Abstract
Intraoperative neurophysiologic monitoring (IONM) is an innovation introduced in neurosurgery in the past decades. It aims to support and guide the neurosurgeon to obtain the best surgical result possible, preventing the occurrence of neurological deficits. The somatosensory evoked potentials (SSEP) assess the integrity of the sensory pathways monitoring the dorsal column–medial lemniscus pathway during spine and cerebral surgery. Motor evoked potentials (MEPs) provide information on the integrity of the motor pathway monitoring the efferent motor pathways from the motor cortex to the muscle through corticospinal (or corticobulbar) tracts. Free-running EMG is the standard technique to monitor peripheral nerves, roots, or cranial motor nerves during surgery. Intraoperative EMG signals are activated during cranial motor nerves damaging or after an irritative stimulus. The duration, morphology, and persistence of EMG reflects the severity of neural injury. Nerve mapping consists of recording muscle activations given by direct nerve stimulation. This technique makes use of a stimulation probe available to the neurosurgeon which allows administering current directly to the nervous tissue (nerves, roots, etc.). Intraoperative neurophysiological monitoring (IONM) represents the standard of care during many procedures, including spinal, intracranial, and vascular surgeries, where there is a risk of neurological damage. Close communication and collaboration between the surgical team, neurophysiologist, and anesthesiologist is mandatory to obtain high-quality neuromonitoring, thus preventing neurologic injuries and gaining the best surgical “safe” results.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Pastor J, Vega-Zelaya L, Pulido P, Garnés-Camarena O, Abreu A, Sola RG. Role of intraoperative neurophysiological monitoring during fluorescence-guided resection surgery. Acta Neurochir. 2013;155(12):2201–13.
Skinner SA, Cohen BA, Morledge DE, McAuliffe JJ, Hastings JD, Yingling CD, McCaffrey M. Practice guidelines for the supervising professional: intraoperative neurophysiological monitoring. J Clin Monit Comput. 2014;28(2):103–11.
Deletis V, Sala F. Intraoperative neurophysiological monitoring of the spinal cord during spinal cord and spine surgery: a review focus on the corticospinal tracts. Clin Neurophysiol. 2008;119(2):248–64.
Buhl LK, Bastos AB, Pollard RJ, Arle JE, Thomas GP, Song Y, Boone MD. Neurophysiologic intraoperative monitoring for spine surgery: a practical guide from past to present. J Intensive Care Med. 2021;36(11):1237–49.
Reddy RP, Chang R, Rosario BP, Sudadi S, Anetakis KM, Balzer JR, Crammond DJ, Shaw JD, Thirumala PD. What is the predictive value of intraoperative somatosensory evoked potential monitoring for postoperative neurological deficit in cervical spine surgery?-a meta-analysis. Spine J. 2021;21(4):555–70.
Legatt AD, Emerson RG, Epstein CM, MacDonald DB, Deletis V, Bravo RJ, López JR. ACNS guideline: transcranial electrical stimulation motor evoked potential monitoring. J Clin Neurophysiol. 2016;33(1):42–50.
Park JH, Hyun SJ. Intraoperative neurophysiological monitoring in spinal surgery. World J Clin Case. 2015;3(9):765–73.
Calancie B. Intraoperative neuromonitoring and alarm criteria for judging MEP responses to transcranial electric stimulation: the threshold-level method. J Clin Neurophysiol. 2017;34(1):12–21.
Szelényi A, Hattingen E, Weidauer S, Seifert V, Ziemann U. Intraoperative motor evoked potential alteration in intracranial tumor surgery and its relation to signal alteration in postoperative magnetic resonance imaging. Neurosurgery. 2010;67(2):302–13.
Kim SM, Yang H, Park SB, Han SG, Park KW, Yoon SH, et al. Pattern-specific changes and discordant prognostic values of individual leg-muscle motor evoked potentials during spinal surgery. Clin Neurophysiol. 2012;123:1465–70.
Langeloo DD, Journée HL, de Kleuver M, Grotenhuis JA. Criteria for transcranial electrical motor evoked potential monitoring during spinal deformity surgery: a review and discussion of the literature. Clin Neurophysiol. 2007;37(6):431–9.
Kim K, Cho C, Bang MS, Shin HI, Phi JH, Kim SK. Intraoperative neurophysiological monitoring: a review of techniques used for brain tumor surgery in children. J Kor Neurosurg Soc. 2018;61(3):363–75.
Deletis V, Fernández-Conejero I. Intraoperative monitoring and mapping of the functional integrity of the brainstem. J Clin Neurol. 2016;12(3):262–73.
Guérit JM. Neuromonitoring in the operating room: why, when, and how to monitor? Electroencephalogr Clin Neurophysiol. 1998;106(1):1–21.
Matthies C, Samii M. Management of vestibular schwannomas (acoustic neuromas): the value of neurophysiology for intraoperative monitoring of auditory function in 200 cases. Neurosurgery. 1997;40(3):459–68.
York D. Visual evoked potentials during surgery. Handb Clin Neurophysiol. 2008;8:172–7.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Di Domenico, M. et al. (2023). Methods and Principles of the Intraoperative Neurophysiologic Monitoring in Neurosurgery. In: Visocchi, M. (eds) The Funnel: From the Skull Base to the Sacrum. Acta Neurochirurgica Supplement, vol 135. Springer, Cham. https://doi.org/10.1007/978-3-031-36084-8_9
Download citation
DOI: https://doi.org/10.1007/978-3-031-36084-8_9
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-36083-1
Online ISBN: 978-3-031-36084-8
eBook Packages: MedicineMedicine (R0)