Basis of Intraoperative Neurophysiological Monitoring

Chapter

Abstract

Intraoperative neurophysiological monitoring is often associated with reducing the risk of postoperative neurological deficits in operations where the nervous system is at risk of being permanently injured. While the main use of electrophysiological methods in the operating room may be for reducing the risk of postoperative neurological deficits, electrophysiological methods are now in increasing use for other purposes. For example, electrophysiological methods are now regarded a necessity for guidance in placement of electrodes for deep brain stimulation (DBP) or for making lesions in specific structures for treating movement disorders and pain. Intraoperative electrophysiological recordings can also help the surgeon in carrying out other surgical procedures. Finding specific neural tissue such as cranial nerves or specific regions of the cerebral cortex are examples of tasks that are included in the subspecialty of intraoperative neurophysiological monitoring. Neurophysiological methods are increasingly used for diagnostic support in operations such as those involving peripheral nerves. In certain operations, intraoperative neurophysiology can increase the likelihood of achieving the therapeutical goal of an operation. Intraoperative neurophysiological recordings have shown to be of help identifying the offending blood vessel in a cranial nerve disorder (hemifacial spasm, HFS).

Keywords

Ischemia 

References

  1. 1.
    Brown RH and CL Nash (1979) Current status of spinal cord monitoring. Spine 4:466–78.CrossRefPubMedGoogle Scholar
  2. 2.
    Grundy B (1983) Intraoperative monitoring of sensory evoked potentials. Anesthesiology 58:72–87.CrossRefPubMedGoogle Scholar
  3. 3.
    Grundy B (1985) Evoked potentials monitoring, in Monitoring in Anesthesia and Critical Care Medicine, C Blitt, Editor. Churchill-Livingstone: New York. 345–411.Google Scholar
  4. 4.
    Raudzens PA (1982) Intraoperative monitoring of evoked potentials. Ann. N. Y. Acad. Sci. 388:308–26.CrossRefPubMedGoogle Scholar
  5. 5.
    Jako G (1965) Facial nerve monitor. Trans. Am. Acad. Ophthalmol. Otolaryngol. 69:340–2.Google Scholar
  6. 6.
    Rand RW and TL Kurze (1965) Facial nerve preservation by posterior fossa transmeatal microdissection in total removal of acoustic tumours. J. Neurol. Neurosurg. Psychiatry 28:311–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Møller AR and PJ Jannetta (1984) Preservation of facial function during removal of acoustic neuromas: use of monopolar constant voltage stimulation and EMG. J. Neurosurg. 61:757–60.CrossRefPubMedGoogle Scholar
  8. 8.
    House J and D Brackmann (1985) Facial nerve grading system. Otolaryngol. Head Neck Surg. 93:146–67.PubMedGoogle Scholar
  9. 9.
    Sekhar LN and AR Møller (1986) Operative management of tumors involving the cavernous sinus. J. Neurosurg. 64:879–89.CrossRefPubMedGoogle Scholar
  10. 10.
    Møller AR (1987) Electrophysiological monitoring of cranial nerves in operations in the skull base, in Tumors of the Cranial Base: Diagnosis and Treatment, LN Sekhar and VL Schramm Jr, Editors. Futura Publishing Co: Mt. Kisco, New York. 123–32.Google Scholar
  11. 11.
    Yingling C (1994) Intraoperative monitoring in skull base surgery, in Neurotology, RK Jackler and DE Brackmann, Editors. Mosby: St. Louis. 967–1002.Google Scholar
  12. 12.
    Deletis V (1993) Intraoperative monitoring of the functional integrety of the motor pathways, in Advances in Neurology: Electrical and Magnetic Stimulation of the Brain, O Devinsky, A Beric and M Dogali, Editors. Raven Press: New York. 201–14.Google Scholar
  13. 13.
    Prass RL and H Lueders (1986) Acoustic (loudspeaker) facial electromyographic monitoring. Part I. Neurosurgery 392–400.CrossRefPubMedGoogle Scholar
  14. 14.
    Kline DG and DJ Judice (1983) Operative management of selected brachial plexus lesions. J. Neurosurg. 58:631–49.CrossRefPubMedGoogle Scholar
  15. 15.
    Møller AR and PJ Jannetta (1987) Monitoring facial EMG during microvascular decompression operations for hemifacial spasm. J. Neurosurg. 66:681–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Haines SJ and F Torres (1991) Intraoperative monitoring of the facial nerve during decompressive surgery for hemifacial spasm. J. Neurosurg. 254–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Møller AR and PJ Jannetta (1985) Microvascular decompression in hemifacial spasm: intraoperative electrophysiological observations. Neurosurgery 16:612–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Deletis V and JL Shils (2004) Neurophysiology in Neurosurgery. Amsterdam: Academic Press.Google Scholar
  19. 19.
    Shils JL, M Tagliati and RL Alterman (2002) Neurophysiological monitoring during neurosurgery for movement disorders, in Neurophysiology in Neurosurgery, V Deletis and JL Shils, Editors. Academic Press: Amsterdam. 405–48.CrossRefGoogle Scholar
  20. 20.
    Penfield W and E Boldrey (1937) Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain 60:389–443.CrossRefGoogle Scholar
  21. 21.
    Ojemann GA, O Creutzfeldt, E Lettich et al (1988) Neuronal activity in human lateral temporal cortex related to short-term verbal memory, naming and reading. Brain 111:1383–403.CrossRefPubMedGoogle Scholar
  22. 22.
    Lenz FA, JO Dostrovsky, HC Kwan et al (1988) Methods for microstimulation and recording of single neurons and evoked potentials in the human central nervous system. J. Neurosurg. 68:630–4.CrossRefPubMedGoogle Scholar
  23. 23.
    Lenz FA, HC Kwan, RL Martin et al (1994) Single unit analysis of the human ventral thalamic nuclear group. Tremor-related activity in functionally identified cells. Brain 117:531–43.CrossRefPubMedGoogle Scholar
  24. 24.
    Lenz FA, JO Dostrovsky, RR Tasker et al (1988) Single-unit analysis of the human ventral thalamic nuclear group: somatosensory responses. J. Neurophysiol. 59:299–316.PubMedGoogle Scholar
  25. 25.
    Lenz FA and NN Byl (1999) Reorganization in the cutaneous core of the human thalamic principal somatic sensory nucleus (Ventral caudal) in patients with dystonia. J. Neurophysiol. 82:3204–12.PubMedGoogle Scholar
  26. 26.
    Ojemann GA (1988) Effect of cortical and subcortical stimulation on human language and verbal memory. Res. Publ. Assoc. Res. Nerv. Ment. Dis. 66:101–15.PubMedGoogle Scholar
  27. 27.
    Ojemann GA (1975) Language and the thalamus: object naming and recall during and after thalamic stimulation. Brain Lang. 2:101–20.CrossRefPubMedGoogle Scholar
  28. 28.
    Ojemann JG, GA Ojemann and E Lettich (1992) Neuronal activity related to faces and matching in human right nondominant temporal cortex. Brain 115:1–13.Google Scholar
  29. 29.
    Penfield W and T Rasmussen (1950) The Cerebral Cortex of Man: A Clinical Study of Localization of Function. New York: Macmillan.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.School of Brain and Behavioral SciencesThe University of Texas at DallasRichardsonUSA

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