Ruba Siddiqi

ISM- Period 1

Zebian, Bassel, et al. “Recent Technological Advances in Pediatric Brain Tumor Surgery.” CNS

Oncology, Future Medicine Ltd, Jan. 2017,

www.ncbi.nlm.nih.gov/pmc/articles/PMC6027926/.

 Intraoperative neuromonitoring (IONM) focuses on giving live feedback to the surgeon

 This live feedback prevents injuring important neural structures such as the spinal cord,
peripheral nerves, cranial nerves, and spinal nerve roots

 Cortical and subcortical brain mapping can help avoid injuring white matter tracts and the
eloquent cortex

 Breakthroughs in IONM consist of motor and somatosensory evoked potentials

 Anesthesia plays a factor in IONM’s efficacy

 Volatile anesthetics (require vaporizers for administration through inhaling) must be

avoided due to their effect in reducing motor-evoked potentials

 Preferred method is intravenous anesthesia which will avoid neuromuscular blockade

(neuromuscular transmission failure)

 Cautions include avoiding overstimulation in order to minimize risk of stimulation-

induced seizures

 Another caution is that the patient’s extremities or limbs must be protected and
appropriately positioned in order to minimize risk of movement-induced injury

 A limitation of pediatric cortical mapping is the central nervous system’s (CNS)

immaturity or lack of development in infants

 Due to the CNS’s immaturity, minimal data exists on cortical mapping’s efficacy on
infants (less than one year old)

 A significant limiting factor in pediatric neurosurgery is that speech cannot be accurately

tested unless patient is conscious or awake
 A possible solution is to place “grid electrodes under the general anesthetic” and
complete the cortical mapping with conscious patient

 Overall, IONM seems very promising for increasing the accuracy and surgeon’s
confidence in pediatric neurosurgery but more research is needed to refine the practice.
 Ruba Siddiqi
ISM-Period 1

MM;, El Beltagy MA;Atteya. “The Benefits of Navigated Intraoperative Ultrasonography during

Resection of Fourth Ventricular Tumors in Children.” Child's Nervous System : ChNS :

Official Journal of the International Society for Pediatric Neurosurgery, U.S. National

Library of Medicine, pubmed.ncbi.nlm.nih.gov/23609897/.

 “the best line of management” for treating pediatric fourth ventricular tumors is excision
(1)

 Pediatric fourth ventricular onco-surgery tends to be challenging for neurosurgeons

 Surgery carries many technical difficulties in completing excising the tumors due to the
surgically challenging area

 Benefits of neuro-navigated intraoperative ultrasonography (NIOUS) are seen at a

clinical trial where thirty cases used NIOUS and another thirty did not during treatment
of fourth ventricular tumors in children

 29 cases in the NIOUS group accomplished total tumor excision compared to 24 cases in
the control group

 It took a mean of 150 minutes for operation in the NIOUS group compared to a mean of
140.6 minutes in the control group (NIOUS had a standard deviation of 18.28 and the
control group had a standard deviation of 18.6)

 Only one patient developed postoperative cerebellar mutism in the NIOUS group
compared to six patients in the control group

 NIOUS works by providing an updated, accurate map of the patient’s anatomy during the
operation

 NIOUS makes it easier to follow progression of operation

 NIOUS improves total tumor excision by displaying any tumor tissue still remaining

 NIOUS’s cost-effectiveness, simple application and interpretation, and ability to be used

in real-time makes it a useful tool that could replace intraoperative MRI in pediatric
neurosurgery.
 Ruba Siddiqi
ISM-Period 1

“Robot-Assisted Surgery.” Nationwide Children's Hospital,

www.nationwidechildrens.org/specialties/pediatric-surgery/minimally-invasive-

surgery/robot-assisted-surgery.

 Robot-assisted surgery is a minimally invasive technique that can reduce appearance of

surgical scars, decrease length of hospital stay, and also reduce pain

 With robot-assisted surgery, surgeon can make “tiny keyhole incisions” (1)

 Due to the robotic equipment’s design, the surgeon can make complex movements on a
small scale which wouldn’t be possible with just the human hand

 Camera enables surgeons to monitor movements “high definition 3D video at extreme

magnification” (1)

 Cameras and remote viewing mean other surgical team members can observe surgery
close up

 A list of benefits from the use of robot-assisted surgery include smaller incisions,
speedier recovery, reduced appearance and quantity of scarring, reduced post-operative
pain meaning less pain medication has to be taken, decreased risk of infection or
complications, and overall better patient/family satisfaction

 Key advantages of robot-assisted surgery include enhanced dexterity, greater precision,

and improved visualization

 Robotic technology provides surgeon with a greater range of motion

 Robotic technology allows for adjustable motion-scaling and eliminates the human
hand’s natural tremor which otherwise reduces precision

 The 3D viewing provides a useful depth perception which guides surgeons during even
the most delicate of procedures

 128 cases utilizing robotic technology in pediatric neurosurgery display a low rate of
complications at 3.9%, a high rate of success at 97.7%, and no post-operative permanent
neurological deficit
 The robotic technology in neurosurgery is termed ROSA

 The clear efficacy of robotic technology in improving patient outcome and also making
the surgery itself easier to perform is encouraging for the expanded use of ROSA.