Faculty Opinions recommendation of Success rate of motor evoked potentials for intraoperative neurophysiologic monitoring: effects of age, lesion location, and preoperative neurologic deficits.

Author(s):  
J Richard Toleikis
Author(s):  
Antoun Koht ◽  
Tod B. Sloan

Intraoperative neurophysiologic monitoring is used for monitoring and mapping of neurological structures during surgery and procedures where the neurological structures are at risk. Among the most commonly used techniques are electrophysiologic techniques, which include spontaneous and evoked electromyography, somatosensory evoked potentials, motor evoked potentials, electroencephalography, and auditory brainstem responses. These methods differ in their responses to anesthesia and in their clinical contribution to monitoring because of differing anatomy. Their use in spinal corrective surgery highlights the role of the anesthesiologist during cases when these techniques are utilized. Optimization of anesthesia, position, and physiology provide better monitoring conditions, enhance signal evaluation, and may lead to better neurological outcome.


2019 ◽  
Author(s):  
Scott Vaughan ◽  
Chadron Vassar ◽  
Nitin Kumar ◽  
Kerolos Yousef

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


Author(s):  
Antoun Koht ◽  
Laura B. Hemmer ◽  
J. Richard Toleikis ◽  
Tod B. Sloan

Intra-operative neurophysiological monitoring (IOM) has evolved substantially since its beginnings in the 1970s with somatosensory evoked potentials (SSEP) and facial nerve electromyography (EMG). The introduction of new techniques (especially motor evoked potentials [MEP]) and refinements of older techniques have become important tools that the surgeon can use to enhance intra-operative decision making and improve patient outcome of surgical (e.g., intracranial, neurovascular, skull base and brainstem, spine and spinal cord, peripheral nerve) procedures. These monitoring modalities are used to map the anatomic location of neural structures and monitor the functional status of the neural tracts. The anaesthetist plays a key supportive role in monitoring and management when IOM indicates potential neural compromise.


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