurophysiologic monitoring techniques (such as ... ...

    Abstract Many different methodologies and paradigms are available to guide surgery of supratentorial tumors with the aim to preserve quality of life of the patients and to increase the extent of tumor resection. Neurophysiologic monitoring techniques (such as different evoked potentials) may help to continuously assess functional integrity of the observed systems and warn about vascular injury. For neurophysiologic mapping methods, the focus is not only to preserve cortical sites, but also to prevent injury to subcortical pathways. Therefore, cortical mapping is not enough but should be combined with subcortical mapping to identify tracts. This may be done by alternating resection and stimulation, or by continuous mapping via an electrified surgical tool such as a stimulating suction tip. Increasingly refined techniques are evolving to improve mapping of complex motor networks as well as language and higher cortical functions. Finally, in deciding between an awake vs asleep intraoperative setting, various factors need to be considered, such as the surgical goal, patient expectation and cooperation, treating team expertise, and neurooncologic aspects including histopathology. Therefore, the choice of protocol depends on the clinical context and the experience of the interdisciplinary team treating the patients.
    MeSH term(s) Brain Mapping/methods ; Brain Neoplasms/pathology ; Brain Neoplasms/surgery ; Evoked Potentials ; Humans ; Neurosurgical Procedures/methods ; Quality of Life
    Language English
    Publishing date 2022-04-11
    Publishing country Netherlands
    Document type Journal Article ; Review
    ISSN 0072-9752
    ISSN 0072-9752
    DOI 10.1016/B978-0-12-819826-1.00013-2
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  7. Article: Electroencephalography, electrocorticography, and cortical stimulation techniques.

    Simon, Mirela V / Nuwer, Marc R / Szelényi, Andrea

    Handbook of clinical neurology

    2022  Volume 186, Page(s) 11–38

    Abstract: Electroencephalography (EEG) and electrocorticography (ECoG) are two important neurophysiologic techniques used in the operating room for monitoring and mapping electrical brain activity. In this chapter, we detail their principle, recording methodology, ...

    Abstract Electroencephalography (EEG) and electrocorticography (ECoG) are two important neurophysiologic techniques used in the operating room for monitoring and mapping electrical brain activity. In this chapter, we detail their principle, recording methodology, and address specifics of their interpretation in the intraoperative setting (e.g., effect of anesthetics), as well as their clinical applications in epilepsy and non-epilepsy surgeries. In addition, we address differences between scalp, surface, and deep cortical recordings that will help towards a more reliable interpretation of the significance of electrophysiologic parameters such as amplitude and morphology as well as in differentiation between abnormal and normal patterns of electrical brain activity. Electrical stimulation is used for intraoperative mapping of different cortical functions such as language, parietal, and motor. Stimulation paradigms used in clinical practice vary with regard to stimulation frequencies and probes being used. Parameters, such as the number of phases per pulse, pulse/phase duration, pulse frequency, organization, and polarity, define their characteristics, including their safety, propensity to trigger seizures, efficiency and reliability of stimulation, and the mapping thresholds. Specifically, in this chapter, we will address differences between monopolar and bipolar stimulation; anodal and cathodal polarity; monophasic and biphasic pulses; constant voltage, and constant current paradigms.
    MeSH term(s) Brain Mapping/methods ; Electric Stimulation/methods ; Electrocorticography ; Electroencephalography/methods ; Humans ; Reproducibility of Results
    Language English
    Publishing date 2022-04-11
    Publishing country Netherlands
    Document type Journal Article ; Review
    ISSN 0072-9752
    ISSN 0072-9752
    DOI 10.1016/B978-0-12-819826-1.00001-6
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  8. Article: Surgery and intraoperative neurophysiologic monitoring for aneurysm clipping.

    Szelényi, Andrea / Fernández-Conejero, Isabel / Kodama, Kunihiko

    Handbook of clinical neurology

    2022  Volume 186, Page(s) 375–393

    Abstract: This chapter describes the feasibility, utilization, and value of intraoperative neurophysiologic monitoring (IONM) in cerebrovascular cases. Practical advice on the integration of these adjunct methods into the modern neurosurgical operating room is ... ...

    Abstract This chapter describes the feasibility, utilization, and value of intraoperative neurophysiologic monitoring (IONM) in cerebrovascular cases. Practical advice on the integration of these adjunct methods into the modern neurosurgical operating room is based on our own neurophysiologic and neurosurgical experience. Most IONM is done for anterior circulation aneurysms. Somatosensory and motor evoked potentials are the modalities of choice covering vascular territories of the internal, anterior, and middle cerebral arteries. While monitoring both hemispheres with the unoperated side as control, monitoring focus is laid upon those territories at risk and bearing the aneurysm. The specificity of IONM is close to 1, and sensitivity ranges from 0.2 to 1, depending on the categorization of transient changes. The overall likelihood of worsened neurologic outcome after any intraoperative signal deterioration (transient or permanent) is 0.4.
    MeSH term(s) Evoked Potentials, Motor/physiology ; Humans ; Intracranial Aneurysm/surgery ; Intraoperative Neurophysiological Monitoring/methods ; Neurosurgical Procedures/methods ; Retrospective Studies
    Language English
    Publishing date 2022-04-11
    Publishing country Netherlands
    Document type Journal Article ; Review
    ISSN 0072-9752
    ISSN 0072-9752
    DOI 10.1016/B978-0-12-819826-1.00008-9
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  9. Article ; Online: Intramedullary spinal cord cavernous malformations-association between intraoperative neurophysiological monitoring changes and neurological outcome.

    Niedermeyer, Sebastian / Szelenyi, Andrea / Schichor, Christian / Tonn, Joerg-Christian / Siller, Sebastian

    Acta neurochirurgica

    2022  Volume 164, Issue 10, Page(s) 2595–2604

    Abstract: Background: Microsurgical resection of spinal cord cavernous malformations can be assisted by intraoperative neurophysiological monitoring (IONM). While the clinical outcome after surgical resection has been discussed in several case series, the ... ...

    Abstract Background: Microsurgical resection of spinal cord cavernous malformations can be assisted by intraoperative neurophysiological monitoring (IONM). While the clinical outcome after surgical resection has been discussed in several case series, the association of intraoperative IONM changes and detailed neurological outcome, however, has not been analyzed so far.
    Methods: Seventeen patients with spinal cavernomas underwent surgery between 02/2004 and 06/2020. Detailed neurological and clinical outcome as well as IONM data including motor-evoked potential (MEP) and somatosensory-evoked potential (SSEP) monitoring were retrospectively analyzed. Intraoperative IONM changes were compared to outcome at 3-month and 1-year follow-up in order to identify surrogate parameters for an impending neurological deficit.
    Results: Compared to the preoperative state, McCormick score at 1-year follow-up remained unchanged in 12 and improved in five patients, none worsened, while detailed neurological examination revealed a new or worsened sensorimotor deficit in 4 patients. The permanent 80% amplitude reduction of MEP and 50% amplitude reduction of SSEP showed the best diagnostic accuracy with a sensitivity of 100% and 67% respectively and a specificity of 73% and 93% respectively. The relative risk for a new neurological deficit at 1-year follow-up, when reversible IONM-deterioration was registered compared to irreversible IONM deterioration, was 0.56 (0.23-1.37) for MEP deterioration and 0.4 (0.18-0.89) for SSEP deterioration.
    Conclusions: Reversible IONM changes were associated with a better neurological outcome at follow-up compared to irreversible IONM deterioration during SCCM surgery. Our study favors the permanent 80% amplitude reduction criterion for MEP and 50% amplitude reduction criterion for SSEP for further prospective evaluation of IONM significance and the effectiveness of corrective maneuvers during SCCM surgeries.
    MeSH term(s) Evoked Potentials, Motor/physiology ; Evoked Potentials, Somatosensory/physiology ; Humans ; Intraoperative Neurophysiological Monitoring ; Retrospective Studies ; Spinal Cord Neoplasms/surgery
    Language English
    Publishing date 2022-09-06
    Publishing country Austria
    Document type Journal Article
    ZDB-ID 80010-7
    ISSN 0942-0940 ; 0001-6268
    ISSN (online) 0942-0940
    ISSN 0001-6268
    DOI 10.1007/s00701-022-05354-z
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  10. Article ; Online: Dorsal column mapping in resection of intramedullary spinal cord tumors: a prospective comparison of two methods and neurological follow-up.

    Ueberschaer, Moritz / Breitkopf, Katharina / Siller, Sebastian / Katzendobler, Sophie / Weller, Jonathan / Greve, Tobias / Zausinger, Stefan / Tonn, Joerg-Christian / Szelenyi, Andrea

    Acta neurochirurgica

    2023  Volume 165, Issue 11, Page(s) 3493–3504

    Abstract: Purpose: In surgery for intramedullary spinal cord tumors (imSCT), distortion of the anatomy challenges the visual identification of dorsal columns (DC) for midline myelotomy. Dorsal column mapping (DCM) and spinal cord stimulation (SCS) can identify DC ...

    Abstract Purpose: In surgery for intramedullary spinal cord tumors (imSCT), distortion of the anatomy challenges the visual identification of dorsal columns (DC) for midline myelotomy. Dorsal column mapping (DCM) and spinal cord stimulation (SCS) can identify DC neurophysiologically. We compare application and feasibility of both methods.
    Methods: Patients with surgically treated imSCT were prospectively included between 04/2017 and 06/2019. The anatomical midline (AM) was marked. SSEPs at the DC after stimulation of tibial/median nerve with an 8-channel DCM electrode and cortical SSEP phase reversal at C3/C4 after SCS using a bipolar concentric probe were recorded. Procedural and technical aspects were compared. Standardized neurological examinations were performed preoperatively, 1 week postoperatively and after more than 12 months.
    Results: The DCM electrode detected the midline in 9/13 patients with handling limitations in the remaining patients. SCS was applicable in all patients with determination of the midline in 9/13. If both recordings could be acquired (6/13), concordance was 100%. If baseline SSEPs were poor, both methods were limited. SCS was less time-consuming (p = 0.001), cheaper, and easier to handle. In 92% of cases, the AM and neurophysiologic midlines were concordant. After myelotomy, 3 patients experienced > 50% reduction in amplitude of SSEPs. Despite early postoperative worsening of DC function, long-term follow-up showed significant recovery and improvement in quality of life.
    Conclusion: DCM and SCS may help confirm and correct the AM for myelotomy in imSCT, leading to a favorable long-term neurological outcome in this cohort. SCS evolved to be superior concerning applicability, cost-effectiveness, and time expenditure.
    MeSH term(s) Humans ; Follow-Up Studies ; Quality of Life ; Evoked Potentials, Somatosensory/physiology ; Spinal Cord Neoplasms/diagnostic imaging ; Spinal Cord Neoplasms/surgery ; Electrodes ; Spinal Cord/surgery
    Language English
    Publishing date 2023-03-17
    Publishing country Austria
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80010-7
    ISSN 0942-0940 ; 0001-6268
    ISSN (online) 0942-0940
    ISSN 0001-6268
    DOI 10.1007/s00701-023-05554-1
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