The use of neural integrity monitor [NIM flextm] tube in patients undergoing posterior fossa surgery: our institutional experience

Neurosurgery for cerebellopontine angle tumour involves handling and dissection of cranial nerves at their origin from the brainstem. Lower cranial nerves or their nuclei may be affected by lesions arising from or extending up to the medulla. Preserving their structural and functional integrity is an important goal during surgical resection. Important functions of vagus nerve include swallowing, speech, respiration and heart rate control and its damage is one of the devastating complications of posterior fossa tumour resection. Electromyographic monitoring for recurrent branch of vagus nerve has been done in thyroid surgeries using a specially designed neural integrity monitor (NIM flexTM) electromyogram (EMG) endotracheal tube containing embedded stimulating electrodes placed at the level of vocal cords. We present our experience with the use of this NIM flexTM EMG endotracheal tube for vagus nerve monitoring in neurosurgery for posterior fossa tumours in four patients. Use of this tube in neurosurgery has been less reported in the Indian literature

Transient facial nerve palsy after scalp block for awake craniotomy: A case report

Awake craniotomy is a unique clinical setting that needs anesthesiologist to provide variable states of sedation and analgesia to ensure optimal operating conditions without compromising patient safety. Scalp block is an integral part of awake craniotomy as it provides regional anesthesia to the nerves innervating the scalp. It minimizes response to noxious stimuli of cranial pin application and craniotomy. We report a case of transient facial nerve palsy after scalp block in awake craniotomy in a patient with a lesion in the motor cortex. Facial nerve palsy has been described as a rare complication of scalp block and is less reported

Intraoperative magnetic resonance imaging for neurosurgery – An anaesthesiologist's challenge

Intraoperative magnetic resonance imaging (MRI)-guided neurosurgery has gained popularity over the years globally. These surgeries require a dedicated operating room and MRI-compatible anaesthesia equipment. The anaesthesiologist providing care in this setup needs to be experienced and vigilant to ensure patient safety. Strict adherence to MRI safety checklists and regular personnel training would avoid potential accidents and life-threatening emergencies. Teamwork, good communication, preprocedure planning, and familiarity with the surroundings are very important for safe care and good outcomes. We performed a literature search in Google Scholar, PubMed and Cochrane databases for original and reviewed articles for the origins, development and applications of intraoperative MRI in neurosurgical procedures. Much of the research has emphasised on the surgical indications than the anaesthetic challenges faced during intraoperative MRI guided surgery. The purpose of this review is to discuss the anaesthetic concerns specific to this unique environment