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Artifact reduction by using alternating polarity stimulus pairs in intraoperative peripheral nerve action potential recording

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Abstract

Intraoperative nerve action potential (NAP) recording permits direct study of an injured nerve for functional assessment of lesions in continuity. Stimulus artifact contamination often hampers NAP recording and interferes with its interpretation. In the present study, we evaluated the artifact reduction method using alternating polarity in peripheral nerve recording. Our study was conducted under controlled conditions in laboratory animals. NAPs were recorded from surgically exposed median or ulnar nerves. For the artifact reduction method with alternating polarity, two sequential recordings, one with normal and one with reversed stimulus polarity, were acquired and the signals from this recording pair were averaged. Simulation was also performed to further evaluate the effects of alternating polarity on the waveforms. The results are as follows: First, we found that this method worked for recordings with unsaturated electrical stimulus artifacts. Second, slightly unequal latencies occurred in an NAP pair, and this inequality contributed to a minimal loss of NAP amplitudes when averaging the two recordings. Third, perfect artifact cancelation and minimal signal loss were also demonstrated by simulation. Finally, we applied the method during nerve inching and demonstrated its usefulness in intraoperative NAP recordings as the method made the recording more resilient to short conduction distances. Thus, our findings demonstrate that this artifact reduction method can be used as a supplemental tool together with our previously described bridge grounding technique or the nonlifting nerve recording configuration to further improve intraoperative peripheral nerve recording. The method can be applied in clinical settings.

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All authors made sure that all data and materials support the published claims and comply with field standards. All raw data will be available upon request.

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Acknowledgements

We thank Mr. Timothy V. Hartke for excellent technical support. We also thank the NIH grant support (Grant R01AR070875) and support from the Neurosurgery Pain Research Institute at the Johns Hopkins University.

Funding

NIH grant R01AR070875 (to MR), and support from the Neurosurgery Pain Research Institute, Department of Neurosurgery, School of Medicine, Johns Hopkins University.

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Authors and Affiliations

  1. Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21287, USA

    Gang Wu, Allan Belzberg & Matthias Ringkamp

  2. Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, 21287, USA

    Jessica Nance, Sergio Gutierrez-Hernandez & Eva K. Ritzl

Authors
  1. Gang Wu
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  2. Allan Belzberg
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  3. Jessica Nance
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  4. Sergio Gutierrez-Hernandez
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  5. Eva K. Ritzl
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  6. Matthias Ringkamp
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Gang Wu, and Matthias Ringkamp. The first draft of the manuscript was written by Gang Wu, and the manuscript was critically revised by Allan Belzberg, Eva K. Ritzl and Matthias Ringkamp. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gang Wu.

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Conflict of interest

GW and MR have electrode patent application pending.

Ethical approval

The study protocol (PR18M295) was approved by the Animal Care and Use Committee of the Johns Hopkins University.

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Wu, G., Belzberg, A., Nance, J. et al. Artifact reduction by using alternating polarity stimulus pairs in intraoperative peripheral nerve action potential recording. J Clin Monit Comput 35, 1467–1475 (2021). https://doi.org/10.1007/s10877-020-00613-9

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  • DOI: https://doi.org/10.1007/s10877-020-00613-9

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