Neurophysiologic Monitoring

Neurophysiologic monitoring is a diverse group of instruments that are used to monitor the central and peripheral nervous system during surgical procedures. Some are used to monitor anesthetic depth, whereas others are used by neurologists to monitor the integrity of the nervous system during surgical procedure. The goal of neurophysiologic monitoring is to have reliable, reproducible, and predictive monitors that can identify impending compromise to the neurologic system (or anesthetic) with minimal false predictive value and high positive predictive value. This allows for the identification of neurologic tissues by location and type that are at risk of compromise by vascular and/or mechanical injury. This review contains 3 figures, 8 tables, and 34 references. Key Words: auditory evoked potentials, bispectral index monitor, electrocorticography, electroencephalography, electromyographic monitoring, M-ENTROPY, motor evoked potentials, narcotrend index, sensory evoked potentials, spectral analysis

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Combined extradural-interdural-intradural approach to a trigeminal nerve cystic haemangiopericytoma with intra-operative cranial nerve monitoring

Neuro-Oncology ◽

10.1093/neuonc/noz167.079 ◽

2019 ◽

Vol 21 (Supplement_4) ◽

pp. iv18-iv18

Author(s):

Joseph Frantzias ◽

José Lavrador ◽

Noémia Pereira ◽

Richard Gullan ◽

Keyoumars Ashkan ◽

...

Keyword(s):

Evoked Potentials ◽

Trigeminal Nerve ◽

Cranial Nerve ◽

Motor Evoked Potentials ◽

Close Relation ◽

Blink Reflex ◽

Neurophysiologic Monitoring ◽

Complete Tumour ◽

Sensory Evoked Potentials ◽

Sensory Evoked

Abstract Objectives Haemangiopericytoma of the trigemimal nerve is extremely rare, with only two previous cases described to our knowledge. We present the surgical approach to this tumour, and describe a previously poorly reported method of monitoring the function of the branches of the trigeminal nerve: mapping of the sensory roots through transcranial somatosensory cortex sensory evoked potentials (SSEPs), motor evoked potentials (MEP) for the motor root and blink reflex. Design Case and technical reports Subjects 32 year-old male patient presenting with headaches and vomiting, found to have a mixed cystic-solid tumour of the left middle skull base region, in close relation with the foramen ovale and Meckel’s cave. Methods The radiological features of the tumour, technical aspects of the technical approach and neurophysiologic monitoring will be described. Results A pterional craniotomy with fronto-temporal extradural-interdural-intradural approach, and the tumour was debulked with MEP, SSEP and blink reflex monitoring of the branches of the trigeminal nerve. Complete tumour removal was achieved with no post-operative cranial nerve deficits. The histopathology revealed a cystic haemangiopericytoma. Conclusions Haemangiopericytoma is a rare entity. MEP and SSEP monitoring of the trigeminal nerve can be used to achieve complete and safe removal of the tumour.

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Intra-operative neurophysiological monitoring

Journal of Neuroanaesthesiology and Critical Care ◽

10.4103/2348-0548.165035 ◽

2015 ◽

Vol 02 (03) ◽

pp. 179-192

Author(s):

Zulfiqar Ali ◽

Parmod Bithal

Keyword(s):

Evoked Potentials ◽

Surgical Procedures ◽

Complication Rate ◽

Motor Evoked Potentials ◽

Neurological Complication ◽

Intraoperative Neurophysiological Monitoring ◽

Neurophysiological Monitoring ◽

Sensory Evoked Potentials ◽

Sensory Evoked

AbstractIntraoperative neurophysiological monitoring has achieved importance due to complexity of cranio-spinal surgical procedures being performed frequently these days. Many studies have proven a decreased neurological complication rate after its introduction. It is broadly of two types: Sensory evoked potentials and motor evoked potentials which are further sub-divided. Its use during surgery requires a controlled anaesthesia technique with no or minimal influence on its recording. Its success depends upon three way communication among the surgeon the neurophysiologist and the anaesthesiologist.

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Intraoperative neurophysiological monitoring

The Neurosurgeon's Handbook ◽

10.1093/med/9780198570677.003.0133 ◽

2010 ◽

pp. 188-193

Author(s):

George Samandouras

Keyword(s):

Evoked Potentials ◽

Motor Evoked Potentials ◽

Intraoperative Neurophysiological Monitoring ◽

Neurophysiological Monitoring ◽

Sensory Evoked Potentials ◽

Sensory Evoked

Chapter 4.3 covers sensory evoked potentials, motor evoked potentials (MEPs), electromyography, and the wake-up test.

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Comparison of vagus sensory evoked potentials (VSEP) and auditory evoked potentials (AEP) in healthy subjects

Klinische Neurophysiologie ◽

10.1055/s-0030-1250896 ◽

2010 ◽

Vol 41 (01) ◽

Author(s):

D Weise ◽

M Adamidis ◽

F Pizzolato ◽

J Claßen

Keyword(s):

Evoked Potentials ◽

Healthy Subjects ◽

Auditory Evoked Potentials ◽

Sensory Evoked Potentials ◽

Sensory Evoked

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Monitoring of Sensory Evoked Potentials During Surgery of Skull Base Tumours

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100035484 ◽

1985 ◽

Vol 12 (S4) ◽

pp. 336-340 ◽

Cited By ~ 32

Author(s):

F. Gentili ◽

W.M. Lougheed ◽

K. Yamashiro ◽

C. Corrado

Keyword(s):

Evoked Potentials ◽

Skull Base ◽

Auditory Evoked Potentials ◽

Significant Risk ◽

Neurological Injury ◽

Neurosurgical Procedures ◽

Critical Areas ◽

Sensory Evoked Potentials ◽

Microsurgical Techniques ◽

Sensory Evoked

ABSTRACT:Despite advances in instrumentation and the use of microsurgical techniques, neurosurgical procedures involving extensive areas of skull base or other critical areas of brain still carry significant risk for neurological injury. The use of intraoperative recording of sensory evoked potentials (SEP) has been advocated to monitor neurologic function during these major neurosurgical procedures to reduce the risk of injury to neural structures.This report summarizes our experience with intraoperative monitoring of SEP in over 200 patients, and details our findings in a group of 12 patients with skull base and posterior fossa tumours. Somatosensory evoked potentials (SSEP) were monitored in all patients, and brain stem auditory evoked potentials (BAEP) in five. While minor changes in BAEP and SSEP parameters were noted in most patients, significant changes occurred in five. Irreversible loss of BAEP in one patient was associated with complete hearing loss postoperatively. Marked, persistent alteration of both BAEP and SSEP was associated with postoperative brainstem dysfunction. No patient with stable BAEP and SSEP at the end of the procedure suffered additional neurological deficit.We conclude that intraoperative SEP monitoring may be valuable in minimizing neural injury during major neurosurgical procedures.

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Intraoperative Neurophysiological Monitoring for Endoscopic Endonasal Approaches to the Skull Base: A Technical Guide

Scientifica ◽

10.1155/2016/1751245 ◽

2016 ◽

Vol 2016 ◽

pp. 1-20

Author(s):

Harminder Singh ◽

Richard W. Vogel ◽

Robert M. Lober ◽

Adam T. Doan ◽

Craig I. Matsumoto ◽

...

Keyword(s):

Nervous System ◽

Evoked Potentials ◽

Skull Base ◽

Auditory Evoked Potentials ◽

Motor Evoked Potentials ◽

Cranial Nerves ◽

Somatosensory System ◽

Intraoperative Neurophysiological Monitoring ◽

Neurophysiological Monitoring ◽

Endoscopic Endonasal

Intraoperative neurophysiological monitoring during endoscopic, endonasal approaches to the skull base is both feasible and safe. Numerous reports have recently emerged from the literature evaluating the efficacy of different neuromonitoring tests during endonasal procedures, making them relatively well-studied. The authors report on a comprehensive, multimodality approach to monitoring the functional integrity of at risk nervous system structures, including the cerebral cortex, brainstem, cranial nerves, corticospinal tract, corticobulbar tract, and the thalamocortical somatosensory system during endonasal surgery of the skull base. The modalities employed include electroencephalography, somatosensory evoked potentials, free-running and electrically triggered electromyography, transcranial electric motor evoked potentials, and auditory evoked potentials. Methodological considerations as well as benefits and limitations are discussed. The authors argue that, while individual modalities have their limitations, multimodality neuromonitoring provides a real-time, comprehensive assessment of nervous system function and allows for safer, more aggressive management of skull base tumors via the endonasal route.

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