Clinical neurophysiology plays a critical role in neurosurgery by providing real-time functional assessment of the nervous system, guiding surgical decisions, and improving patient outcomes. The integration of neurophysiological techniques in neurosurgical procedures has significantly enhanced safety and precision.
Clinical neurophysiology supports neurosurgery in three key areas:
IONM is essential for preventing neurological deficits during surgery. Techniques include:
| Modality | Application in Neurosurgery |
|---|---|
| Somatosensory Evoked Potentials (SSEPs) | Monitors dorsal column pathways during spinal cord surgeries. |
| Motor Evoked Potentials (MEPs) | Assesses corticospinal tract function in brain and spine surgery. |
| Electrocorticography (ECoG) | Identifies epileptogenic zones during epilepsy surgery. |
| Brainstem Auditory Evoked Potentials (BAEPs) | Used in acoustic neuroma and brainstem surgeries. |
| Visual Evoked Potentials (VEPs) | Evaluates optic nerve function in tumor and vascular surgeries. |
| Direct Cortical Stimulation | Identifies motor and language areas during awake craniotomies. |
| Electromyography (EMG) | Detects nerve root irritation during spinal surgery. |
Clinical neurophysiology is indispensable in modern neurosurgery, providing functional guidance before, during, and after surgery to optimize patient safety and improve surgical outcomes.
In the 18th century, Luigi Galvani proposed the hypothesis of animal electricity, which is produced by the brain and distributed through the nerves to the muscles. This was the cornerstone of what is known today as the modern study of nerve function, earning him the title of the Father of Clinical Neurophysiology. The 19th century was subsequently marked by two major figures: Santiago Ramón y Cajal (Neuron Theory) and Hans Berger, known for describing cerebral electrical activity and recording the first electroencephalograms. In Mexico, Clinical Neurophysiology emerged in the late 19th century and consolidated itself in the first half of the 20th century. In the year of 1938, Dr. Clemente Robles and Teodoro Flores Covarrubias built the first electroencephalograph, marking the beginning of the era of Clinical Neurophysiology. Initially, this diagnostic tool was primarily applied to psychiatric patients, as there was no clear separation between psychiatry and neurology, and patients were treated jointly at the largest psychiatric center of that time, “La Castañeda.” In 1968, the Mexican Society of Electroencephalography A.C. was founded and later changed its name to the Mexican Society of Clinical Neurophysiology A.C. Simultaneously, its members achieved universal recognition of the medical specialty, which has become established in clinical practice and has shown progressive academic and scientific growth in Mexico 1)