Intraoperative Neurophysiology A Comprehensive Guide to Monitoring and Mapping 2nd Edition by Mirela Simon ISBN 9781617052941 1617052949

Part I. The Basics

1. Neurophysiologic Tests in the Operating Room

I. Introduction

II. Electroencephalogram

III. Short-Latency Somatosensory Evoked Potentials (SSEPs)

IV. Brainstem Auditory Evoked Potentials

V. Motor Evoked Potentials (MEPs)

VI. Free-Run and Triggered EMG (fEMG and tEMG)

VII. Nerve-to-Nerve Recordings (NAPs)

VIII. Combinations of Tests

IX. Safety Issues

2. Anesthesia and Intraoperative Neurophysiology

I. Introduction

II. General Effects of Anesthetics on Neurophysiologic Tests

III. Anesthetic Agents and Their Specific Effects on Neurophysiologic Tests

IV. Assessing the Depth of Anesthesia

V. The Concept of Anesthetic Fade

VI. Physiological Parameters and Their Impact on Neurophysiologic Tests

Conclusions

3. The Trouble of Troubleshooting

I. Introduction

II. Troubleshooting Electrodes

III. System Settings, Software, and Hardware

IV. 60 Hz and Related Noise

Conclusions

Part II. Cerebrum

4. EEG Monitoring During Carotid Endarterectomy

I. Introduction

II. Surgical Techniques for CEA

III. Principles for Monitoring of Carotid Endarterectomies

IV. Methods

V. Interpretation

5. Neurophysiologic Monitoring During Cardiac and Thoracic Aortic Surgery

I. Introduction

II. Neurologic Complications

III. Cardiopulmonary Bypass (CPB)

IV. Cerebral Neuroprotection

V. Neurophysiologic Monitoring

Conclusions

6. Intraoperative Electrocorticography in Epilepsy Surgery

I. Introduction

II. Historical Perspective

III. The Controversial Role of ECoG in Epilepsy Surgery

IV. Indications

V. Methodology

VI. Interpretation

VII. Anesthesia Considerations

Conclusions

7. Electrocorticography in Nonepilepsy Surgery

I. Introduction

II. Indications

III. Methodology

Conclusions

8. An Introduction to Functional Mapping

I. Maximal Resection

II. Maximal Safe Resection: Functional Mapping Methods

8A. Mapping and Monitoring of Motor and Primary Somatosensory Functions

I. Functional Anatomy

II. Central Sulcus Localization

III. Motor Mapping and Monitoring via Electrical Stimulation

IV. Primary Somatosensory Function Mapping and Monitoring

Conclusions

8B. Mapping and Monitoring of Language and Parietal Functions

I. Introduction

II. Anatomy of Language and Parietal Functions

III. Planning

IV. Methodology

V. Performing the Procedure and Interpreting the Results

Conclusions

8C. Intraoperative Neurophysiologic Monitoring and Mapping of the Visual Pathways

I. Introduction

II. Anatomy of Visual Pathways

III. Monitoring

IV. Mapping the Visual Pathways

V. Anesthesia Considerations

Conclusions

9. Surgical Clipping of Cerebral Aneurysms: General Surgical Approach and the Role of Neuromonitoring

I. Introduction

II. Operative Approach, Critical Steps, and the Role of IOM

III. Assessing the Adequacy of Blood Flow and of Aneurysmal Clipping

Conclusions

10. Deep Brain Stimulation

I. Introduction

II. Methodology: General Approach

III. Subthalamic Nucleus

IV. Globus Pallidus Internus

V. Ventral Intermediate Nucleus of the Thalamus

Conclusions

Part III. Brainstem

11. Neurophysiologic Mapping and Monitoring of Cranial Nerves and Brainstem

I. Introduction

II. Anatomy and Pathophysiology

III. Techniques

IV. Anesthesia Considerations

V. Safety Considerations

VI. Applications

VII. Limitations

VIII. Future Directions

Conclusions

Part IV. Spinal Cord and Nerve Roots

12. Intramedullary Spinal Cord Tumor Resection

I. Introduction

II. The Role of Intraoperative Neurophysiology

III. A Historical Perspective

IV. Intraoperative Neurophysiologic Monitoring and Mapping: A Step-by-Step Approach

Conclusions

13. Intradural Extramedullary Spinal Cord Tumor Resection

I. Introduction

II. IDEM Tumors

III. Intraoperative Neurophysiologic Monitoring of IDEM Tumors

IV. Postoperative Complications and Outcome

Conclusions

14. Decompressive Surgery of the Spine

I. Introduction

II. Intraoperative Neurophysiologic Monitoring: A Step-by-Step Approach

Conclusions

15. 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

Conclusions

16. Intraoperative Neurophysiologic Monitoring in Thoracoabdominal Aneurysm Repair

I. Introduction

II. The Vascularization of the Spinal Cord

III. Operative Techniques

IV. Delayed Neurological Events and Surgical Outcomes

Conclusions

Part V. Peripheral Nerve

17. Intraoperative Neurophysiology in Peripheral Nerve Surgery

I. Introduction

II. The Main Roles of Intraoperative Neurophysiology

III. Types of Nerve Injury Based on the Extent of Structural Damage and Mechanisms of Occurrence

IV. Surgical Management of Posttraumatic Nerve Injury

V. Nerve Tumor Surgery

VI. Minimally Invasive Surgery

VII. Examples of Common Clinical Scenarios

VIII. Anesthesia Considerations

Conclusions

Part VI. Special Topics

18. Intraoperative Neurophysiologic Monitoring and Mapping in Pediatric Population

I. Introduction

II. Development and Maturation of the Nervous System Pathways

III. Intraoperative Neurophysiologic Monitoring and Mapping Techniques

IV. IONM and Anesthetic Considerations in Pediatric Population

Conclusions

19. Preoperative Functional Mapping for Epilepsy Surgery

I. Introduction

II. Historical Perspective

III. Methodology

IV. Procedure and Results

V. Functional Mapping

VI. Pediatric Functional Mapping

VII. Safety Concerns

Conclusions

20. Questions and Answers

Questions

Answers

Index