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Intraoperative Neurophysiologic Monitoring

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  • 113 b/w illus. 12 colour illus. 28 tables
  • Page extent: 252 pages
  • Size: 246 x 189 mm
  • Weight: 0.74 kg

Library of Congress

  • Dewey number: 616.8/047547
  • Dewey version: 22
  • LC Classification: RD52.N48 I558 2010
  • LC Subject headings:
    • Neurophysiologic monitoring
    • Monitoring, Intraoperative--methods
    • Intraoperative Complications--prevention & control
    • Surgical Procedures, Operative--methods
    • Trauma, Nervous System--prevention & control

Library of Congress Record

Hardback

 (ISBN-13: 9780521518031)

Intraoperative Neurophysiologic Monitoring
Cambridge University Press
9780521518031 - Intraoperative Neurophysiologic Monitoring - By Gloria M. Galloway, Marc R. Nuwer, Jaime R. López and Khaled M. Zamel
Index

Index

abdominal aorta repair 65

abducens nerve (VI) 109, 111, 164

abducens nucleus 126

abductor hallucis muscle 69, 71

abductor pollucis brevis muscle 69

accessory nerve (XI) 109, 120

monitoring 124

Accreditation Council for Graduate Medical Education (ACGME) 4

acoustic masking 96

acoustic neuroma 116, 117, 234

resection 2

air embolism 49, 50

alfentanil 49

all-or-none response 66

alpha motor neurons 42

American Academy of Neurology (AAN) 5

American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) 212

American Board of Clinical Neurophysiology (ABCN) 5

American Board of Psychiatry and Neurology (ABPN) 5

American Board of Registration in Electrodiagnostic Technology (ABRET) 8, 33

American Board of Registration of Electroencephalographic and Evoked Potential Technology 7

American Boards of Medical Specialties (ABMS) 5

American Clinical Neurophysiology Society (ACNS) 5

American Electroencephalographic Society 212

American Medical Association (AMA) 5

American Society of Electroneurodiagnostic Technologists (ASET) 7, 33, 40, , 212

American Society of NeuroMonitoring (ASNM) 5

American Society of Neuromuscular and Electrodiagnostic Medicine (AANEM) 5

amobarbital sodium 184,

amplifiers 37

amyotrophic lateral sclerosis 29

anal sphincter 199, 204

recording from 17

anesthesia 35–37

children 166, 169

confounding factors 209

cranial nerve monitoring 111

cranial nerve nuclei monitoring 129

EEG effects 175

emergence 43, 49

induction 43, , 48

maintenance 43

neuromuscular blockade 36

premedication 43

selective dorsal rhizotomy 199–200

total intravenous

See total intravenous anesthesia

anesthesiologist 36

anesthesiology team 42

anesthetic checklists 10

anesthetic fade 57, 70, 74

anesthetics 42–50

choice of 42

EEG and ECoG effects 85

effect on CNAPs 148

effect on MEPs 68–69

inhalational 48, , 50

intravenous

See total intravenous anesthesia

mode of action 42

aneurysm clipping 61

angioplasty 174

anterior cerebral artery 174, 178

antiemetics 43

antihypertensives 43

aortic aneurysm

thoracic or thoracoabdominal 180–181

aortic artery repair 232, 234

aphasia 191

aphasia syndromes 83

apraxia 145

Ashworth scale 205

modified 205

aspiration pneumonia 202,

atropine 47

auditory evoked potentials 2

brainstem

See brainstem auditory evoked potentials

short-latency 90

auditory pathways

surgery 96

auditory responsive naming 83

auditory system 90–92

axonotmesis 145, , 151

back pain 202

baclofen pump 68

BAEPs

See brainstem auditory evoked potentials

BAER huggers 43

barbiturates 49, 129

EEG effects 84

Barker, Anthony 19

basilar artery 178

benzodiazepines 43, 49

EEG effects 84

intravenous 68

biceps muscle 69, 71

bispectral index 222

bleeding radiculopathy 105

bone wax 105

Boston Naming Test 82

botulinum toxin 196

brachial plexus injury 146, 148, 156,

brachioradialis muscle 70, 71

brain monitoring 4

brainstem 120, 125

brainstem auditory evoked potentials 2, 14, 44, 90–99, 163, 174, 182, 185, 208

amplitude 98

children 164

components of 90–92

critical changes 212–218,

indications 96

interpretation 96–98

latency 97–98

localization of neurologic injury 98

montages 95–96

postoperative studies 228, 233

recording electrodes and acquisition parameters 95

sound intensity 94

stimulus 93–94

rate 94

source 93

technique 92

brainstem auditory evoked response 228

brainstem monitoring 14

brainstem tumors 119

brisk hyperactive response 200

bronchospasm 202

burns 39,

scalp 40, 65

burst-suppression 82

cardiac arrhythmias 66

cardiac pacemaker 68

cardiac surgery 77

EEG 85

cardiopulmonary bypass machines 39

carotid artery

endarterectomy

See carotid endarterectomy

stenosis 173–174

surgery 174

carotid cross-clamping 176

carotid endarterectomy 1, 8, 77, 78, 163, 172, 191, 208

EEG 85

carotid stent placement 174

cauda equina surgery 3

cavitron ultrasonic surgical aspirator 39

central conduction time 172

central nervous system

maturation in children 164–165

cerebellar tumors 119

cerebellopontine angle 98, 120

tumors of 119

cerebral aneurysm 181–183, , 191

clipping 77

cerebral arteriovenous malformation 181, 183

cerebral blood flow 87, 172–173

cerebral cavernous malformation 181

cerebral ischemia 1, 77, 172, 174, 177, 179, 191

cerebral oximetry 179

cerebral palsy 15, 203

spastic 197

cerebropontine angle tumor resection 61

cerebrospinal fluid leaks 106

Certificate in Neurophysiologic Intraoperative Monitoring (CNIM) 7

certification 4–6

cervical peaks 56,

child life provider 16

children 163–170

anesthesia 166, 169

CNS maturation 164–165

inhalational anesthetic agents 48

lice infestation 13

scoliosis 166–167

selective dorsal rhizotomy 167–168

skeletal factors 164

tethered cord syndrome 168

circle of Willis 81

clinical neurophysiologist 33

physical presence of 34

skills of 34

training and experience 35

Clinical Neurophysiology fellowships 4

clip electrodes 78

closed-circuit TV monitors 36

CMAPs

latency 113

oculomotor muscles 112

See under compound muscle action potentials

CNAPs

amplitude 150

clinical utility 150

recording 149–150

stimulation technique 147–149

See under compound nerve action potentials

cochlea 90

collodion 65, 77, 187

Committee on Accreditation for Education in Electroneurodiagnostic Technology (CoA-END) 7

compound muscle action potentials 27, 29, 102, 103, 147, 150–151, 230

compound nerve action potentials 142, 143, , 147,

continuing medical education 5

cortical ischemia

EEG 81

cortical stimulation 3, 77, 78–79, 82–84, 86

auditory responsive naming 83

conscious patient 82

safety 79, 86

seizures 79

visual responsive naming 83

word-generation tasks 83

corticospinal tract monitoring 3, 20

cranial nerve monitoring 14, 49, 109–138

accessory nerve 124

and anesthesia 111

data interpretation 133–134

electrical stimulation 110–111

EMG 109–110

facial nerve 116–117

evoked potentials 118–119

F waves 119

lateral spread reflex 119–120

stimulation and recording 117–118

glossopharyngeal nerve 120–122

hypoglossal nerve 124–125

lower cranial nerves 120

oculomotor function 111–115

postoperative studies 233

special considerations 111

trigeminal nerve 115–116

vagus nerve 122–124

cranial nerve nuclei 109, 125

anesthesia for monitoring 129

IOM 126–127

monitoring protocol 130–133

stimulation and recording 127–129

craniotomy 2, 77, 82

cricothyroid ligament 122

cup electrodes 64, 95

data acquisition 207–210

data interpretation and reporting 207–219

deep brain electrode implantation 2, 3

density-modulated spectral array 176

desflurane 44, , 222

sedative effects 84

dexamethasone 71

dexmedetomidine 48, 84

diagnosis 6

diagnostic interpretation 6, 8,

diagnostic tests 6

Diplomates of the American Board of NeuroMonitoring (DABNM) 5

diplopia 111

direct (D) wave 26, 27, 31, 42, 64

direct cortical stimulation

See cortical stimulation

direct supervision 4

disk electrodes 53, 64, 77

diskectomy 65

droperidol 84

Duchenne muscular dystrophy 232

dysarthria 120

dysesthesia 202

dysgeusia 120

dysphagia 120

dysphonia 120

ECoG

See electrocorticography

Edinburgh Visual Gait Assessment 202

EEG

See electroencephalography

electrical interference 39, 96, 110

electrocardiography 6

electrocerebral silence 85

electrocochleagram 90

electrocorticography 1, 2, , 3, 77–87

anesthetic effects 84–85

epilepsy 85–86

interpretation and testing 82

montages 78

page speed 78

recording 78

stimulation 78–79

electroencephalography 1, 2, , 3, 6, 8, 77–87, 163, 172

anesthetic effects 84–85, 175

automated 81

cardiac surgery 85

carotid endarterectomy 85

computer-processed 176

interpretation and testing 81–82

montages 78

page speed 78

scalp 1, 77–78

simultaneous screen display 78

stimulation 78–79

vascular disorders 174–176, 182

critical changes 175–176

interpretation 175

electromyography (EMG) 1, 2, , 6, 101–107, 142, 182, 208

anesthesia effects 154

children 164

cranial nerve monitoring 2, 109–110

critical changes 212

electrically triggered 154

electrodes 153

interpretation 102–105

pedicle screw placement 101

peripheral nerve monitoring 152–154,

scouting 103

technical difficulties 154

electrooculography 113

electrophysiology 172–173

EMG

See electromyography

endotracheal intubation 49, 122

endovascular procedures 209

endovascular surgery 174

epilepsy 13

ECoG 82, 85–86

monitoring 77

epilepsy surgery 1, 78

children 169

epileptic kindling 67

epileptic spikes 83

EPs

See evoked potentials

equipment 2, 10, 37–269, 38,

amplifiers 37

confounding factors 209

electrical interference 39

magnetic fields 39

overheating 39

siting of 37

space for 10

Erb’s point 56, 61

etomidate 36, 46, 84

side effects 49

evoked potentials (EPs) 1, 2, 3, 6

motor

See motor evoked potentials

neurogenic 2

oculomotor nerve 113

transcranial magnetic 156

visual monitoring 2

expert consultants 5

eye movements 111

facial colliculus 126, 127, 138

facial nerve (VII) 109, 164

evoked potentials 118–119

F waves 119, 138

lateral spread reflex 119–120

monitoring 116–117

stimulation and recording 117–118

false alarms 1, 57–58

false-negatives 1, 2, 7, , 58, 64

false-positives 58

Faraday, Michael 19, , 20

fecal incontinence 202

fellowships 4

fentanyl 43, 49, 199

findings 6

flumazenil 222

foramen magnum 120

forced vital capacity 232

Friedreich’s ataxia 222

functional magnetic resonance imaging 13

gastrocnemius muscle 71

genioglossus muscle 124, 128

glossopharyngeal nerve (IX) 109, 120

monitoring 120–122

grid electrodes 77, 78, 86

gross motor functional measure (GMFM-88) 201

Gross Motor Functional scale 196

halothane 44

sedative effects 84

hemifacial spasm 119,

history of IOM 1–2

hookwire electrodes 109, 114, , , 116, 121, 122, 128, 130, 153

hydromorphine 49

hypercarbia 166

hyperesthesia 202

hyperthermia 201

hypoglossal nerve (XII) 109, 120, 124, 125, , 128, 164

monitoring 124–125

nucleus 126

recording from 128

hypoglossal trigone 127

hypotension 57

hypothermia 57, 85, 148, 166

hypoxia 57, 166

hypoxiai–schemia 85

indirect (I) wave 26, 27, 31, 42, 64

injury potentials or spikes 86

internal carotid artery 173

International Electrotechnical Commission standards 39

interventional neuroradiology 184–185

intracranial cerebrovascular disorders 181

intracranial monitoring 61

intraoperative monitoring (IOM) 1

advantages of 1

application for 2–3

confounding factors 208–210

clinical example 214–215

critical changes 210–211, 218,

dangers of inexperience 5

goal of 33

multimodal 35

procedures 3

techniques 208

IOM

See intraoperative monitoring

isoflurane 44, , 129, 200

children 166

sedative effects 84

jugular foramen 120

ketamine 36, 46, , 48, 68,

selective dorsal rhizotomy 47

side effects 49

Krause, Fedor 143

kyphosis 106, 167

Lambert–Beer law 179

laminectomy 65

language mapping 82, 86, 87

visual object naming 82

lateral spread reflex 119–120

lice infestation 13

lidocaine 222

lip, lacerations of 66

lower extremity

SEPs 52–62

peaks 56

recording channels 54–55

magnetic coils 22–23, 29

cap or cone 23

circular 22

figure-of-eight 22

magnetic cortical stimulation 48

magnetic fields 39

magnetic resonance imaging (MRI) 6, 125

magnetic stimulation 19–31

transcranial

See transcranial magnetic stimulation

magnetoencephalography 13

magnetophosphenes 19

MagStim stimulator 29

mean alveolar concentration (MAC) 44

medial longitudinal fasciculus 126

median nerve

recording from 10

SEPs 14

stimulation 52, 57, 182, 185

MEPs

See motor evoked potentials

methohexital 85

microvascular decompression 2

midazolam 43, 47, 48, 49, 199, 222

middle cerebral artery occlusion 173

monitoring 3, 4

brain 4

brainstem 14

choice of modality 13

real-time 4

remote 4

simultaneous 4

spinal cord 4

monitoring team 4, 33–35

clinical neurophysiologist’s role 33

preoperative assessment 10

morphine 43, 49

motor evoked potentials 2, 3, 14, 25, 27, 35, 44, 67, 72, 163, 222

anesthetic effects 68–69,

children 163

facial nerve 118–119

muscle group selection 16, 71

neuromuscular blockade affecting 68–69

sensitivity to anesthetics 36

spinal surgery 58

motor unit potentials (MUPs) 109, 110, 152

moyamoya disease 183

multimodality monitoring 13, 225

MUPs

See motor unit potentials

muscle groups

selection for recording 15–16

muscle hematoma 66

muscle relaxants 102

N9 peaks 56

N13 peaks 56

N18 peaks 56

N20 peaks 56

N22 peaks 56

naming deficits 83

near infrared spectroscopy 174, 178, 179–180

needle electrodes 34, 53, 65, , 77, 95

cranial nerve monitoring 109

cranial nerve nuclei monitoring 130

EMG 153

pedicle screw placement 106

vocal cord insertion 122

neonates 48, 50

nerve conduction monitoring 3

nerve conduction testing 3, 6

nerve conduction velocity (NCV) 1, 2

nerve root compression 107

nerve root impingement 106

nerve transection 145

neurapraxia 145, , 151

neurologic intraoperative monitoring

See intraoperative monitoring

neurolysis 147

neuromuscular blockade 36, 43, 47, 53, 82

effect on MEPs 68–69

EMG effects 111, 154, 161

pedicle screw placement 107

neuronavigation system 113

neurotmesis 145, , 151

neurotonic discharges 103, 106, 138, 152, 161

nitrous oxide 43, 44, 47, 48, 49, 84, 166, 200

ECoG effects 84

normocapnia 43

North American Symptomatic Carotid Endarterectomy Trial (NASCET) 174

oculomotor function 111–115

oculomotor nerve (III) 109, 111, 164

operating room 11, 39

environment 209

safety 39–40

opioids 49

osteopenia 106

osteoporosis 104

oxygenation 43

P14 peaks 56

paralysis, prevention of 71

paraparesis 180,

paraplegia 180,

prevention of 72

parapontine reticular formation 126

Passive Range of Motion scale 202

paste-on electrodes 53

pathological spontaneous activity 134

patient history 11–13

Pediatric Evaluation Disability inventory 202

Pediatric Evaluation of Disability scale 196

pediatric monitoring

See children

pedicle screw placement 2, 3, 14, 101–107,

children 166

complications 106

computer-assisted 106

EMG interpretation 102–105

lower cervical and upper thoracic spine levels 105

muscle group selection 102, 107,

preparation for 101

procedure 101–102

pentobarbital 42–50

peripheral nerve anatomy 145

peripheral nerve injury 143–147

classification 145, 151, 160

Seddon 145, 151

Sunderland 145, 151, 160

monitoring technique 147

severity 145

peripheral nerve monitoring 142–161

applications 143

CMAPs

See compound muscle action potentials

CNAPs

See compound nerve action potentials

EMG 152–154,

anesthesia effects 153

electrically triggered 154

technical difficulties 154

history 143

SEPs 154–155,

transcranial magnetic evoked potentials 155–156,

traumatic nerve injury 142–146

technique 147

peroneal nerve

injury 157

stimulation 52

personal supervision 4, 8

petroclival area 120

physician supervision 3–4

pneumothorax 222

pontine cavernous malformations 128

positron emission tomography 6

posterior tibial nerve stimulation 2, 52, 56, 62, 182

postoperative studies 231

postoperative studies 225–234

brainstem auditory evoked potentials (BAEPs) 228, 233

cranial nerve monitoring 233

pedicle screw placement 228

pudendal nerve monitoring 231

selective dorsal rhizotomy 228–229

tethered cord syndrome 233

TMS 225–228

vascular disorders 232

Prader–Willi syndrome 106

premedication 43

preoperative assessment 10–18

information obtained from 11

patient history 11–13

selection of modalities 13

propofol 46, 48, 68, 85, 199, 222

children 166

ECoG recording 84

pudendal nerve monitoring 199

postoperative studies 229–231

pulmonary function 13

radicular injury 17

rectus femoris muscle 71

reflex testing 3

remifentanil 46, 49, 85, 129, 199

remote monitoring 4

rhomboid fossa 120, 125–126,

rocuronium 43

safety 39–40

scalp

burns 40, 66

EEG 1, 77–78

electrode placement 65, 74

SEPs 2

stimulation sites 54

scoliosis 13, 17, 29, 34, 44, 208, 219

children 166–167

definition of 101

multicenter survey 58

pedicle screw placement

See pedicle screw placement

Prader–Willi syndrome 106

rod placement 71

screening 101

TES 65, 73–74

scouting 53–54, 65, 103

seizures 13, 16, 66, 81

cortical stimulation-induced 79

selective dorsal rhizotomy 14–15, 17, 37, 196–204, 234

anesthesia 199–200

avoidance of muscle relaxants 47

children 167–168

clinical assessment and set-up 197–198

clinical outcome 201–202

complications 202

interpretation 200–201

method 198–199,

muscle group selection 15–16, , 199

postoperative studies 228–229

rationale and functional assessment 196–197

response grading 201

sensorimotor activation 13

sensory deficit 71

sentence-reading deficits 83

sevoflurane 44, , , 45, 46, 68, 74, 166, 200

sedative effects 84

selective dorsal rhizotomy 47

shock artifacts 164

short-latency auditory evoked potentials 90

single-pulse TMS 21

extraoperative use 29

skeletal factors in children 164

somatosensory evoked potentials 2, , 3, 14, 35, 44, 52–62, 142, 172, 208, 221

and cerebral blood flow 44

anesthesia effects 36, 57

children 166

critical changes 211–212,

clinical example 215–217

false alarms 57–58

filters 55–56

interpretation 57

intracranial monitoring 61

lower extremity

peaks 56

recording channels 54–55

monitoring tactics 61

neurologic outcome prediction 59

peripheral nerve monitoring 154–155,

recording 53–56

repetitions 52

scalp 2

scouting 53–54

sensitivity to manipulations 71

site nomenclature 54

sites for stimulation 52

spinal cord 1, , 7

spinal surgery 58–61

stimulation 52

techniques 52–53,

trigeminal nerve 115

upper extremity 14

peaks 56

recording channels 55

validity 59

vascular disorders 176–178

montages 187–188

recording 187

stimulation 186–187

spasticity 14–15

spinal angioma 29

TES 74

spinal cord

cavernous angioma

See spinal angioma

epidural recordings 2

IOM 1–2

ischemia 219, 234

monitoring 4

SEPs 1, , 7

stimulation 64

surgery 29

tethered 65

spinal cord evoked potential 64

spinal corrective surgeries 231–232

spinal surgery

MEPs 58

SEPs 58–61

vascular 65

spinal tumor resection 65

SEPs

See somatosensory evoked potentials

sternocleidomastoid muscle 124

strip electrodes 77, 78, 86

stroke 173, 174, , 179

stump pressure measurements 178

stylopharyngeus muscle 120

subcutaneous fat 164

succinylcholine 47

sufentanil 49

superior olivary nucleus 92

surgeon-269– 39

experience 38

warning of problems 39

surgical checklists 10, 17

surgical protocols 209

Tarlov cyst 149, 158

TES

See transcranial electrical stimulation

TcMEPs

See under transcranial electrical motor evoked potentials

technical confounding factors 209

technologists 35

role of 6–7, 8, 33

training of 6–7, 33

telemedicine

Web-based 35

testing 3, 4

tetanic stimulation 199

tethered cord syndrome 168, 234,

postoperative studies 233

thenar muscles 69

thiopental 48, 49

thoracic or thoracoabdominal aortic aneurysm 180–181,

TMS

See transcranial magnetic stimulation

tongue

lacerations of 66

recording from 124

total intravenous anesthesia 28, 36, 47, 48

children 166

train-of-four stimulations 102

training 8

physicans 4–6

technologists 6–7

transcortical motor stimulation 42

interstimulus interval 42

transcranial Doppler 6, 178–179

transcranial electric stimulation

children 164, 169

transcranial electrical motor evoked potentials 118, 126, 129, 130, 133, 155–156, 180, 181, 182, , 183, 185, 208, 210

critical changes 212,

clinical example 215–217

neurogenic 155

recording 188

stimulation 186, 188

transcranial electrical stimulation 14, 35, 64–75

abnormal patterns 69–71

all-or-none response 66

anesthetic effects 68–69

clinical indications 65–66

contraindications 16

limitations 66

methods 64–65

neuromuscular blockade affecting 68–69

response to 26–27

risks 66–68

safety considerations 40

scoliosis 73–74

screening questionnaire 16

spinal angioma 74

versus transmagnetic stimulation 23–25

warning criteria 69–71

transcranial magnetic stimulation 14, 19

children 165

coils 22–23, 29

electronics 14

evoked potentials 155–156,

paired-pulse 21

postoperative studies 225–228

rapid-rate 22

repetitive 19

response to 26–27

seizure risk 17

single-pulse 21, 29

triple or quadruple pulse 21

utility of 27–28

versus transcranial electrical stimulation 23–25

transcranial stimulation 2, 3, 13, , 14

trapezius muscle 124

traumatic nerve injury

See peripheral nerve injury

trigeminal nerve (V) 109, 164

monitoring of 115–116

trochlear nerve (IV) 109, 111, 164

tumor resection 78

EEG or ECoG 86

Tuohy needle 64

tympanic membrane 90

ulnar nerve

recording from 10

SEPs 14

stimulation 52

ultrasound 112

upper extremity

SEPs 14, 17

peaks 56

recording channels 55

urethral sphincter 199, 204

urinary incontinence 202

urinary retention 202

vagus nerve (X) 109, 120, 164

monitoring 122–124

valvular heart disease 68

vascular disorders 172–191

carotid artery stenosis 173–174

carotid artery surgery 174

cerebral aneurysm 181–183

cerebral arteriovenous malformation 183

critical changes 185–186

interventions 185–186

EEG 174–176

critical changes 175–176

interpretation 175

interventional neuroradiology 184–185

intracranial 181

moyamoya disease 183

near infrared spectroscopy 179–180

postoperative studies 232

procedures 173

SSEPs 176–178

montages 187–188

recording 187

stimulation 186–187

thoracic or thoracoabdominal aortic aneurysm 180–181

transcranial Doppler 178–179

vastus lateralis muscle 69, 71

vecuronium 47, , 199

vertebral artery 178

penetration 105

visual object naming task 82

visual responsive naming 83

vocal cords

needle insertion 122

wake-up test 71, 75, 167, 221–223

circumstances of 222

role of intraoperative monitoring team 222

Wallerian degeneration 145

word-generation tasks 83




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