Intraoperative neurophysiological monitoring
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
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 1).
Somatosensory evoked potentials (SSEP)
Brainstem auditory evoked potentials (BAEP)
Visual evoked potentials (VEP)
Electromyography (EMG) .
Spontaneous-EMG.
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.