Skip to main content
SpringerLink
Log in

Indication for Evoked Potential Monitoring: A Surgical View

  • Chapter
Central Nervous System Monitoring in Anesthesia and Intensive Care

Abstract

Evoked potentials (EP) have proven to be a useful diagnostic tool in clinical neurophysiology. They can be used to establish objective evidence of an abnormality when clinical signs and symptoms are equivocal or when the patient is not able to co-operate. They may also give evidence of “silent” or “subclinical” lesions, which are electrical abnormalities in a pathway when clinical function seems to be normal. Moreover, EP can help to define the anatomical level of a lesion. Although pathologic potentials do not reflect a certain disease, the relationship between clinical signs and changes in amplitudes, latencies, and wave shapes can give the clinician some hints to assess the general category of pathology, e.g., demyelinating versus compressive disorders. Finally, EP may be used on the intensive care unit for prognostic evaluation of comatose patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

References

  1. Agnew WF, McCreery DB (1987) Considerations for safety in the use of extracranial stimulation for motor evoked potentials. Neurosurgery 20:143–147

    Article  PubMed  CAS  Google Scholar 

  2. Allen A, Starr A, Nudleman K (1981) Assessment of sensory function in the operating room utilizing cerebral evoked potentials: a study of fifty-six surgically anesthetized patients. Clin Neurosurg 28:457–482

    PubMed  CAS  Google Scholar 

  3. Barker AT, Freeston IL, Jalinous R, Jarratt JA (1988) Magnetic and electrical stimulation of the brain: safety aspects. In: Rossini PM, Marsden CD (eds) Noninvasive stimulation of brain and spinal cord. Liss, New York, pp 131–144

    Google Scholar 

  4. Barker AT, Jalinous R, Freeston IL (1985) Non-invasive magnetic stimulation of the human motor cortex. Lancet 1:1106–1107

    Article  PubMed  CAS  Google Scholar 

  5. Beradelli A, Inghilleri M, Cruccu G, Manfredi M (1991) Corticospinal potentials after electrical and magnetic stimulation in man. In: Levy WJ et al. (eds) Magnetic motor stimulation. Basic principles and clinical experience (EEG Suppl 43). Elsevier, Amsterdam, pp 147–154

    Google Scholar 

  6. Boyd SG, Rothwell JC, Cowan JMA, Webb PJ, Morley T (1986) A method of monitoring functions in corticospinal pathways during scoliosis surgery with a note on motor conduction velocities. J Neurol Neurosurg Psychiatry 49:251–257

    Article  PubMed  CAS  Google Scholar 

  7. Breitner S, Matzen KA (1985) Scalp recorded somatosensory evoked potentials during spinal surgery. In: Schramm J, Jones SJ (eds) Spinal cord monitoring. Springer, Berlin Heidelberg New York, pp 173–178

    Chapter  Google Scholar 

  8. Brown RH, Nash CL (1984) Implementation and evaluation of intraoperative somatosensory cortical potential - procedures and pitfalls. In: Homma S, Tamaki T (eds) Fundamental and clinical application of spinal cord monitoring. Saikon, Tokyo, pp 373–384

    Google Scholar 

  9. Cedzich C, Schramm J, Fahlbusch R (1987) Are flash-evoked visual potentials useful for intraoperative monitoring of visual pathway function? Neurosurgery 21:709–715

    Article  PubMed  CAS  Google Scholar 

  10. Cedzich C, Schramm J, Mengedoht CF, Fahlbusch R (1988) Factors that limit the use of flash visual evoked potentials for surgical monitoring. Electroencephalogr Clin Neurophysiol 71:142–145

    Article  PubMed  CAS  Google Scholar 

  11. Costa e Silva J, Wang AD, Symon L (1985) The application of flash visual evoked potentials during operations on the anterior visual pathways. Neurol Res 7:11–16

    PubMed  Google Scholar 

  12. Coyer PE, Simeone FA, Michele J (1981) Latency of the cortical component of the somatosensory evoked potential in relation to cerebral blood flow measured in the white matter of the cat during focal ischemia Neurosurgery 4:497–502

    Google Scholar 

  13. Croft TJ, Brodkey JS, Nulsen FE (1972) Reversible spinal cord trauma: a model for electrical monitoring of spinal cord function. J Neurosurg 36:402–406

    Article  PubMed  CAS  Google Scholar 

  14. Date M, Schmid U, Hess CW, Schmid J (1991) Influence of peripheral nerve stimulation of the responses in small hand muscles to transcranial magnetic cortex stimulation. In: Levy WJ, Cracco AT, Barker AT, Rothwell J (eds) Magnetic motor stimulation: basic principles and clinical experience. Elsevier, Amsterdam, pp 212–223

    Google Scholar 

  15. Dinner DS, Lueders H, Lesser RP, Morris HH, Barne HG, Klem G (1986) Intraoperative spinal somatosensory evoked potential monitoring. J Neurosurg 65:807–414

    Article  PubMed  CAS  Google Scholar 

  16. Edmonds HL, Paloheimo MP J, Backman MH, Johnson JR, Holt RT, Shields CB (1989) Transcranial magnetic motor evoked potentials (tcMEP) for functional monitoring of motor pathways during scoliosis surgery. Spine 14:683–686

    Article  PubMed  Google Scholar 

  17. Fehlings MG, Tator CH, Linden RD, Piper IR (1987) Motor evoked potentials recorded from normal and spinal cord-injured rats. Neurosurgery 20:125–130

    Article  PubMed  CAS  Google Scholar 

  18. Friedman WA, Kaplan BJ, Gravenstein D, Rhoton AL (1985) Intraoperative brain-stem auditory evoked potentials during posterior fossa microvascular decompression. J Neurosurg 62:552–557

    Article  PubMed  CAS  Google Scholar 

  19. Friedman WA, Kaplan BL, Day AL, Sypert GW, Curran MT (1981) Evoked potential monitoring during aneurysm operation: observations after fifty cases. Neurosurgery 20:678–687

    Article  Google Scholar 

  20. Ginsburg HH, Shetter AG, Raudzens PA (1985) Postoperative paraplegia with preserved intraoperative somatosensory evoked potentials. J Neurosurg 63:296–300

    Article  PubMed  CAS  Google Scholar 

  21. Goddard GV, Mclntyre DC, Leech CK (1969) A permanent change in brain function resulting from daily electrical stimulation. Exp Neurol 25:295–330

    Article  PubMed  CAS  Google Scholar 

  22. Grundy BL (1983) Electrophysiologic monitoring: EEG and evoked potentials. In: Newfield P, Cottrell J (eds) Manual of Neuroanesthesia. Little Brown, Boston, pp 28–59

    Google Scholar 

  23. Hacke W, Hündgen R, Zeumer H, Ferbert A, Buchner H (1985) Überwachung der therapeutischen neurologischen Untersuchungs- und Therapieverfahren mittels evozierten Potentialen. Z EEG EMG 16:93–100

    CAS  Google Scholar 

  24. Hicks RG, Burke DJ, Stephen JPH (1991) Monitoring spinal cord function during scoliosis surgery with Cotrel-Dubousset instrumentation. Med J Aust 154:82–86

    PubMed  CAS  Google Scholar 

  25. Homma S, Tamaki T (eds) (1984) Fundamental and clinical application of spinal cord monitoring. Saikon, Tokyo

    Google Scholar 

  26. Horwitz NH, Rizzoli HV (1982) Postoperative complications of intracranial neurological surgery. Williams and Wilkins, Baltimore, pp 55–100, 132–141

    Google Scholar 

  27. Hughes JR, Fino J, Sagnon L (1984) A comparison of flash and pattern evoked potentials in patients with demyelinating disease and in normal controls. In: Nodar RH, Colin B (eds) Evoked potentials II. Butterworth, Boston, pp 302–309

    Google Scholar 

  28. Jellinek D, Jewkes D, Symon L (1991) Noninvasive intraoperative monitoring of motor evoked potentials under propofol anesthesia: effects of spinal surgery on the amplitude and latency of motor evoked potentials. Neurosurgery 29:551–557

    Article  PubMed  CAS  Google Scholar 

  29. Jellinek D, Platt M, Jewkes D, Symon L (1991) Effects of nitrous oxide on motor evoked potentials reduced from sceletal muscle in patients under total anesthesia with intravenously administered propofol. Neurosurgery 29:558–562

    Article  PubMed  CAS  Google Scholar 

  30. Jones SJ, Carter L, Edgar MA, Morley T, Ransford AO, Webb PJ (1985) Experience of epidural spinal cord monitoring in 410 cases. In: Schramm J, Jones SJ (eds) Spinal cord monitoring. Springer, Berlin Heidelberg New York, pp 215–220

    Chapter  Google Scholar 

  31. Jones SJ, Howard L, Shakwat F (1988) Criteria for detection and pathological significance of response decrement during spinal cord monitoring. In: Ducker TL, Brown RH (eds) Neurophysiology and standards in spinal cord monitoring. Springer, Berlin Heidelberg New York, pp 201–206

    Chapter  Google Scholar 

  32. Keller BP, Haghighi SS, Oro JJ, Eggers GWN (1992) The effects of propofol anesthesia on transcortical electric evoked potentials in the rat. Neurosurgery 30:557–560

    Article  PubMed  CAS  Google Scholar 

  33. Kitagawa H, Itoh T, Takano H, Takekuwa K, Yamamoto N, Yamada H (1989) Motor evoked potential monitoring during upper cranial spine surgery. Spine 14:1078–1083

    Article  PubMed  CAS  Google Scholar 

  34. Koht A (1988) Anesthesia and evoked potentials: an overview. Int J Clin Monit Comput 5:167–173

    Article  PubMed  CAS  Google Scholar 

  35. Koshino K, Kuroda R, Mogani H, Takimoto H (1978) Flashing diode evoked responses for detecting optic nerve function during surgery. Med J Osaka Univ 29:39–47

    PubMed  CAS  Google Scholar 

  36. Lesser RP, Raudzens PA, Lueders H, Nuwer MR, Goldie WB, Morris HH, Dinner DS, Klem G, Hahn JF, Shetter AG, Ginsburg HH, Gurd AR (1986) Postoperative neurological deficits may occur despite unchanged intraoperative somatosensory evoked potentials. Ann Neurol 19:22–25

    Article  PubMed  CAS  Google Scholar 

  37. Levy W (1983) Spinal cord potentials from the motor tracts. J Neurosurg 58:38–44

    Article  PubMed  CAS  Google Scholar 

  38. Levy WJ (1987) Clinical experience with motor and cerebellar evoked potential monitoring. Neurosurgery 20:169–182

    PubMed  Google Scholar 

  39. Levy WJ, McCaffrey M, York D (1986) Motor evoked potential in cats with acute spinal cord injury. Neurosurgery 19:9–19

    Article  PubMed  CAS  Google Scholar 

  40. Little JR, Lesser RP, Lueders H (1987) Electrophysiological monitoring during basilar aneurysm operation. Neurosurgery 20:421–427

    Article  PubMed  CAS  Google Scholar 

  41. Little JR, Lesser RP, Lueders H, Farlan AJ (1983) Brain stem auditory evoked potentials in posterior circulation surgery. Neurosurgery 12:496–502

    Article  PubMed  CAS  Google Scholar 

  42. Maccabee PJ, Levine DB, Pinkhasov EI, Cracco RQ, Tsairis P (1983) Evoked potentials recorded from scalp and spinous processes during spinal column surgery. Electroencephalogr Clin Neurophysiol 56:569–582

    Article  PubMed  CAS  Google Scholar 

  43. Matsuda H, Shimazu A (1989) Intraoperative spinal cord monitoring using electric responses to stimulation of caudal spinal cord or motor cortex. In: Desmedt JE (ed) Neuromonitoring in surgery. Elsevier, Amsterdam, pp 175–190

    Google Scholar 

  44. McWilliam RC, Conner AN, Pollock JCS (1985) Cortical somatosensory evoked potentials during surgery of scoliosis and coarctation of the aorta. In: Schramm J, Jones SJ (eds) Spinal cord monitoring. Springer, Berlin Heidelberg New York, pp 167–172

    Chapter  Google Scholar 

  45. Merton PA, Morton HB (1980) Stimulation of the cerebral cortex in the intact human subject. Nature 285:227

    Article  PubMed  CAS  Google Scholar 

  46. Moller AT, Jannetta PJ (1991) Compound action potentials recorded intracranially from the auditory nerve in man. Exp Neurol 74:862–874

    Article  Google Scholar 

  47. Momma F, Wang AD, Symon L (1987) Effects of temporary arterial occlusions on somatosensory evoked response in anerysm surgery. Surg Neurol 27:343–352

    Article  PubMed  CAS  Google Scholar 

  48. Narayan PV, Gilmour MP, Lloyd AJ, Dahn MS, King SD (1985) An assessment of the variability of early scalp-components of the somatosensory evoked response in uncomplicated, unshunted carotid endarterectomy. Clin Electroenc 3:157–160

    Google Scholar 

  49. Nash CL, Brodkey JS (eds) (1977) Proceedings: clinical application of spinal cord monitoring for operative treatment of spinal diseases. Case Western Reserve University, Cleveland

    Google Scholar 

  50. Nash CL, Brown RH (1989) Current concepts review. Spinal cord monitoring. J Bone Joint surg 71:627–630

    PubMed  Google Scholar 

  51. Nash CL, Brown RH (eds) (1979) Proceedings: spinal cord monitoring workshop. Case Western Reserve University, Cleveland

    Google Scholar 

  52. Nogueira MC, Brunko E, Vandesteen A, De Rood M, Zegers de Beyl D (1989) Differential effects of isoflurane on SEP recorded over parietal and frontal scalp. Neurology 39:1210–1215

    PubMed  CAS  Google Scholar 

  53. Nuwer MR (1986) Evoked potential monitoring in the operating room. Raven, New York, pp 1–4

    Google Scholar 

  54. Owen JH, Jenny AB, Naito M, Weber K, Bridwell KH, McGhee R (1989) Effects of spinal cord lesioning on somatosensory and neurogenic-motor evoked potentials. Spine 914:673–682

    Article  Google Scholar 

  55. Owen JH, Naito M, Bridwell KH, Oakley DM (1990) Relationship between duration of spinal cord ischemia and postoperative neurological deficits in animals. Spine 15:846–851

    Article  PubMed  CAS  Google Scholar 

  56. Pelosi L, Caruso G, Balbi P (1988) Characteristics of spinal potentials to transcranial motor cortex stimulation: intraoperative recording. In: Rossini PM, Marsden CD (eds) Non-invasive stimulation of brain and spinal cord. Liss, New York, pp 297–304

    Google Scholar 

  57. Raudzens PA (1982) Intraoperative monitoring of evoked potentials. Ann NY Acad Sci 388:308–326

    Article  PubMed  CAS  Google Scholar 

  58. Raudzens PA, Shetter AG (1982) Intraoperative monitoring of brain-stem auditory evoked potentials. J Neurosurg 57:341–348

    Article  PubMed  CAS  Google Scholar 

  59. Romstock J, Watanabe E, Schramm J (1988) Variability of epidural SEP from below and above spinal cord lesions - the effect of the lesion on spinal SEP. In: Ducker TL, Brown RH (eds) Neurophysiology and standards of spinal cord monitoring. Springer, Berlin Heidelberg New York, pp 261–267

    Chapter  Google Scholar 

  60. Rosenberg JNC (1991) Somatosensory and magnetic evoked potentials in a postoperative paraparetic patient: case report. Arch Phys Med Rehabil 72:154–156

    PubMed  CAS  Google Scholar 

  61. Salzman SK, Dobney KW, Mendez AA, Beauchamp JT, Daley JC, Freemen GM (1988) The somatosensory evoked potential predicts neurologic deficits and serotonergic pathochemistry after spinal distraction injury in experimental scoliosis. J Neurotrauma 5:173–186

    Article  PubMed  CAS  Google Scholar 

  62. Schmid UB, Boll J, Liechti S, Schmid J, Hess CW (1992) Influence of some anesthetic agents on muscle responses to transcranial magnetic cortex stimulation: a pilot study in humans. Neurosurgery 30:85–92

    Article  PubMed  CAS  Google Scholar 

  63. Schramm J (1985) Spinal cord monitoring: current status and new developments. CNS trauma 2:207–225

    CAS  Google Scholar 

  64. Schramm J (1988) Acute evoked potential changes in operative treatment: a summary. In: Ducker TL, Brown HR (eds) Neurophysiology and standards of spinal cord monitoring. Springer, Berlin Heidelberg New York, pp 268–273

    Chapter  Google Scholar 

  65. Schramm J (1989) Intraoperative monitoring with evoked potentials in cerebral vascular surgery and posterior fossa surgery. In: Desmeth JE (ed) Neuromonitoring in surgery. Elsevier Science, Amsterdam, pp 243–262

    Google Scholar 

  66. Schramm J, Jones SJ (eds) (1985) Spinal cord monitoring. Springer, Berlin Heidelberg New York

    Google Scholar 

  67. Schramm J, Koht A, Schmid G, Pechstein U, Taniguchi M, Fahlbusch R (1990) Surgical and electrophysical observations during clipping of 134 aneurysms with evoked potential monitoring. Neurosurgery 26:61–70

    Article  PubMed  CAS  Google Scholar 

  68. Schramm J, Kurthen M (1992) Recent developments in neurosurgical spinal cord monitoring. Paraplegia 30:609–616

    Article  PubMed  CAS  Google Scholar 

  69. Schramm J, Romstock J, Watanabe E (1986) Intraoperatives Riickenmarkmonitor- ing: eigene Ergebnisse and Bestandsaufnahme. Z Orthop 124:671–682

    Article  Google Scholar 

  70. Schramm J, Watanabe E, Strauss C, Fahlbusch R (1989) Neurophysiologic monitoring in posterior fossa surgery. I. Technical principles, applicability and limitations. Acta Neurochir (Wien) 98:9–18

    Google Scholar 

  71. Shiau JS, Zappulla RA, Nieves J (1992) The effect of graded spinal cord injury on the extrapyramidal and pyramidal motor evoked potentials of the rat. Neurosurgery 30:76–84

    Article  PubMed  CAS  Google Scholar 

  72. Shimoji K, Tamaki T (eds) (1991) Spinal cord monitoring and electrodiagnosis. Springer, Berlin Heidelberg New York

    Google Scholar 

  73. Tamaki T, Takano H, Takakuwa K, Tsuji H, Nakayawa T, Imai I, Inooe S (1985) Assessment of the use of spinal cord evoked potentials in prognosis estimation of injured spinal cord. In: Schramm J, Jones SJ (eds) Spinal cord monitoring. Springer, Berlin Heidelberg New York, pp 221–226

    Chapter  Google Scholar 

  74. Taniguchi M, Cedzich C, Schramm J (1993) Modification of cortical stimulation for motor evoked potentials under general anesthesia: technical description. Neurosurgery 32:219–226

    Article  PubMed  CAS  Google Scholar 

  75. Taniguchi M, Miiller K, Rodel R, Schramm J (1992) Intraoperative monitoring of hearing function during acoustic neurinoma surgery using BAEP and CNAP from the eighth nerve. In: Tos M, Thomsen J (eds) Proceedings of the first international conference on acoustic neurinoma. Kugler, Amsterdam, pp 549–556

    Google Scholar 

  76. Taniguchi M, Nadstawek J, Pechstein U, Schramm J (1992) Total intravenous anesthesia for improvement of intraoperative monitoring of somatosensory evoked potentials during aneurysm surgery. Neurosurgery 31:891–897

    Article  PubMed  CAS  Google Scholar 

  77. Taniguchi M, Schramm J (1991) Motor evoked potentials facilitated by an additional peripheral nerve stimulation. In: Levy WJ et al. (eds) Magnetic motor stimulation: basic principles and clinical experience (EEG Suppl 43). Elsevier, Amsterdam, pp 202–211

    Google Scholar 

  78. Taniguchi M, Schramm J, Cedzich C (1991) Recording of myogenic motor evoked potentials (mMEP) under general anesthesia. In: Schramm J, Moller AR (eds) Intraoperative electrophysiological monitoring. Springer, Berlin Heidelberg New York, pp 72–87

    Chapter  Google Scholar 

  79. Thompson PD, Day BL, Crockard HA, Caldler I, Murray NMF, Rothwell JC (1991) Intraoperative recording of motor tract potentials at the cervico-medullary junction following scalp electrical and magnetic stimulation of the motor cortex. J Neurol Neurosurg Psychiatry 54:618–623

    Article  PubMed  CAS  Google Scholar 

  80. Tsubokawa T, Yamamoto T, Hirayama T, Maejima S, Katayama Y (1986) Clinical application of corticospinal evoked potentials as a monitor of pyramidal function. Nikon Univ J Med 28:27–37

    Google Scholar 

  81. Veilleux M, Daube JR, Cucchiara RF (1987) Monitoring of cortical evoked potentials during surgical procedures on the cervical spine. Mayo Clin Proc 62:256–264

    PubMed  CAS  Google Scholar 

  82. Watanabe E, Schramm J, Strauss C, Fahlbusch R (1989) Neurophysiologic monitoring in posterior fossa surgery. II. BAEP-waves I and V and preservation of hearing. Acta Neurochir (Wien) 98:118–128

    Google Scholar 

  83. Wilson WB, Kirsch WM, Neville H, Stears J, Feinsod M, Lehrmann RAW (1976) Monitoring of visual function during parasellar surgery. Surg Neurol 5:323–329

    PubMed  CAS  Google Scholar 

  84. Zentner J (1989) Noninvasive motor evoked potential monitoring during neurosurgical operations on the spinal cord. Neurosurgery 24:709–712

    Article  PubMed  CAS  Google Scholar 

  85. Zentner J (1991) Motor evoked potential monitoring during neurosurgical operations on the spinal cord. Neurosurg Rev 14:29–36

    PubMed  CAS  Google Scholar 

  86. Zentner J (1991) Motor evoked potential monitoring in operations on the brain stem and posterior fossa. In: Schramm J, Moller AR (eds) Intraoperative electrophysiological monitoring. Springer, Berlin Heidelberg New York, pp 95–105

    Chapter  Google Scholar 

  87. Zentner J, Albrecht T, Heuser D (1992) Influence of halothane, enflurane, and isoflurane on motor evoked potentials. Neurosurgery 31:298–305

    Article  PubMed  CAS  Google Scholar 

  88. Zentner J, Ebner A (1989) Nitrous oxide suppresses the electromyographic response evoked by electrical stimulation of the motor cortex. Neurosurgery 24:60–62

    Article  PubMed  CAS  Google Scholar 

  89. Zileli M, Taniguchi M, Cedzich C, Schramm J (1989) Vestibulospinal evoked potential versus motor evoked potential monitoring in experimental spinal cord injuries in cats. Acta Neurochir (Wien) 101:141–148

    Article  CAS  Google Scholar 

  90. Zornow MH, Drummond JC (1989) Intraoperative somatosensory evoked responses recorded during onset of the anterior spinal artery syndrome. J Clin Monit 5:243–346

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. J. Zentner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Schramm
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, University Hospital Eppendorf, University of Hamburg, Martinistrasse 52, 20246, Hamburg, Germany

    J. Schulte am Esch  & E. Kochs  & 

Rights and permissions

Reprints and permissions

Copyright information

© 1986 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Zentner, J., Schramm, J. (1986). Indication for Evoked Potential Monitoring: A Surgical View. In: Schulte am Esch, J., Kochs, E. (eds) Central Nervous System Monitoring in Anesthesia and Intensive Care. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-78441-5_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-78441-5_11

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-78443-9

  • Online ISBN: 978-3-642-78441-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation