Intraoperative neurophysiological monitoring [Neurosurgery Wiki]

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====== Intraoperative neurophysiological monitoring ======

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[[Intraoperative]] [[neurophysiological monitoring]] (IONM) or intraoperative [[neuromonitoring]] is the use of electrophysiological methods to monitor the functional integrity of certain neural structures (e.g., nerves, spinal cord, and parts of the brain) during surgery. The purpose of IONM is to reduce the risk to the patient of iatrogenic damage to the nervous system, and/or to provide functional guidance to the surgeon and anesthesiologist.


===== Indications =====



see [[Intraoperative neurophysiological monitoring indications]].

===== Anesthesia =====

[[Intraoperative neurophysiological monitoring Anesthesia]].

===== Checklist =====
see [[Vitale checklist]]


===== Modalities =====

Intraoperative neuromonitoring encompasses a variety of different modalities in which different neuropathways are monitored either continuously or at defined time points throughout a neurosurgical procedure. Surgical morbidity can be mitigated with careful patient selection and thoughtful implementation of the appropriate neuromonitoring modalities through the identification of eloquent areas or early detection of iatrogenic pathway disruption
((Wong AK, Shils JL, Sani SB, Byrne RW. Intraoperative Neuromonitoring. Neurol Clin. 2022 May;40(2):375-389. doi: 10.1016/j.ncl.2021.11.010. Epub 2022 Mar 31. PMID: 35465881.)).

[[Evoked potentials]]:

[[Somatosensory evoked potentials]] ([[SSEP]])

[[Motor evoked potential]] ([[MEP]])

[[Brainstem auditory evoked potentials]] ([[BAEP]])

[[Visual evoked potentials]] ([[VEP]])
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[[Electroencephalography]] ([[EEG]])
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[[Electromyography]] ([[EMG]]) .

Spontaneous-[[EMG]].

[[Triggered electromyography]].

see [[Intraoperative stimulation mapping]]:

[[Direct cortical stimulation]]



===== Case series =====

[[Intraoperative neurophysiological monitoring case series]].

===== Special Topic Issue =====

Seidel K, Krieg SM. Special Topic Issue: Intraoperative Neurophysiological Monitoring. J Neurol Surg A Cent Eur Neurosurg. 2021 Jul;82(4):297-298. doi: 10.1055/s-0041-1731685. Epub 2021 Jul 14. PMID: 34261154.
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https://www.ncbi.nlm.nih.gov/books/NBK563203/