Neurosurgery

Key Points

• Various techniques for intraoperative neuro-physiological monitoring are available to neurosurgeons for use during procedures that involve both the central and peripheral nervous system.

• Some of these techniques have a proven utility and play an integral role during a number of neurosurgical cases. Other techniques are used as a matter of personal preference or remain in the experimental realm.

• Several of these methods, particularly EEG and SSEP monitoring, are effective at demonstrating neurophysiological changes attributable to ischemia, and therefore are of use in procedures that place the CBF at risk.

• Techniques such as SSEP, MEP, BAEP, EMG and NCV recording allow for monitoring of afferent or efferent activity through regions of the nervous system placed at risk by neuro-surgical manipulation.

• Monitoring/mapping of cortical functions can be performed using techniques such as phase reversal, microelectrode recording or cortical stimulation (either electrical or magnetic).

References

1. Zampella E, Morawetz RB, McDowell HA, Zeiger HE, Varner PD, McKay RD et al. The importance of cerebral ischemia during carotid endarterectomy. Neurosurgery 1991;29:727-30.

2. Salvian AJ, Taylor DC, Hsiang YN et al. Selective shunting with EEG monitoring is safer than routine shunting for carotid endarterectomy. Cardiovasc Surg 1997;5: 481-5.

3. Redekop G, Ferguson G. Correlation of contralateral stenosis and intraoperative electroencephalogram change with risk of stroke during carotid endarterec-tomy. Neurosurgery 1992;30:191-4.

4. Plestis KA, Loubser P, Mizrahi EM, Kantis G, Jiang ZD, Howell JF. Continuous electroencephalographic monitoring and selective shunting reduces neurologic morbidity rates in carotid endarterectomy. J Vasc Surg 1997; 25:620-8.

5. Schwartz TH, Bazil CW, Forgione M, Bruce JN, Goodman RR. Do reactive post-resection "injury" spikes exist? Epilepsia 2000;41:1463-8.

6. Fisher RS, Raudzens P, Nunemacher M. Efficacy of intraoperative neurophysiological monitoring. J Clin Neurophysiol 1995;12:97-109.

7. Haupt WF, Horsch S. Evoked potential monitoring in carotid surgery: a review of 994 cases. Neurology 1992; 42:835-8.

8. Guerit JM. Neuromonitoring in the operating room: why, when, and how to monitor? Electroencephalogr Clin Neurophysiol 1998;106:1-21.

9. Fava E, Bortolani E, Ducati A, Schieppati M. Role of SEP in identifying patients requiring temporary shunt during carotid endarterectomy. Electroencephalogr Clin Neurophysiol 1992;84:426-32.

10. Nuwer MR, Dawson EG, Carlson LG, Kanim LE, Sherman JE. Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scol-iosis surgery: results of a large multicenter survey. Electroencephalogr Clin Neurophysiol 1995;96:6-11.

11. Milhorat TH, Kotzen RM, Capocelli AL Jr, Bolognese P, Bendo AA, Cottrell JE. Intraoperative improvement of somatosensory evoked potentials and local spinal cord blood flow in patients with syringomyelia. J Neurosurg Anesthesiol 1996;8:208-15.

12. May DM, Jones SJ, Crockard HA. Somatosensory evoked potential monitoring in cervical surgery: identification of pre- and intraoperative risk factors associated with neurological deterioration. J Neurosurg 1996; 85:566-73.

13. Dawson EG, Sherman JE, Kanim LE, Nuwer MR. Spinal cord monitoring. Results of the Scoliosis Research Society and the European Spinal Deformity Society survey. Spine 1991;16:S361-4.

14. Wilson-Holden TJ, Padberg AM, Parkinson JD, Bridwell KH, Lenke LG, Bassett GS. A prospective comparison of neurogenic mixed evoked potential stimulation methods: utility of epidural elicitation during posterior spinal surgery. Spine 2000;25:2364-71.

15. Pereon Y, Bernard JM, Fayet G, Delecrin J, Passuti N, Guiheneuc P. Usefulness of neurogenic motor evoked potentials for spinal cord monitoring: findings in 112 consecutive patients undergoing surgery for spinal deformity. Electroencephalogr Clin Neurophysiol 1998; 108:17-23.

16. Kothbauer K, Schmid UD, Seiler RW, Eisner W. Intraoperative motor and sensory monitoring of the cauda equina. Neurosurgery 1994;34:702-7.

17. Kothbauer K, Deletis V, Epstein FJ. Intraoperative spinal cord monitoring for intramedullary surgery: an essential adjunct. Pediatr Neurosurg 1997;26:247-54.

18. Nagle KJ, Emerson RG, Adams DC et al. Intraoperative monitoring of motor evoked potentials: a review of 116 cases. Neurology 1996;47:999-1004.

19. Hariz MI, Fodstad H. Do microelectrode techniques increase accuracy or decrease risks in pallidotomy and deep brain stimulation? A critical review of the literature. Stereotact Funct Neurosurg 1999;72:157-69.

20. Fischer G, Fischer C, Remond J. Hearing preservation in acoustic neurinoma surgery. J Neurosurg 1992;76: 910-17.

21. Fahlbusch R, Neu M, Strauss C. Preservation of hearing in large acoustic neurinomas following removal via sub-occipito-lateral approach. Acta Neurochir (Wien) 1998; 140:771-7.

22. Sundt TM. The ischemic tolerance of neural tissue and the need for monitoring and selective shunting during carotid endarterectomy. Stroke 1983;14:93-8.

23. Ackerstaff RG, Moons KG, van de Vlasakker CJ et al. Association of intraoperative transcranial doppler monitoring variables with stroke from carotid endarterec-tomy. Stroke 2000;31:1817-23.

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