Advertisement

Evoked Potential Monitoring in Neurosurgical Practice

  • L. Symon
  • F. Momma
  • K. Schwerdtfeger
  • P. Bentivoglio
  • I. E. Costa E Silva
  • A. Wang
Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 14)

Abstract

The functions of the central nervous system are accurately reflected in the generation of electrical impulses. Modern electronic techniques have enabled us to record and analyse a vast number of electrical signals from the central and peripheral nervous system and to attempt a correlation of the form and consistency of these signals with a variety of disease states. For many years the principal effort in understanding the brain’s electrical signals lay in an attempt to unscramble the complexity of the electroencephalogram, and indeed immensely valuable advances in the understanding of the function of the nervous system was made by such efforts. From the neurosurgeon’s point of view, however, the greatest advance in electronic technology was the application of event related potentials, potentials which could be produced by an externally applied stimulus to a normal pathway, and the behavior of the central and peripheral nervous systems to such stimulation recurrently assessed. It is now possible to challenge the function of all the major afferent systems, somatosensory, visual, and auditory and to monitor their activity at various levels throughout the CNS. Increasing interest has now been shown in the evocation of motor activity by direct stimulation of the CNS and over the next few years we may expect increasing sophistication, both in the techniques for stimulation and of analysis which will render their application to neurosurgical circumstances both easier and more widespread.

Keywords

Conduction Time Acoustic Neuroma Cochlear Microphonic Potential Monitoring Median Nerve Stimulation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Adler G, Schwerdtfeger K, Kivelitz R, Nacimiento AC, Loew F (1983) The use of somatosensory and brain-stem evoked potentials for prognostic and localization purposes in the assessment of head injury. Acta Neurochir (Wien) 68: 155–156Google Scholar
  2. 2.
    Adler G, Schwerdtfeger K, Lange E, Kivelitz R, Nacimiento AC, Loew F (1985) The use of somatosensory visual and brain-stem auditory evoked potentials for prognostic and localization purposes in the assessment of head injury. In: Rizzo PA, Morocutti C (eds) Evoked potentials-neurophyiological and clinical aspects, Elsevier, (in press)Google Scholar
  3. 3.
    Allison T (1962) Recovery function of somatosensory responses in man. Electroencephalogr Clin Neurophysiol 14: 331–343PubMedCrossRefGoogle Scholar
  4. 4.
    Astrup J, Siesjö BK, Symon L (1981) Thresholds in cerebral ischemia—the ischemic penumbra. Stroke 12: 723–725PubMedCrossRefGoogle Scholar
  5. 5.
    Astrup J, Symon L, Branston NM, Lassen NA (1977) Cortical evoked potential and extracellular K + and H + at critical levels of brain ischemia. Stroke 8: 51–57PubMedCrossRefGoogle Scholar
  6. 6.
    Becker DP, Miller JD, Ward JD, Greenberg RP, Young HF, Sakalas R (1977) The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47: 491–502PubMedCrossRefGoogle Scholar
  7. 7.
    Bell BA, Symon L, Branston NM (1985) CBF and time threshold for the formation of ischemic cerebral edema, and effect of reperfusion in baboons. J Neurosurg 62: 31–41PubMedCrossRefGoogle Scholar
  8. 8.
    Branston NM, Strong A J, Symon L (1977) Extracellular potassium activity, evoked potential and tissue blood flow. J Neurol Sci 32: 305–328PubMedCrossRefGoogle Scholar
  9. 9.
    Branston NM, Symon L (1980) Cortical SEP, blood flow and potassium change in experimental ischemia. In: Barber D (ed) Evoked potentials. Lancaster, England MTP, pp 527–530Google Scholar
  10. 10.
    Branston NM, Symon L, Crockard HA, Pásztor E (1974) Relationship between the cortical evoked potential and local cortical blood flow following acute middle cerebral artery occlusion in the baboon. Exp Neurol 45: 195–208PubMedCrossRefGoogle Scholar
  11. 11.
    Brewer CC, Resnik DM (1984) The value of BAEP in assessment of the comatose patient. In: Nodar RH, Barber C (eds) Evoked potentials II Butterworth Publishers, Boston-London-Sydney-Wellington-Durban-Toronto, pp 578–581Google Scholar
  12. 12.
    Bruce DA, Gennarelli TA, Langfitt TW (1978) Resuscitation from coma due to head injury. Crit Care Med 6: 254–269PubMedCrossRefGoogle Scholar
  13. 13.
    Calvet J, Cathala HP, Hirsch J, Scherer J (1956) La response de l’homme étudiée par une méthode d’ integration. CR Soc Biol (Paris) 150: 1348–1351Google Scholar
  14. 14.
    Casler JA, Hoffman R, Berger L, Billinger TW, Sinus JK, Bickford RG (1973) Use of photo diode stimulations in clinical and experimental electroencephalography and electroretinography. Electroencephalogr Clin Neurophysiol 34: 437–439PubMedCrossRefGoogle Scholar
  15. 15.
    Ciganek L (1961) The EEG response (evoked potential) to light stimulus in man. Electroencephalogr Clin Neurophysiol 13: 165–172PubMedCrossRefGoogle Scholar
  16. 16.
    Cloward RB (1958) The anterior approach for removal of ruptured cervical discs. J Neurosurg 15: 602–617PubMedCrossRefGoogle Scholar
  17. 17.
    Costa e Silva IE, Wang AD, Symon L (1985) The applications of flash visual evoked potentials during operations on the anterior visual pathways. Neurol Res 7: 11–16Google Scholar
  18. 18.
    Desmedt JE, Cheron G (1980) Central somatosensory conduction in man: Neural generators and interpeak latencies of the far field components recorded from the neck and right and left scalp and earlobes. Electroencephalogr Clin Neurophysiol 50: 382–403PubMedCrossRefGoogle Scholar
  19. 19.
    Desmedt JE, Cheron G (1980) Somatosensory evoked potentials to finger stimulation in healthy octogenarians and in young adults: Wave forms, scalp topography and transit times of parietal and frontal components. Electroencephalogr Clin Neurophysiol 50: 404–425PubMedCrossRefGoogle Scholar
  20. 20.
    Feinsod M, Selhorst JB, Hoyt WF, Wilson WB (1976) Monitoring optic nerve function during craniotomy. J Neurosurg 44: 29–31PubMedCrossRefGoogle Scholar
  21. 21.
    Ferguson GG, Harper AM, Fitch W, Rowan JO, Jennett B (1972) Cerebral blood flow measurements after spontaneous subarachnoid hemorrhage. Eur Neurol 8: 15–22PubMedCrossRefGoogle Scholar
  22. 22.
    Fox JE, William B, 1984: Central conduction following surgery for cerebral aneurysm. J Neurol Neurosurg Psychiatry 47: 873–875PubMedCrossRefGoogle Scholar
  23. 23.
    Gennarelli TA, Spielman GM, Langfitt TW, Gildenberg PL, Harringtom T, Jane JA, Marshall LF, Miller JD, Pitts LH (1982) Influence of the type of intracranial lesion on outcome from severe head injury. J Neurosurg 56: 26–32PubMedCrossRefGoogle Scholar
  24. 24.
    Goldie WD, Chiappa KH, Young RR, Brooks EB (1981) Brainstem auditory and short-latency evoked responses in brain death. Neurology (NY) 31: 248–256Google Scholar
  25. 25.
    Greenberg RP, Becker DP, Miller JD, Mayer DJ (1977) Evaluation of brain function in severe head trauma with multimodality evoked potentials. Part 2, Localization of brain dysfunction and correlation with post-traumatic neurological conditions. J Neurosurg 47: 163–177PubMedCrossRefGoogle Scholar
  26. 26.
    Greenberg RP, Mayer DJ, Becker DP, Miller JD (1977) Evaluation of brain function in severe human head trauma with multimodality evoked potentials. Part 1, Evoked brain-injury potentials, methods, and analysis. J Neurosurg 47: 150–162PubMedCrossRefGoogle Scholar
  27. 27.
    Grubb RL Jr, Raichle ME, Eichling JO, Gado MH (1977) Effect of subarachnoid hemorrhage on cerebral blood volume, blood flow, and oxygen utilization in humans. J Neurosurg 46: 446–453PubMedCrossRefGoogle Scholar
  28. 28.
    Grundy BL, Nelson PB, Lina A, Heros RC (1982) Monitoring of cortical SSEP to determine safety of sacrificing the anterior cerebral artery. Neurosurgery 11: 64–67PubMedCrossRefGoogle Scholar
  29. 29.
    Grundy BL, Yanetta PJ, Procopio PhT, Lina A, Boston JR, Dayle E (1982) Intraoperative monitoring of brainstem auditory evoked potentials. J Neurosurg 57: 674–681PubMedCrossRefGoogle Scholar
  30. 30.
    Halliday AM, Halliday E, Kriss A, McDonald WI, Mushin J (1976) The pattern-evoked potentials in compression of anterior visual pathways. Brain 99: 357–374PubMedCrossRefGoogle Scholar
  31. 31.
    Harding GFA (1977) The use of visual evoked potentials to flash stimuli in the diagnosis of visual defects. In: Desmedt JE (ed) Visual evoked potentials in man: new developments. Clarendon Press, London, pp 500–508Google Scholar
  32. 32.
    Harris RJ, Symon L (1984) Extracellular pH, potassium, and calcium activities in progressive ischemia in rat cortex. Cereb Blood Flow Metab 4: 178–186CrossRefGoogle Scholar
  33. 33.
    Heiss WD, Hayakawa T, Waltz AG (1976) Cortical neuronal function during ischemia. Arch Neurol 33: 813–820PubMedGoogle Scholar
  34. 34.
    Homma S, Tamaki T (eds) (1984) Fundamentals and clinical application of spinal cord monitoring. Saikon Publishing, TokyoGoogle Scholar
  35. 35.
    Hume AL, Cant BR (1978) Conduction time in somatosensory pathways in man. Electroencephalogr Clin Neurophysiol 45: 361–375CrossRefGoogle Scholar
  36. 36.
    Hume AL, Cant BR (1981) Central somatosensory conduction after head injury. Ann Neurol 10: 411–419PubMedCrossRefGoogle Scholar
  37. 37.
    Hume AL, Cant BR, Shaw NA (1979) Central somatosensory conduction time in comatose patients. Ann Neurol 5: 379–384PubMedCrossRefGoogle Scholar
  38. 38.
    Hume AL, Cant BR, Shaw NA, Cowan JC (1982) Central somatosensory conduction time from 10 to 79 years. Electroencephalogr Clin Neurophysiol 54: 49–54PubMedCrossRefGoogle Scholar
  39. 39.
    Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28: 14–20PubMedCrossRefGoogle Scholar
  40. 40.
    Jacobson JH, Hirose T, Suzuke TA (1968) Simultaneous ERG and VER in lesions of the optic pathway. Invest Ophtalmol 7: 279–292Google Scholar
  41. 41.
    James IM (1968) Changes in cerebral blood flow and in systemic arterial pressure following spontaneous subarachnoid hemorrhage. Clin Sci 35: 11–22PubMedGoogle Scholar
  42. 42.
    Jennett B, Bond M (1975) Assessment of outcome after severe brain damage—a practical scale. Lancet 1: 480–484PubMedCrossRefGoogle Scholar
  43. 43.
    Jennett B, Teasdale G, Galbraith S, Pickard J, Grant H, Braakman R, Avezaat C, Maas A, Minderhead J, Vecht CJ, Heiden J, Small R, Caton W, Kurze T (1977) Severe head injuries in three countries. J Neurol Neurosurg Psychiatry 40: 291–298PubMedCrossRefGoogle Scholar
  44. 44.
    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 Tokyo, pp 221–226Google Scholar
  45. 45.
    Jones TA, Stockard JJ, Henry KR (1978) Temperature-independent alterations of brainstem auditory evoked responses by enflurane. Soc Neurosci Abstr 4: 154Google Scholar
  46. 46.
    Jones SJ, Thomas DGT (1985) Assessment of long sensory tract conduction in patients undergoing dorsal root entry zone coagulation for pain relief. In: Schramm J, Jones SJ (eds), Spinal cord monitoring. Springer, Berlin Heidel¬berg New York Tokyo, pp 266–273Google Scholar
  47. 47.
    Kálmánchey R, Avila A, Symon L (1986) The use of brainstem auditory evoked potentials during posterior fossa surgery. Acta Neurochir (Wien) 82: 128–136CrossRefGoogle Scholar
  48. 47.
    Kálmánchey R, Avila A, Symon L (1986) The use of brainstem auditory evoked potentials during posterior fossa surgery. Acta Neurochir (Wien) 82: 128–136CrossRefGoogle Scholar
  49. 49.
    Kotani H, Hattori S, Senzoku F, Kawai S, Saiki K, Yamasaki H, Omote K (1985) Evaluation of cord function in cervical spondylosis by a combined method using segmental and conductive spinal evoked potentials (SEP). In: Schramm J, Jones SJ (eds), Spinal cord monitoring. Springer, Berlin Heidelberg New York Tokyo, pp 274–283Google Scholar
  50. 50.
    Kriss A (1982) Stimulating techniques and recording problems. In: Halliday AM (ed) Evoked potentials in clinical testing. Churchill Livingstone, Bath, England, pp 45–70Google Scholar
  51. 51.
    Ladds A, Branston NM, Symon L (1984) Changes in the SEP in thalamus during a selective thalamic ischemic lesion. Electroencephalogr Clin Neurophysiol 58: 114Google Scholar
  52. 52.
    Larson SJ, Sances A Jr, Ackmann JJ, Reigei DH (1973) Non-invasive evaluation of head trauma patients. Surgery 74: 34–40PubMedGoogle Scholar
  53. 53.
    Levine RA, Ojemann RG, Montgomery WM, McGaffìgan P (1984) Monitoring of auditory evoked potentials during acoustic neuroma surgery: Insight into mechanisms of the hearing loss. Ann Otol Rhinol Laryngol 93: 116–123PubMedGoogle Scholar
  54. 54.
    Lindsay KW, Carlin J, Kennedy I, Fry J, McInnes A, Teasdale GM (1981) Evoked potentials in severe head injury-analysis and relation to outcome. J Neurol Neurosurg Psychiatry 44: 796–802PubMedCrossRefGoogle Scholar
  55. 55.
    Merory J, Thomas DJ, Humphrey PRD, Du Boulay GH, Marshall J, Ross Russell RW, Symon L, Zilkha E (1980) Cerebral blood flow after surgery for recent subarachnoid hemorrhage. J Neurol Neurosurg Psychiatry 43: 214–221PubMedCrossRefGoogle Scholar
  56. 56.
    Meyer CHA, Lowe D, Meyer M, Richardson PL, Neil-Dwyer G (1983) Progressive change in cerebral blood flow during the first three weeks after subarachnoid hemorrhage. Neurosurgery 12: 58–76PubMedCrossRefGoogle Scholar
  57. 57.
    McEwan GD, Bunnell WP, Sriram K (1975) Acute neurological complications in the treatment of scoliosis: a report of scoliosis research society. J Bone Joint Surg (Am) 57-A: 404–408Google Scholar
  58. 58.
    Momma F, Wang AD, Symon L (1985) Effects of temporary arterial occlusion on somatosensory evoked responses in aneurysm surgery. Surg Neurol (in press)Google Scholar
  59. 59.
    Morawetz RB, de Girolami U, Ojemann RG, Marcoux RW, Crowell RM (1978) Cerebral blood flow determined by hydrogen clearance during middle cerebral artery occlusion in unaesthetized monkeys. Stroke 9: 143–149Google Scholar
  60. 60.
    Nakagawa T, Imai K, Murakami M, Inoue SI, Maie M, Yamane T, Yamashita T (1985) Spinal evoked potentials in patients with meningomyelocele. In: Schramm J, Jones SJ (eds) Spinal cord monitoring. Springer, Berlin Heidelberg New York Tokyo, pp 231–236Google Scholar
  61. 61.
    Newlon PG, Greenberg RP, Hyatt MS, Enas GG, Becker DP (1982) The dynamics of neuronal dysfunction and recovery following severe head injury assessed with serial multimodality evoked potentials. J Neurosurg 57: 168–177PubMedCrossRefGoogle Scholar
  62. 62.
    Ojemann RG, Levine RA, Montogomery WM, McGaffìgan P (1984) Use of intraoperative autidory evoked potentials to preserve hearing in unilateral acoustic neuroma removal. J Neurosurg 61: 938–948PubMedCrossRefGoogle Scholar
  63. 63.
    Overgaad J, Christensen S, Hvid-Hansen O, Haase J, Land AM, Hein O, Pedersen KK, Tweed WA (1973) Prognosis of head injury based on early clinical examination. Lancet 2: 631–635CrossRefGoogle Scholar
  64. 64.
    Raudzens PA (1982) Intraoperative monitoring of evoked potentials. Ann NY Acad Sci 388: 308–326PubMedCrossRefGoogle Scholar
  65. 65.
    Rosenstein J, Wang AD, Symon L, Suzuki M (1985) Relationship between hemispheral CBF, CCT, and clinical grade in aneurysmal subarachnoid hemorrhage. J Neurosurg 62: 25–30PubMedCrossRefGoogle Scholar
  66. 66.
    Sachs L (1984) Angewandte Statistik. 6. Aufl. Springer, Berlin Heidelberg New York TokyoGoogle Scholar
  67. 67.
    Seals DM, Rossiter VS, Weinstein ME, Spencer JD (1979) Brainstem auditory evoked responses in patients comatose as a result of blunt head trauma. J Trauma 19: 347–353CrossRefGoogle Scholar
  68. 68.
    Starr A, Achor LJ (1975) Auditory brain stem responses in neurological disease. Arch Neurol 32: 761–768PubMedGoogle Scholar
  69. 69.
    Sundt TM Jr, Sharbrough FM, Anderson PE, Michenfelder JD (1974) Cerebral blood flow measurements and electroencephalograms during carotid endarterectomy. J Neurosurg 41: 310–320PubMedCrossRefGoogle Scholar
  70. 70.
    Symon L (1985) Flow thresholds in brain ischemia and the effects of drugs. Br J Anesth 57: 34–43CrossRefGoogle Scholar
  71. 71.
    Symon L (1985) Threshold of ischemia applied to aneurysm surgery. Acta Neurochir (Wien) 77: 1–7CrossRefGoogle Scholar
  72. 72.
    Symon L, Ackerman R, Bull JW, Du Boulay GH, Marshall J, Rees JE, Ross Russell RW (1972) The use of xenon clearance method in subarachnoid hemorrhage. Eur Neurol 8: 8–14PubMedCrossRefGoogle Scholar
  73. 73.
    Symon L, Brierley J (1976) Morphological changes in cerebral blood vessels in chronic ischaemic infarction flow correlation obtained by the hydrogen clearance method. In: Cervos-Navarro J, Matakas F (eds) The Cerebral Vessel Wall Symposium, Berlin, March 14–15,1975, Raven Press, New York, pp 165–174Google Scholar
  74. 74.
    Symon L, Jakubowsky J (1979) Transcranial management of pituitary tumours with suprasellar extention. J Neurol Neurosurg Psychiatry 42: 123–133PubMedCrossRefGoogle Scholar
  75. 75.
    Symon L, Wang AD, Silva IEC, Gentili F (1984) Perioperative use of somatosensory evoked responses in aneurysm surgery. J Neurosurg 60: 269–275PubMedCrossRefGoogle Scholar
  76. 76.
    Takano H, Takakuwa K, Tsuji H, Nakagawa T, Imai K, Inoue S (1985) An 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 Tokyo, pp 221–226Google Scholar
  77. 77.
    Tawana LK, Pickard JD, Sedgwick EM, Docherty TB (1983) Changes in evoked potentials and clinical tests of vision in relation to pituitary surgery. Presented during the first Joint Meeting of the EEG Society and Psychophysiology Society. Burden Neurological Institute, 29th June–lst July, 1983Google Scholar
  78. 78.
    Teasdale G, Jennett B (1976) Assessment of coma and impaired consciousness. A practical scale. Lancet 2: 81–84Google Scholar
  79. 79.
    Trojaborg W, Boysen G (1973) Relation between EEG, regional cerebral blood flow and internal carotid endarterectomy. Electroencephalogr Clin Neurophysiol 34: 61–69PubMedCrossRefGoogle Scholar
  80. 80.
    Uhl RR, Squires KC, Bruce DL, Starr A (1980) Variation in visual evoked potentials under anesthesia. In: Kornhuber HH, Deecke L (eds) Progress in brain research, Vol. 54. Elsevier, North Holland, pp 463–466Google Scholar
  81. 81.
    Valencak E, Witzmann A, Reisecker F (1985) Intraoperative spinal cord monitoring at differential levels and with varying surgical pathology. In: Schramm J, Jones SJ (eds), Spinal cord monitoring. Springer, Berlin Heidel-berg New York Tokyo, pp 237–244Google Scholar
  82. 82.
    Walser H, Yasargil MG, Curcic M (1982) Auditory brainstem responses in patients with posterior fossa tumours. Surg Neurol 18: 405–415PubMedCrossRefGoogle Scholar
  83. 83.
    Wang AD, Cone J, Symon L, Silva IEC (1984) Somatosensory evoked potential monitoring during the management of aneurysmal SAH. J Neurosurg 60: 264–268PubMedCrossRefGoogle Scholar
  84. 84.
    Wang AD, Silva IEC, Symon L, Jewkes D (1985) The effects of halothane on somatosensory evoked potentials during operations. Neurol Res 7: 58–62PubMedGoogle Scholar
  85. 85.
    Wilson WB, Kirsch WN, Neville H, Stears J, Feinsod M, Lehman RAW (1976) Monitoring of visual function during parasellar surgery. Surg Neurol 5: 323–329PubMedGoogle Scholar
  86. 86.
    Wright JE, Arden G, Jones BR (1973) Continuous monitoring of visually evoked responses during intraorbital surgery. Trans Ophthalmol Soc UK 93: 311–314PubMedGoogle Scholar
  87. 87.
    Schwerdtfeger K, Ludt H (1986) Stainless steel skin staples—a useful electrode system for long-term electrophysiological measurements in neurosurgery. Acta Neurochir (Wien) 82: 137–140CrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 1986

Authors and Affiliations

  • L. Symon
    • 1
    • 2
  • F. Momma
    • 1
    • 2
  • K. Schwerdtfeger
    • 1
    • 2
  • P. Bentivoglio
    • 1
    • 2
  • I. E. Costa E Silva
    • 1
    • 2
  • A. Wang
    • 1
    • 2
  1. 1.Gough-Cooper Department of Neurological SurgeryInstitute of NeurologyLondonUK
  2. 2.Department of NeurosurgerySaarland University Medical SchoolHomburg/SaarFederal Republic of Germany

Personalised recommendations