Intraoperative Monitoring of Neural Function

Section I: Overview and general clinical considerations: Overview and history. Physiology. Anatomy. EEG and anesthetic effects. Anesthetic effects on EPS. Section II: CNP techniques used in monitoring neural function during surgery: Electroencephalography used in monitoring neural function during surgery. Electrocorticography . Direct cortical stimulation to localize sensory, motor, and language function. Deep brain stimulation, electrodeplacement, and pallidotomy monitoring and testing, microneuronography. Visual evoked potentials during surgery. Somatosensory evoked potential monitoring with scalp and cervical recording. Somatosensory evoked potential monitoring with dermatomal stimulation. Monitoring spinal epidural potentials to peripheral nerve stimulation. Somatosensory evoked potentials for intraoperative mapping of the sensorimotor cortex. Motor EP physiology, risks and specific anesthetic effects. Corticospinal tract monitoring with D and I waves from the spinal cord and muscle MEPs from limb muscles. Recording MEPs to transcranial electrical stimulation and SEPs to peripheral nerve stimulation simultaneously from the spinal cord. Transcranial electrical MEP with muscle recording. Neurogenic mixed evoked potentials. Magnetic cortical stimulation techniques. Mapping the corticospinal tract. BAEPs in surgery. Mapping the brainstem: floor of the fourth ventricle. Introperative peripheral nerve stimulation and recording. Intraoperative facial nerve monitoring. Oculomotor and lower cranial nerve monitoring. Intraoperative monitoring with free-running EMG. Introperative EMG during spinal pedicle screw instrumentation. Sacral roots and nerves, and monitoring for neuro-urologic procedures. Motor evoked potentials from external anal and urethral sphincter muscles by transcranial cortical stimulation during surgery. Selective dorsal rhizotomy. Nerve root assessment with SEP and MEP. Technological advances in intraoperative neurophysiological monitoring. Section III: Disorders monitored during surgery: Neurophysiology during epilepsy surgery. Intraoperative neurophysiology during surgery for cerebral tumors. Movement disorders. Mapping and monitoring for brainstem lesions. Cranial base surgery. Neurophysiology during microvascular facial nerve decompression. Neurophysiology during middle ear, mastoid and parotid surgery. Monitoring during surgery around the acoustic and vestibular nerves. Monitoring neural function during surgery around the glossopharyngeal, vagus and laryngeal nerves during neck (thyroid, larynx, carotid) and chest procedures. Monitoring during the surgical treatment of scoliosis. Monitoring during spinal surgery for fractures and extramedullary tumours. Intraoperative neurophysiological monitoring during surgery for intramedullary spinal cord tumors. Neurophysiologic monitoring during spinal endovascular procedures. Monitoring the spinal cord during surgery for ccervical mmyelopathy. Monitoring during lumbar stenosis and fusion surgery. Surgery for tethered cord syndrome and other cauda equina lesions. Dorsal root entry zone procedures and other surgeries for pain. Intraoperative testing and monitoring during brachial plexus surgery. Intraoperative testing and monitoring during lumbosacral plexus surgery. Monitoring of neural structures involved in micturition and sexual functionMonitoring during total hip arthroplasty. Monitoring neural function during pelvic surgery. Intraoperative testing and monitoring during peripheral nerve surgery. Intraoperative monitoring during carotid endarterectomy. Monitoring during carotid balloon test occlusion. Monitoring during surgery for intracranial aneurysms. Spinal cord monitoring during descending aortic procedures. Intraoperative monitoring during cardiac surgery. Section IV : Intensive care monitoring : Neonatal ICU monitoring. ICU EEG monitoring for acute seizures and status epilepticus. ICU EEG monitoring for vasospasm and other focal cortical disorders Section V: Other issues: Safety issues during surgical monitoring. Monitoring the depth of anesthesia. Monitoring of cerebral perfusion with transcranial Doppler ultrasound. Cerebral oximetry as a tool in the operating room and intensive care unit.