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Evaluating the Benefits of Intraoperative Neurophysiological Monitoring

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Intraoperative Neurophysiological Monitoring

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Abstract

The benefits from monitoring that are aimed at reducing postoperative neurological deficits should be evaluated on their abilities to reduce the risk of iatrogenic injuries to the nervous system in patients who are operated upon and to improve the quality of medical care in general, as well as on their ability to provide economic savings in the service of evidence based medicine. Intraoperative monitoring of the facial nerve has been regarded as a standard of care in connection with surgical removal of vestibular schwannoma for many years (1). Investigators (Sala et al. 2002 (2)) have concluded that published studies provide sufficient evidence to recommend intraoperative monitoring as a standard of care in many kinds of surgical operations. After they surveyed various studies in the literature on outcome and complications, these authors recommend that monitoring be performed in operations on supratentorial CNS structures (tumors, aneurysms, etc.), brain stem tumors, intramedullary spinal cord tumors, conus and cauda equina tumors, rhizotomy for relief of spasticity and spina bifida with tethered cord.

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Notes

  1. 1.

    Evidence based medicine: process and use of relevant information from peer-reviewed clinical and epidemiologic research to address a specific clinical issue, and thereby weighing the attendant risks and benefits of diagnostic tests and therapeutic measures; literature to address a specific clinical problem; the application of simple rules of science and common sense to determine the validity of the information; and the application of the information to the clinical problem (Stedman’s Electronic Medical Dictionary).

  2. 2.

    The decibel scale is a logarithmic measure of ratios, such as the ratio between the amplitude of the output and that of the input; thus, it is a measure of attenuation or amplification. For voltage ratios it is defined as 20 log10 Eo/Ei, where Ei is the input voltage and Eo is the output voltage, an attenuation of 3 dB means that the output is 0.707 times the input, a 6 dB attenuation means that the output voltage is half of the input, a 10 dB attenuation means that the output is 0.3 of the input, a 20 dB attenuation means that the output is 0.1 of the input, and so on.

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Authors and Affiliations

  1. School of Brain and Behavioral Sciences, The University of Texas at Dallas, 800 W. Campbell Road, Richardson, TX, 75080, USA

    Aage R. Møller PhD (DMedSci)

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  1. Aage R. Møller PhD (DMedSci)
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Correspondence to Aage R. Møller PhD (DMedSci) .

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Møller, A.R. (2011). Evaluating the Benefits of Intraoperative Neurophysiological Monitoring. In: Intraoperative Neurophysiological Monitoring. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7436-5_19

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  • DOI: https://doi.org/10.1007/978-1-4419-7436-5_19

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-7435-8

  • Online ISBN: 978-1-4419-7436-5

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