Intraoperatives Monitoring und Anästhesieeffekte

  • R. F. Ghaly
  • W. J. Levy
  • J. L. Stone


Die intraoperative Anwendung der transkraniellen Magnetstimulation als Instrument zum Monitoring basiert darauf, daß selbst bei anästhetisierten Patienten normale Muskelantworten nach Kortexstimulation eine intakte Funktion der kortikospinalen Bahnen anzeigen (Boyd et al. 1986; Levy 1987; Pelosi et al. 1987; Katayama et al. 1988; Edmonds et al. 1989; Kitagawa et al. 1989; Zenter 1989; Shields et al. 1990). Umgekehrt werden veränderte kortikal ausgelöste Muskelantworten als Hinweis für eine Schädigung der absteigenden motorischen Bahnen angesehen (Merton u. Morton 1980; Barker et al. 1987; Levy et al. 1984; Boyd et al. 1986; Amassian et al. 1987; Cracco 1987; Levy 1987; Pelosi et al. 1987; Thompson et al. 1987; York 1987; Dimitrijevic et al. 1988; Edmonds et al. 1989; King u. Chiappa 1989; Kitagawa et al. 1989; Zenter 1989; Booth et al. 1990; Dominkus et al. 1990; Dvorak et al. 1990b; Shields et al. 1990; Jones et al. 1991). Die Magnetstimulation bietet sich als Instrument für ein intraoperatives Monitoring an, da sie auch einen Nachweis subklinischer Läsionen zu erlauben scheint.


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  1. Agnew WF, McCreery DB (1987) Consideration for safety in the use of extracranial stimulation for motor evoked potentials. Neurosurgery 20: 143–147PubMedCrossRefGoogle Scholar
  2. Ammassian VE, Stewart M, Quirk GJ, Rosenthal JL (1987) Physiological basis of motor effects of a transient stimulus to cerebral cortex. Neurosurgery 20: 74–93Google Scholar
  3. Ammassian VE, Cracco RQ (1987) Human cerebral cortical responses to contralateral transcranial stimulation. Neurosurgery 20: 148–155Google Scholar
  4. Anderson T, Persson A, Siden A (1990) Somatosensory evoked potentials and transcutaneous cortical stimulation in the examination of central nervous dysfunction. Electroencephalogr Clin Neurophysiol 75: S3Google Scholar
  5. Bailey PL, Stanley TH (1990) Narcotic intravenous anesthesia. In: Miller RD (ed) Anesthesia. Churchill Livingstone, New York, pp 281–366Google Scholar
  6. Barker AT, Freeston IL, Jalinous R, Jarratt JA (1987) Magnetic stimulation of the human brain and peripheral nervous system: an introduction and the results of an initial clinical evaluation. Neurosurgery 20: 100–109PubMedCrossRefGoogle Scholar
  7. Ben-David B, Haller G, Taylor P (1987) Anterior spinal fusion complicated by paraplegia. A case report of a false negative somatosensory evoked potential. Spine 12: 536–539PubMedCrossRefGoogle Scholar
  8. Berardelli A, Inghilleri M, Cruccu G, Mercuri B, Manfredi M (1990) Transcranial stimulation (TCD) in hemiplegia. Electroencephalogr Clin Neurophysiol: S11Google Scholar
  9. Blacher RA (1975) On awakening paralyzed during surgery: a syndrome of traumatic neurosis. JAMA 234: 67PubMedCrossRefGoogle Scholar
  10. Booth KR, Streletz LJ, Herbison GJ, Hwang M, Cohen ME (1990) Motor evoked potentials as a predictor of motor recovery after spinal cord injury. Neurology 40 (Suppl 1): 612SGoogle Scholar
  11. Boyd SG, Rothwell JC, Cowan JM, Webb PJ, Morley T, Asselman P, Marsden CD (1986) A method of monitoring function in corticospinal pathways during scoliosis surgery with a note on motor conduction velocities. J Neurol Neurosurg Psychiat 49: 251–257PubMedCrossRefGoogle Scholar
  12. Caramia MD, Zarola F, Spadaro M, Pardal AM, Bernardi G (1988) Neurophysiologic testing of the central impulse propagation characteristics in patients with sensorimotor disorders. In: Rossini PM, Marsden CD (eds) Noninvasive stimulation of brain and spinal cord: fundamentals and clinical applications. Liss, New York, pp 193–206Google Scholar
  13. Chatrian GE, Berger MS, Wirch AL (1988) Discrepancy between intraoperative SSEPs and postoperative function: case report. J Neurosurg 69: 450–454PubMedCrossRefGoogle Scholar
  14. Claus D, Mills KR, Murray NMF (1988) Facilitation of muscle responses to magnetic brain stimulation by mechanical stimuli in man. Exp Brain Res 71: 273–278PubMedCrossRefGoogle Scholar
  15. Cowan JMA, Day BL, Marsden CD, Rothwell JC (1986) The effect of percutaneous motor cortex stimulation on H-reflexes in muscles of the arm and leg in intact man. J Physiol 377: 333–347PubMedGoogle Scholar
  16. Cracco RQ (1987) Evaluation of conduction in central motor pathways: techniques, pathophysiology, and clinical interpretation. Neurosurgery 20: 199–203PubMedCrossRefGoogle Scholar
  17. Dimitrijevic MR, Eaton WJ, Sherwood AM, Van der Linden C (1988) Assessment of corticospinal tract integrity in human chronic spinal cord injury. In: Rossini PM, Marsden CD (eds) Noninvasive stimulation of brain and spinal cord: fundamentals and clinical applications. Liss, New York, pp 243–253Google Scholar
  18. Dominikus M, Grisold W, Jelinek V (1990) Transcranial electrical motor evoked potentials as a prognostic indicator for motor recovery in stroke patients. J Neurol Neurosurg Psychiat 53: 745–748CrossRefGoogle Scholar
  19. Dubin S, Yodlowski E (1988) Effect of halothane on motor evoked potentials. Anesthesiology 69: A605CrossRefGoogle Scholar
  20. Dvorak J, Herdmann J, Janssen B, Theiler R, Grob D (1990) Motor evoked potentials in patients with cervical spine disorders. Spine 15: 1013–1016PubMedCrossRefGoogle Scholar
  21. Edmonds HL, Paloheimo MPJ, Backman MH, Johnson JR, Holt RT, Shields CB (1989) Transcranial magnetic motor evoked potentials (tcMMEP) for functional monitoring of motor pathways during scoliosis surgery. Spine 14: 683–686PubMedCrossRefGoogle Scholar
  22. Fehlings MG, Tator CH, Linden D, Piper IR (1987) Motor evoked potentials recorded from normal and spinal cord-injured rats. Neurosurgery 20: 125–130PubMedCrossRefGoogle Scholar
  23. Fehlings MG, Tator CH, Linden D, Piper IR (1988) Motor and somatosensory evoked potentials recorded from the rat. Electroencephalogr Clin Neurophysiol 69: 65–78PubMedCrossRefGoogle Scholar
  24. Fragen RJ, Avram MJ (1990) Barbiturates. In: Miller RD (ed) Anesthesia. Churchill Livingstone, New York, pp 225–242Google Scholar
  25. Gancher S, Laxer KD, Krieger W (1984) Activation of epileptogenic activity by etomidate. Anesthesiology 61: 616–618PubMedCrossRefGoogle Scholar
  26. Ghaly RF, Stone JL, Aldrete JA, Kartha RK (1989a) Transcranial magnetic-induced motor evoked potential: the technique and anesthetic effects. Proc IEEE Engineering in Medicine and Biology Society 11: 1573–1574Google Scholar
  27. Ghaly RF, Stone JL, Levy WJ (1989b) Effects of three anesthetic agents on electromyographic threshold and amplitude of responses after transcranial magnetic stimulation. J Clin Neurophysiol 6: 356–357Google Scholar
  28. Ghaly RF, Stone JL, Aldrete JA (1990a) Incremental dose-effect of ketamine on trans-cranial magnetic motor evoked potential: a primate study. J Neurosurg Anesthesiol 2: 79–85PubMedCrossRefGoogle Scholar
  29. Ghaly RF, Stone JL, Levy WJ, Aldrete JA, Kartha RK (1990b) The effect of nitrous oxide on transcranial magnetic-induced electromyographic responses in the monkey. J Neurosurg Anesthesiol 2: 175–181PubMedCrossRefGoogle Scholar
  30. Ghaly RF, Stone JL, Levy WJ, Roccaforte P, Brunner EB (1990c) The effect of etomidate on transcranial magnetic-induced motor evoked potentials in the monkey. Neurosurgery 27: 936–942PubMedCrossRefGoogle Scholar
  31. Ghaly RF, Stone JL, Aldrete JA (1990d) Effects of ketamine on electromyographic responses following transcranial magnetic stimulation in primates. In: Domino EF (ed) Status of ketamine in anaesthesiology. NPP, Ann Arbor MI, pp 193–197Google Scholar
  32. Ghaly RF, Stone JL, Levy WJ, Kartha RK, Aldrete JA, Brunner EA, Roccaforte P (1991a) The effect of an anesthetic induction dose of midazolam on motor potentials evoked by transcranial magnetic stimulation. J Neurosurg Anesthesiol 3: 20–27PubMedCrossRefGoogle Scholar
  33. Ghaly RF, Stone JL, Levy WJ, Kartha RK, Brunner EA, Aldrete JA, League R (1991b) The effect of neuroleptanalgesis (droperidol-fentanyl) on motor potentials evoked by transcranial magnetic stimulation in the monkey. J Neursurg Anesthesiol 3: 117–123CrossRefGoogle Scholar
  34. Ginsburg HH, Shetter AG, Raudzens PA (1985) Postoperative paraplegia with preserved intraoperative somatosensory evoked potentials: case report. J Neurosurg 63: 296–300PubMedCrossRefGoogle Scholar
  35. Grundy BL (1983) Intraoperative monitoring of sensory evoked potentials. Anesthesiology 58: 72–78PubMedCrossRefGoogle Scholar
  36. Grundy BL, Nash CL, Brown RH (1982) Deliberate hypotension for spinal fusion: prospective randomized study with evoked potential monitoring. Can Anesth Soc J 29: 452–461CrossRefGoogle Scholar
  37. Haghighi SS, Green KD, Oro JJ, Drake RK, Kracke GR (1990a) Depressive effect of isoflurane anesthesia on motor evoked potentials. Neurosurgery 26: 993–997PubMedCrossRefGoogle Scholar
  38. Haghighi SS, Madsen R, Green KD, Oro JJ, Kracke GR (1990b) Supression of motor evoked potentials by inhalation anesthetics. J Neurosurg Anesthesiol 2: 73–78PubMedCrossRefGoogle Scholar
  39. Haghighi SS, Oro JJ (1989) Effects of hypovolemic hypotensive shock on somatosensory and motor evoked potentials. Neurosurgery 24: 246–252PubMedCrossRefGoogle Scholar
  40. Hall JE, Levine CR, Sudhir KG (1978) Intraoperative awakening to monitor spinal cord function during Harrington instrumentation and spine fusion: description of procedure and report of three cases. J Bone Joint Surgery [Am] 60: 533Google Scholar
  41. Hitchon PW, Dyste GN, Osenbach RK, Jensen AE (1990) Response of spinal cord blood flow and motor and sensory evoked potentials to aortic ligation. Surg Neurol 34: 279–285PubMedCrossRefGoogle Scholar
  42. Hufnagel A, Christian EE, Marx W, Ising A (1990a) Magnetic motor evoked potentials in epilepsy: effects of the disease and of anticonvulsant medication. Ann Neurol 28: 680–686PubMedCrossRefGoogle Scholar
  43. Hufnagel A, Elger CE, Durwen HF et al. (1990b) Activation of the epileptic focus by transcranial magnetic stimulation of the human brain. Ann Neurol 27: 49–60PubMedCrossRefGoogle Scholar
  44. Jaskolski DJ, Jarratt JA, Jakubowski J (1989) Clinical evaluation of magnetic stimulation in cervical spondylosis. Br J Neurosurg 3: 541–548PubMedCrossRefGoogle Scholar
  45. Jaskolski DJ, Laing RJ, Jarratt JA, Jakubowski J (1990) Pre-and postoperative motor conduction times, measured using magnetic stimulation, in patients with cervical spondylosis. Br J Neurosurg 4: 187–192PubMedCrossRefGoogle Scholar
  46. Jones SM, Streletz LJ, Graziani V, Fernandez R, Belevich JK, Herbison GJ (1991) Motor evoked potentials and acute spinal cord injury: MEPs and clinical motor recovery. Neurology 41 [Suppl] 11: 376 PGoogle Scholar
  47. Katayama Y, Tsubokawa T, Maejima S, Hirayama T, Yamamoto T (1988) Corticospinal direct response in humans: identification of the motor cortex during intracranial surgery under general anesthesia. J Neurol Neurosurg Psychiat 51: 50–59PubMedCrossRefGoogle Scholar
  48. Kitagawa H, Itoh T, Takano H, Takakuwa K, Yamamoto N, Yamada H, Tsuij H (1989) Motor evoked potential monitoring during upper cervical spine surgery. Spine 14: 1078–1083PubMedCrossRefGoogle Scholar
  49. Jellinek DA, Symon L, Jewkes DA (1991) Changes in motor evoked potentials and conduction time in humans under propofol anaesthesia. J Physiol 434: 18 PGoogle Scholar
  50. King PJL, Chiappa KH (1989) Motor evoked potentials. In: Chiappa KH (ed) Evoked potentials in clinical medicine. Raven, New York, pp 509–561Google Scholar
  51. Koblin RD (1990) Mechanisms of action. In: Miller RD (ed) Anesthesia. Churchill Livingstone, New York, pp 51–83Google Scholar
  52. Konrad PE, Tacker WA, Levy WJ, Reedy P, Cook J, Geddes LA (1987) Motor evoked potentials in the dog: effects of global ischemia on spinal cord and peripheral nerve signals. Neurosurgery 20: 117–124PubMedGoogle Scholar
  53. Lesser RP, Raudzens P, Lueders H et al. (1986) Postoperative neurological deficits may occur despite unchanged intraoperative somatosensory evoked potentials. Ann Neurol 19: 22–25PubMedCrossRefGoogle Scholar
  54. Levy WJ (1987) Clinical experience with motor and cerebellar evoked potential monitoring. Neurosurgery 20: 169–182PubMedGoogle Scholar
  55. Levy WJ (1988) Use of motor evoked potential as a monitoring tool. In: Rossini PM, Marsden CD (eds) Non-invasive stimulation of brain and spinal cord: fundamentals and clinical applications. Liss, New York, pp 275–296Google Scholar
  56. Levy WJ, McCaffrey M, York D (1986) Motor evoked potentials in cats with acute spinal cord injury. Neurosurgery 19: 9–19PubMedCrossRefGoogle Scholar
  57. Levy WJ, McCaffrey M, Haghighi SS (1987) Motor evoked potentials as a predictor of recovery in chronic spinal cord injury. Neurosurgery 20: 138–142PubMedGoogle Scholar
  58. Levy WJ, York DH, McCaffrey M, Tanzer F (1984) Motor evoked potentials from transcranial stimulation of the motor cortex in humans. Neurosurgery 15: 287–302PubMedCrossRefGoogle Scholar
  59. Loughnan BA, Anderson SK, Hetreed MA, Weston PF, Boyd SG, Hall GM (1989) Effects of halothane on motor evoked potentials recorded in the extradural space. Br J Anesth 63: 561–564CrossRefGoogle Scholar
  60. McCaffrey M, Erickson JP (1987) Modulation of cat motor evoked potential by prior cerebellar or somatosensory stimulation. Neurosurgery 20: 193–194PubMedCrossRefGoogle Scholar
  61. Macdonnell RAL, Donnan GA, Bladin PF (1989) A comparison of somatosensory evoked and motor evoked potentials in stroke. Ann Neurol 25: 68–73CrossRefGoogle Scholar
  62. Maertens de Noordhout AM, Remade JM, Born JD, Delwaide PJ (1991) Magnetic stimulation of the motor cortex in cervical spondylosis. Neurology 41: 75–80PubMedGoogle Scholar
  63. Masur H, Eiger CE, Render K, Fahrendorf G, Ludolph AC (1989) Functional deficits of central sensory and motor pathways in patients with cervical spinal stenosis: a study of SEPs and EMG responses to non-invasive brain stimulation. Electroencephalogr Clin Neurophysiol 74: 450–457PubMedCrossRefGoogle Scholar
  64. Merton PA, Morton HB (1980) Stimulation of the cerebral cortex in the intact human subject. Nature 285: 227PubMedCrossRefGoogle Scholar
  65. Oro J, Levy WJ (1987) Motor evoked potential as a monitor of middle cerebral artery ischemia and stroke. Neurosurgery 20: 192–193PubMedCrossRefGoogle Scholar
  66. Owen JH, Jenny AB, Naito M, Weber K, Bridwell KH, McGhee (1989) Effects of spinal cord lesioning on somatosensory and neurogenic motor evoked potentials. Spine 14: 673–682PubMedCrossRefGoogle Scholar
  67. Owen JH, Laschinger J, Bridwell KH, Shimon S, Nielsen C, Dunlap J, Kain C (1988) Sensitivity and specificity of somatosensory and neurogenic motor evoked potentials in animals and humans. Spine 13: 1111–1118PubMedCrossRefGoogle Scholar
  68. Owen JH, Naito M, Bridwell KH (1990) Relationship among level of distraction, evoked potentials, spinal cord ischemia and integrity, and clinical status in animals. Spine 15: 852–857PubMedCrossRefGoogle Scholar
  69. Pardal AM, Nogues MA, Miguel MA (1990) SEPs and CNS magnetic stimulation in syringomyelia. Electroencephalogr Clin Neurophysiol 75: S114Google Scholar
  70. Pelosi L, Caruso G, Baldi P, Milano C, Paolino G, Lotti G (1987) Motor evoked potentials to transcranial electrical stimulation in man: intraoperative recordings along the spinal cord. Electroencephalogr Clin Neurophysiol 66: S79Google Scholar
  71. Peterson RE, Short LH, Morgan PD (1990) Anesthetic alterations of the neurogenic motor evoked potentials in swine. Anesthesiology 73: A202CrossRefGoogle Scholar
  72. Reyes JG, Glass PSA (1990) Nonbarbiturate intravenous anesthetics. In: Miller RD (ed) Anesthesia. Churchill Livingstone, New York, pp 243–279Google Scholar
  73. Rossini PM, Caramia MD, Zarola F (1987) Mechanisms of nervous propagation along central motor pathways: non-invasive evulation in healthy subjects and in patients with neurological disease. Neurosurgery 20: 183–191PubMedCrossRefGoogle Scholar
  74. Schönle PW, Isenberg C, Crozier TA, Dressler D, Machetanz J, Conrad B (1989) Changes of transcranially evoked motor responses in man by midazolam, a short acting benzodiazepine. Neurosci Lett 101: 321–324PubMedCrossRefGoogle Scholar
  75. Segura MJ, Gandolfo CN (1990) Central motor conduction in ischaemic and haemorrhagic cerebral lesions. Electromyogr Clin Neurophysiol 30: 41–45PubMedGoogle Scholar
  76. Shields CB, Paloheimo MPJ, Backman MH, Edmonds HL, Johnson JR (1990) Intraoperative use of transcranial magnetic motor evoked potentials. In: Chokroverty S (ed) Magnetic stimulation in clinical neurophysiology. Butterworth, Boston, pp 173–184Google Scholar
  77. Short LH, Peterson RE, Morgan PD (1990) Effects of physiologic alterations on neurogenie motor evoked potentials in swine. Anesthesiology 73: A207CrossRefGoogle Scholar
  78. Simpson RK, Baskin DS (1987) Corticomotor evoked potentials in acute and chronic blunt spinal cord injury in the rat: correlation with neurological outcome and histological damage. Neurosurgery 20: 131–137PubMedCrossRefGoogle Scholar
  79. Sloan TB (1991) Mild hypothermia alters cortical magnetic motor evoked potentials. Anesth Analg 72: S260Google Scholar
  80. Sloan TB, Erian R (1990a) Atracurium alters cortical magnetic motor evoked potentials. J Neurosurg Anesthesiol 2: 231CrossRefGoogle Scholar
  81. Sloan TB, Erian R (1990b) Vecuronium alters cortical magnetic motor evoked potentials. J Neurosurg Anesthesiol 2: 251CrossRefGoogle Scholar
  82. Sloan TB, Hickey R (1991) Alterations in ventilation does not alter the onset of cortical magnetic motor evoked potentials. Anesth Analg 72: S261Google Scholar
  83. Stone JL, Ghaly RF, Levy WJ, Krinisky L, Roccaforte P (1992) A comparative analysis of enflurane influence on primate motor and somatosensory evoked potentials. Electroencephalogr Clin Neurophysiol 84: 180–187PubMedCrossRefGoogle Scholar
  84. Strain GM, Prescott-Mathews JS, Tedford BL (1990) Motor potentials evoked by transcranial stimulation of the canine motor cortex. Prog Vet Neurol 1: 321–331Google Scholar
  85. Sudhir KG, Smith RM, Hall JE, Hansen DD (1976) Intraoperative awakening for early recognition of possible neurological sequalae during Harrington-rod spinal fusion. Anesth Analg 55: 526PubMedCrossRefGoogle Scholar
  86. Thompson PD, Dick JPR, Asselman P, Griffin GB, Day BL, Rothwell JC, Sheehy MP, Marsden CD (1987) Examination of motor function in lesions of the spinal cord by stimulation of the motor cortex. Ann Neurol 21: 389–396PubMedCrossRefGoogle Scholar
  87. Troni W, Cantello R, de Mattei M, Bergamini L (1988) Muscle responses elicited by cortical stimulation in the human hand: differential conditioning by activation of the propioceptive and exteroceptive fibers of the median nerve. In: Rossini PM, Marsden CD (eds) Non-invasive stimulation of brain and spinal cord: fundamentals and clinical applications. Liss, New York, pp 73–83Google Scholar
  88. Trop D (1986) Conscious-sedation analgesia during the neurosurgical treatment of epilepsies–practice at the Montreal Neurological Institute. Int Anesthesiol Clin 24: 175–184PubMedCrossRefGoogle Scholar
  89. Tung HC, Drummond JC, Bickford RG (1988) The effects of anesthetic and sedative agents on magnetic motor evoked responses. Anesthesiology 69: A313CrossRefGoogle Scholar
  90. Vauzelle C, Stagnara P, Jouvinroux P (1973) Functional monitoring of spinal cord activity during spinal surgery. Clin Orthop 93: 173–178PubMedCrossRefGoogle Scholar
  91. York DH (1987) Review of descending motor pathways involved with transcranial stimulation. Neurosurgery 20: 70–73PubMedCrossRefGoogle Scholar
  92. Zenter J (1989) Noninvasive motor evoked potential monitoring during neurosurgical operations on the spinal cord. Neurosurgery 24: 709–712CrossRefGoogle Scholar
  93. Zenter J, Ebner A (1989) Nitrous oxide suppresses the electromyographic response evoked by electrical stimulation of the motor cortex. Neurosurgery 24: 60–62CrossRefGoogle Scholar
  94. Zenter J, Kiss I, Ebner A (1989) Influence of anesthetics–nitrous oxide in particular-on electromyographic response evoked by transcranial electrical stimulation of the cortex. Neurosurgery 24: 253–256CrossRefGoogle Scholar

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© Springer-Verlag, Berlin Heidelberg 1992

Authors and Affiliations

  • R. F. Ghaly
  • W. J. Levy
  • J. L. Stone

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