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Intraoperative Neurophysiological Monitoring During Brainstem Surgery

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Brainstem Tumors

Abstract

Brainstem surgery is challenging due to the high concentration of essential neural structures such as cranial nerve nuclei, sensorimotor and auditory pathways, as well as the reticular formation. Therefore, even a small injury to the brainstem can hinder the functional integrity of one or more of these neural pathways and result in neurological deficits.

Intraoperative neurophysiology aims not merely to predict but also to prevent neurological injury, thanks to the tailored intraoperative use of standard clinical neurophysiological techniques such as electromyography, and somatosensory, brainstem auditory and motor evoked potentials. Monitoring these potentials allows to prevent an injury to the long pathways within the brainstem. In addition, mapping techniques provide functional identification of critical anatomical landmarks, whenever their visual identification is ambiguous, to select the safest entry route to the brainstem.

In this chapter we critically review the various intyraoperative mapping and monitoring techniques that can be used during surgery for lesions in the midbrain, pons, and medulla oblongata.

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Abbreviations

APB:

Abductor pollicis brevis

BAEPs:

Brainstem auditory evoked potentials

CMAP:

Compound muscle action potential

CSF:

Cerebrospinal fluid

CSTs:

Corticospinal tracts

DTI:

Diffusor tensor imaging

EMG:

Electromyography

ION:

Intraoperative neurophysiology

MEPs:

Motor evoked potentials

mMEP:

Muscle motor evoked potential

SSEPs:

Somatosensory evoked potentials

TA:

Tibialis anterior

TES:

Transcranial electrical stimulation

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Authors and Affiliations

  1. Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, Verona, Italy

    Francesco Sala & Alberto D’Amico

Authors
  1. Francesco Sala
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  2. Alberto D’Amico
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Correspondence to Francesco Sala .

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Editors and Affiliations

  1. Department of Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins University School of Medicine, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA

    George I. Jallo

  2. Department of Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins University School of Medicine, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA

    Mohammad Hassan A. Noureldine

  3. Institute of Neuroscience, Geisinger Medical Center, Geisinger Commonwealth School of Medicine, Danville, PA, USA

    Nir Shimony

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Sala, F., D’Amico, A. (2020). Intraoperative Neurophysiological Monitoring During Brainstem Surgery. In: Jallo, G., Noureldine, M., Shimony, N. (eds) Brainstem Tumors. Springer, Cham. https://doi.org/10.1007/978-3-030-38774-7_5

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  • DOI: https://doi.org/10.1007/978-3-030-38774-7_5

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