Methods of using nerve evoked potentials to monitor a surgical procedure

Patent metadata

Field	Value
Publication number	US-10105091-B2
Application number	US-201414205784-A
Country	US
Kind code	B2
Filing date	Mar 12, 2014
Priority date	Mar 12, 2013
Publication date	Oct 23, 2018
Grant date	Oct 23, 2018

Abstract

Methods for intra-operatively monitoring nerve evoked potentials such as somatosensory nerve evoked potentials during a surgical procedure. The methods include orthodromic and antidromic monitoring of nerve evoked potentials. Monitoring includes navigating the surgical pathway to avoid insult to anatomical tissue, minimizing activation of sensory nerves that result in undesirable side effects in a patient, and determining the suitable location for placement of an implantable medical device.

First claim

What is claimed is:

1. A method of implanting a neurostimulator in a patient's body comprising:
stimulating a stimulation site of the patient's body with an electrode having stimulation parameters;
obtaining a measurement of a somatosensory nerve evoked potential (SSEP) to determine whether the stimulation of the stimulation site elicits a SSEP in a nerve comprising sensory fibers that are responsible for the patient's perception of pain or discomfort at a recording site, the nerve propagating in an antidromic direction and innervating the recording site, the recording site located on the face, nasal cavity or mouth of the patient's body;
minimizing stimulation of the sensory fibers such that the patient's perception of pain or discomfort at the recording site is minimized by adjusting the stimulation parameters and/or the electrode position in response to the stimulation of the stimulation site eliciting SSEP;
determining an implantation site for the neurostimulator as suitable based on the minimizing and the measurement;
navigating a surgical pathway to the suitable implantation site; and
implanting the neurostimulator in the patient's body at the suitable implantation site.

2. The method of claim 1 , wherein stimulating the stimulation site of the patient's body comprises stimulating a stimulation site of the patient's autonomic nervous system.

3. The method of claim 2 , wherein the stimulation site is a sphenopalatine ganglion (SPG).

4. The method of claim 1 , wherein the suitable implantation site is within a pterygopalatine fossa (PPF).

5. The method of claim 1 , wherein the nerve is at least one of a superior labial nerve, a greater palatine nerve, a lesser palatine nerve, a posterior superior alveolar nerve, a zygomaticotemporal nerve, a nasopalatine nerve, a superior gingival branch, a superior dental plexus, a nasal branch of an infraorbital nerve, an anterior superior alveolar nerve, or an inferior palpebral branch.

6. The method of claim 1 , wherein the suitable implantation site is within the skull of the patient.

7. The method of claim 1 , wherein the suitable implantation site is within the maxillofacial region of the patient.

8. The method of claim 1 , wherein the somatosensory nerve evoked potential is measured in substantially real-time.

Assignees

• Cleveland Clinic Found
• Autonomic Tech Inc

Inventors

• Papay Francis A
• Hardage Mike
• Caparso Anthony V
• Pless Benjamin D

Classifications

• A61B5/4836 Primary

  Diagnosis combined with treatment in closed-loop systems or methods (A61B5/0036 takes precedence) · CPC title

• A61B5/4893

  Nerves · CPC title

• A61B5/388

  Nerve conduction study, e.g. detecting action potential of peripheral nerves · CPC title

• A61N1/08

  Arrangements or circuits for monitoring, protecting, controlling or indicating {(for external stimulators A61N1/3603; for implantable neurostimulators A61N1/36128; for heart stimulators A61N1/37; for defibrillators A61N1/3925)} · CPC title

• A61B5/04001

  Human Necessities · mapped topic