Intraoperative Neurophysiology: A Comprehensive Guide to Monitoring and Mapping

Neurophysiologic intraoperative monitoring (IOM) neurologic monitoring during complex operative procedures is increasingly used to help prevent damage to the nervous system during surgery. Intraoperative Neurophysiology discusses all aspects of IOM with a hands- on approach to this challenging and exciting new frontier. Everything is covered from set-up, monitoring and mapping, troubleshooting, interpretation of results, and medical management. Interweaving contributions from neurologists and surgeons, the book presents a practical integrated blueprint for effective neurophysiological testing in the operating theater.
Intraoperative Neurophysiology is visual and comprehensive in scope and coverage. It begins by reviewing basic neurophysiologic and neuroanatomic knowledge and presents detailed technical information on each basic test, providing the foundation necessary for choosing the right test and customizing monitoring and mapping according to the specifics of individual surgical procedures.

Intraoperative Neurophysiology utilizes a unique structure to provide insights into successful monitoring practices and techniques. The book uses the steps of each surgical procedure as the skeleton upon which the IOM procedure is built, thereby presenting a developmental step-by-step approach to IOM procedures and the possible complications and pitfalls - that may arise at different moments of the surgery. In addition, it promotes and encourages the use of EEG in the operating room, and offers unprecedented coverage of ECoG, functional mapping, and EEG monitoring.

With over 275 illustrations, numerous tables, and the most important clinical points made in writing and exemplified graphically, Intraoperative Neurophysiology: Monitoring and Mapping delivers in words and pictures everything one needs to know to master the art and science of intraoperative neurophysiologic procedure and reduce the operative risk of neurological damage in surgical patients.


Contents

1. Neurophysiologic Tests Used in the Operating Room: I. Introduction; II. Electroencephalogram (EEG); III. Short-latency Somatosensory Evoked Potentials (SSEPs); IV. Motor Evoked Potentials (MEPs); V. Free-Run and Triggered EMG (fEMG and CMAPs); VI. Nerve-to-Nerve or Nerve Action Potentials (NAPs) Recordings; VII. Brainstem Auditory Evoked Potentials; (BAEPs); VIII. Combinations of Tests; IX. Safety Issues; References; 2. EEG Monitoring During Carotid Endarterectomy: I. Introduction; II. Principles of Monitoring CEAs; III. Methods; IV. Interpretation; References; 3. Electrocorticography: I. Introduction; II. Historical Perspective; III. The Controversial Role of ECoG in Epilepsy Surgery; IV. Indications; V. Methodology; VI. Interpretation; VII. Anesthesia Considerations; VIII. Concluding Remarks; References; 4. Functional Cortical Mapping: I. Introduction; II. Surgical Preparation; III. Sensorimotor Mapping; IV. Language Mapping; V. Cortical Mapping Threshold Variability; VI. ECoG During Functional Mapping; VII. Anesthesia Considerations; 5. Intraoperative Neurophysiologic Monitoring and Mapping of the Spinal Cord: 5A Intramedullary Spinal Cord Tumor Resection: I. Introduction; II. T he Role of Intraoperative Neurophysiology; III. A Historical Perspective; IV. Intraoperative Neurophysiologic Monitoring; References; 5B Decompressive Surgery of the Spine: I. Introduction; II. Intraoperative Neurophysiologic Monitoring: A Step-By-Step Approach; References; 5C Spine Deformity Surgery: I. Introduction; II. Surgical Indications; III. The Nuts and Bolts of Deformity Surgery; IV. The Role of Intraoperative Neurophysiology; V. Intraoperative Neurophysiologic Monitoring: A Step-By-Step Approach; VI. Conclusion; References; 5D Thoracoabdominal Aneurysm Repair; I. Introduction; II. The Vascularization of the Spinal Cord; III. Operative Techniques: Preventing Acute Spinal Cord Ischemia; IV. Delayed Neurologic Events and Surgical Outcomes; V. Conclusion; References; 6. Peripheral Nerve Surgery: I. Introduction; II. Surgery at the Level of the Cauda Equina and Nerve Root; III. Nerve Tumor Surgery; IV. Never Injury Surgery; V. Anesthesia Considerations; References; 7. Intraoperative Neurophysiologic Monitoring of the Cranial Nerves and Brainstem:I. Introduction; II. Midbrain; III. Pons; IV. Medulla; V. Anesthesia Considerations; VIII. Conclusions; References; 8. The Effects of Anesthetics on Intraoperative Neurophysiology Studies:I. Introduction; II. Benzodiazepines; III. Barbiturates; IV. Propofol; V. Narcotics; VI. Inhalational Agents; VII. Etomidate; VIII. Ketamine; IX. Dexmedetomidine; X. Muscle Relaxants; XI. Effects on Peripheral Nervous System and Cranial Nerve Monitoring; References; Index

About the Author

Mirela Simon, MD
Director, Intraoperative Neurophysiology Monitoring Unit, Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, Massachusetts.