- Preface
- Abbreviations
- Contributors
- Chapter 1 Nerve, muscle, and neuromuscular junction
- Chapter 2 The motor unit
- Chapter 3 Motor control: spinal and cortical mechanisms
- Chapter 4 Cortical activity: single cell, cell assemblages, and networks
- Chapter 5 Recording of neural signals, neural activation, and signal processing
- Chapter 6 Nerve conduction studies
- Chapter 7 Electromyography
- Chapter 8 Quantitative electromyography
- Chapter 9 Axonal excitability: molecular basis and assessment in the clinic
- Chapter 10 Reflex studies
- Chapter 11 Electroencephalography
- Chapter 12 Intracranial electroencephalographic recordings
- Chapter 13 Magnetoencephalography
- Chapter 14 Transcranial magnetic stimulation
- Chapter 15 Evoked potentials
- Chapter 16 Polysomnography and other investigations for sleep disorders
- Chapter 17 Clinical neurophysiology of the pelvic floor
- Chapter 18 The clinical approach to neurophysiology
- Chapter 19 Focal neuropathies
- Chapter 20 Generalized peripheral neuropathies
- Chapter 21 Disorders of single nerves, roots, and plexuses
- Chapter 22 Neurophysiology in amyotrophic lateral sclerosis and other motor degenerations
- Chapter 23 Clinical aspects of neuromuscular junction disorders
- Chapter 24 Primary muscle diseases
- Chapter 25 Paediatric conditions
- Chapter 26 EMG-guided botulinum toxin therapy
- Chapter 27 Genetic generalized epilepsy
- Chapter 28 Focal epilepsy
- Chapter 29 Syncope
- Chapter 30 Convulsive and non-convulsive status epilepticus
- Chapter 31 Presurgical evaluation for epilepsy surgery
- Chapter 32 Encephalopathy, central nervous system infections, and coma
- Chapter 33 Migraine, stroke, and cerebral ischaemia
- Chapter 34 Electroclinical features of paediatric conditions
- Chapter 35 Sleep disorders
- Chapter 36 Intraoperative monitoring
- Index
(p. 437) Intraoperative monitoring
- Chapter:
- (p. 437) Intraoperative monitoring
- Author(s):
Marc R. Nuwer
- DOI:
- 10.1093/med/9780199688395.003.0036
Intraoperative monitoring and testing is conducted to improve neurological outcomes from surgery that incurs risk of neurological injury. Many techniques are familiar from the outpatient neurodiagnostic laboratory, and can be applied with minor modifications to the operating room setting. Other techniques are specific to the operating room. Transcranial electrical motor evoked potentials cannot be applied to awake patients, but are commonly used under general anaesthesia. Monitoring teams understand the tactics for obtaining quality recordings and calling alarms when potentials change past preset limits. Surgeons and anaesthesiologists have a variety of tactics for responding to adverse neurodiagnostic changes beginning with easy actions. In experienced hands, intraoperative neurophysiological monitoring substantially reduces post-operative deficits. For example, in spinal cord monitoring the risk of paraplegia and paraparesis is reduced by 60%. Monitoring is carried out by a technologist in the operating room under the supervision of an experienced neurophysiologist. In straightforward cases, the neurophysiologist may remotely monitor from outside the operating room.
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- Preface
- Abbreviations
- Contributors
- Chapter 1 Nerve, muscle, and neuromuscular junction
- Chapter 2 The motor unit
- Chapter 3 Motor control: spinal and cortical mechanisms
- Chapter 4 Cortical activity: single cell, cell assemblages, and networks
- Chapter 5 Recording of neural signals, neural activation, and signal processing
- Chapter 6 Nerve conduction studies
- Chapter 7 Electromyography
- Chapter 8 Quantitative electromyography
- Chapter 9 Axonal excitability: molecular basis and assessment in the clinic
- Chapter 10 Reflex studies
- Chapter 11 Electroencephalography
- Chapter 12 Intracranial electroencephalographic recordings
- Chapter 13 Magnetoencephalography
- Chapter 14 Transcranial magnetic stimulation
- Chapter 15 Evoked potentials
- Chapter 16 Polysomnography and other investigations for sleep disorders
- Chapter 17 Clinical neurophysiology of the pelvic floor
- Chapter 18 The clinical approach to neurophysiology
- Chapter 19 Focal neuropathies
- Chapter 20 Generalized peripheral neuropathies
- Chapter 21 Disorders of single nerves, roots, and plexuses
- Chapter 22 Neurophysiology in amyotrophic lateral sclerosis and other motor degenerations
- Chapter 23 Clinical aspects of neuromuscular junction disorders
- Chapter 24 Primary muscle diseases
- Chapter 25 Paediatric conditions
- Chapter 26 EMG-guided botulinum toxin therapy
- Chapter 27 Genetic generalized epilepsy
- Chapter 28 Focal epilepsy
- Chapter 29 Syncope
- Chapter 30 Convulsive and non-convulsive status epilepticus
- Chapter 31 Presurgical evaluation for epilepsy surgery
- Chapter 32 Encephalopathy, central nervous system infections, and coma
- Chapter 33 Migraine, stroke, and cerebral ischaemia
- Chapter 34 Electroclinical features of paediatric conditions
- Chapter 35 Sleep disorders
- Chapter 36 Intraoperative monitoring
- Index