Abstract
Peripheral nerves are often vulnerable to damage during surgeries, with risks of significant pain, loss of motor function, and reduced quality of life for the patient. Intraoperative methods for monitoring nerve activity are effective, but conventional systems rely on bench-top data acquisition tools with hard–wired connections to electrode leads that must be placed percutaneously inside target muscle tissue. These approaches are time and skill intensive and therefore costly to an extent that precludes their use in many important scenarios. Here we report a soft, skin-mounted monitoring system that measures, stores, and wirelessly transmits electrical signals and physical movement associated with muscle activity, continuously and in real-time during neurosurgical procedures on the peripheral, spinal, and cranial nerves. Surface electromyography and motion measurements can be performed non-invasively in this manner on nearly any muscle location, thereby offering many important advantages in usability and cost, with signal fidelity that matches that of the current clinical standard of care for decision making. These results could significantly improve accessibility of intraoperative monitoring across a broad range of neurosurgical procedures, with associated enhancements in patient outcomes.
Highlights
Injuries to peripheral nerves during surgical procedures constitute a significant source of morbidity and result in worsened quality of life for many patients.[1,2] Iatrogenic peripheral nerve damage is a common and devastating clinical entity that leads to significant pain and compromised functional outcomes.[2,3,4] For example, approximately 5% of patients undergoing arthroscopic hip repair suffer from transient neuropraxia.[5,6] Permanent damage to nerves is a well-known and debilitating health risk associated with peripheral, cranial, and spinal nerve access.[4]
Mechanics designs, and manufacturing methods establish the foundations for classes of thin, mechanically compliant electronic systems that enable multimodal sensing on the surface of the skin at nearly any body location.[17,18,19]
The result is a non-invasive, easy-to-use platform for capturing EMG and motion signals, with capabilities that reproduce the key functionalities of conventional, large-scale electronic platforms, which serve as the current clinical standard of care (Figs. 3, 4, Fig. S2)
Summary
Injuries to peripheral nerves during surgical procedures constitute a significant source of morbidity and result in worsened quality of life for many patients.[1,2] Iatrogenic peripheral nerve damage is a common and devastating clinical entity that leads to significant pain and compromised functional outcomes.[2,3,4] For example, approximately 5% of patients undergoing arthroscopic hip repair suffer from transient neuropraxia.[5,6] Permanent damage to nerves is a well-known and debilitating health risk associated with peripheral, cranial, and spinal nerve access.[4] In such cases, intraoperative monitoring techniques, primarily involving evoked potentials as well as stimulated and spontaneous electromyography (EMG), provide surgeons with the ability to identify and assess vulnerable nerve sites by probing nerve-muscle activities during surgery.[7,8,9,10,11,12] Real-time monitoring strategies offer a powerful set of capabilities for surgeons that can positively affect outcomes, but existing intraoperative systems are large, expensive, and cumbersome; they include data acquisition consoles coupled to sensing electrode leads via multiple, fixed electrical connections. This set of clinical limitations establishes a clear need for alternative intraoperative monitoring approaches
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