Linked e-resources
Details
Table of Contents
Front Cover
Neurophysiology in Neurosurgery
Copyright Page
Dedication
Reference
Contents
List of contributors
Preface
Intraoperative neurophysiological monitoring-why we need it and a personal perspective of its development
1 Introduction
2 Theoretical background
3 Detection of developing neural damage and avoidance of permanent deficits
4 Intraoperative neurophysiological monitoring as a teaching tool
5 Detection of adverse systemic or nonsurgical influences
6 Reassurance to surgeon about lack of damaging effect of specific risky maneuvers
7 Value of intraoperative neurophysiological monitoring in today's world
8 Conclusion on why we need intraoperative neurophysiological monitoring
9 A personal perspective on the development of intraoperative neurophysiological monitoring
9.1 An early period of evoked potential applications
9.2 From diagnostics to intraoperative neurophysiological monitoring
9.3 Further clinical development
9.4 The problem of motor-evoked potentials monitoring
10 Conclusion
References
I. Introduction to intraoperative neurophysiology
1 Animal and human motor system neurophysiology related to intraoperative monitoring
1.1 Introduction
1.2 Corticospinal responses
1.2.1 Configuration of corticospinal tract waves
1.2.1.1 Conducted impulses
1.2.1.2 Blocked impulses
1.2.2 Eliciting D waves
1.2.3 Eliciting I waves
1.2.3.1 Extrinsic inputs
1.2.3.2 Intrinsic inputs
1.3 Muscle responses
References
2 Intraoperative neurophysiology and methodologies used to monitor the functional integrity of the motor system
2.1 Intraoperative monitoring of the motor system: a brief history
2.1.1 Penfield's time
2.1.2 Spinal cord to spinal cord
2.1.3 Spinal cord to peripheral nerve (muscle)
2.2 New methodologies.
2.2.1 Single-pulse stimulation technique
2.2.2 Multipulse stimulation technique
2.3 Methodological aspects of transcranial electrical stimulation during general anesthesia
2.3.1 Electrode montage over the scalp for eliciting motor-evoked potentials (for single and multipulse stimulation techniques)
2.4 Recording of MEPs over the spinal cord (epidural and subdural spaces) using single-pulse stimulation technique
2.4.1 D-wave recording technique through an epidurally or subdurally inserted electrode
2.4.1.1 Choice of electrode
2.4.2 Proper placement of epidural electrodes
2.4.2.1 Percutaneous placement of catheter electrode
2.4.2.2 Placement of electrode after laminectomy/laminotomy or flavectomy/flavotomy
2.4.3 Factors influencing D- and I-wave recordings
2.4.4 Neurophysiological mechanisms leading to the desynchronization of the D-wave
2.5 Recording of motor-evoked potentials in limb muscles elicited by a multipulse stimulating technique
2.5.1 Selection of optimal muscles in upper and lower extremities for motor-evoked potential recordings
2.5.2 Neurophysiological mechanisms for eliciting muscle motor-evoked potentials using a multipulse stimulation technique
2.5.2.1 Recovery of amplitude and latency of the D-wave
2.5.2.2 Facilitation of I-wave
2.5.2.3 Total number of D- and I-waves
2.5.2.4 Generation of muscle MEPs depends on two systems: the CST and the supportive system of the spinal cord
2.5.3 Surgically induced transient paraplegia
2.5.3.1 Neurophysiological basis for surgically induced transient paraplegia
2.6 Conclusion
References
3 Monitoring somatosensory evoked potentials
3.1 Introduction
3.2 History
3.3 Methodology
3.3.1 Basic techniques
3.3.1.1 Electrodes
3.3.1.2 Stimulation
3.3.1.3 Recording
3.3.1.4 Potentials and sites.
3.3.1.4.1 Peripheral controls
3.3.1.4.2 Cortical monitors
3.3.1.4.3 Other potentials
3.3.1.5 Averaging
3.3.2 Traditional methods
3.3.3 Optimal methods
3.3.3.1 Lower limbs
3.3.3.2 Upper limbs
3.3.3.3 Optional derivations
3.3.3.4 Fallback derivations
3.3.3.5 Benefits
3.4 Warning criteria
3.4.1 Traditional criteria pitfalls
3.4.2 Recommended adaptive criterion
3.5 Cortical somatosensory evoked potential mapping
3.5.1 Median nerve
3.5.2 Tibial and trigeminal nerves
3.6 Future directions
3.7 Conclusion
References
4 Neurophysiology of the visual system: basics and intraoperative neurophysiology techniques
4.1 Introduction
4.2 Historical review
4.3 Neurophysiology of the visual pathway
4.4 Recording of intraoperative flash visual evoked potentials
4.4.1 Indication for intraoperative visual evoked potential monitoring
4.4.2 Anesthesia
4.4.3 Stimulation
4.4.4 Recording
4.4.5 Waveform acquisition
4.4.6 Intraoperative assessment of visual evoked potentials and warning criteria
4.5 Results
4.5.1 Case examples
4.6 Optic nerve action potentials and evoked potentials
4.7 Monitoring and mapping the posterior visual pathway
4.8 Conclusion
References
5 Neurophysiology of the auditory system: basics and ION techniques
5.1 The auditory nerve
5.2 History of recordings of the auditory brainstem response
5.3 Generation of far-field-evoked potentials
5.4 Intraoperative neurophysiological monitoring of the auditory brainstem response
5.4.1 Techniques for recording the auditory brainstem response
5.4.2 Getting interpretable responses in the shortest possible time
5.4.3 Optimal stimulus rate and intensity
5.4.4 Reduction of electrical and magnetic interference.
5.4.5 Optimal placement of the recording electrodes for auditory brainstem response for intraoperative monitoring
5.4.6 Filtering of the auditory brainstem response
5.4.7 Practical ways of recording auditory brainstem responses intraoperatively
5.5 Detection of signs of hearing loss from manipulations of the auditory nerve
5.6 Recording directly from the exposed auditory nerve
5.7 Recording of the response from the cochlear nucleus
5.8 What to report to the surgeon?
5.9 The neural generators of the auditory brainstem response
5.9.1 Generators of peak I and II of the auditory brainstem response
5.9.2 Contribution to the auditory brainstem response from nuclei
5.9.2.1 The cochlear nucleus
5.9.2.2 Superior olivary complex
5.9.2.3 Lateral lemniscus
5.9.2.4 Inferior colliculus
5.9.3 Lateralization of auditory-evoked potentials
5.9.4 The absence of contributions from some ascending auditory pathways
5.9.5 Summary of the neural generators of the auditory brainstem response
5.10 Use of auditory brainstem response in monitoring to detect changes in the function of the brainstem
References
6 Intraoperative neurophysiological monitoring of the sacral nervous system
6.1 Introduction
6.2 Functional anatomy
6.2.1 Neural control of the lower urinary tract
6.2.2 Anorectum
6.2.3 Sexual organs
6.3 Clinical neurophysiological tests in diagnostics
6.4 Intraoperative clinical neurophysiology
6.4.1 Basic technical aspects of stimulation for intraoperative sacral monitoring
6.4.2 Basic technical aspects of recording for intraoperative sacral monitoring
6.4.3 Specific sacral neuromuscular system monitoring procedures
6.4.3.1 Pudendal dorsal root action potentials
6.4.3.2 Pudendal spinal somatosensory evoked responses
6.4.3.3 Pudendal cerebral somatosensory evoked potentials.
6.4.3.4 Anal sphincter motor response monitoring
6.4.3.5 Bulbocavernosus reflex monitoring
6.5 Discussion and Conclusion
References
Further reading
7 Neurophysiology of language and cognitive mapping
7.1 Introduction
7.2 Language mapping
7.2.1 Current model of language organization
7.2.2 Language mapping workup
7.2.2.1 Preoperative workup
7.2.2.2 Neuropsychological evaluation
7.2.2.3 Language examination
7.2.2.4 Training to the awake phase
7.2.2.5 Intraoperative workup
7.2.2.6 Postoperative workup
7.2.3 Neurophysiological approach
7.2.4 Defining eloquent sites in language mapping
7.2.5 How to perform the mapping?
7.2.6 Besides standard language mapping
7.2.6.1 Reading and writing
7.2.6.2 Language mapping in multilingual patients
7.3 Advanced mapping: cognitive mapping
7.3.1 Brain mapping of visual system and visuospatial cognition
7.3.2 Cognitive control
7.4 Conclusion
References
8 Effects of subthreshold stimuli on the excitability of axonal membrane
8.1 Introduction
8.2 Methodology
8.2.1 Test subjects
8.2.2 Stimulation
8.2.2.1 Median nerve
8.2.2.2 Facial nerve
8.2.3 Recording
8.2.3.1 Median nerve
8.2.3.2 Facial nerve
8.2.4 Testing protocol
8.3 Results
8.4 Discussion
8.5 Conclusion
References
II. Intraoperative neurophysiology: neurophysiologic perspective
9 Cortical and subcortical brain mapping
9.1 Introduction
9.2 Brain mapping and anesthesia
9.3 Recording and documentation
9.4 Physical background
9.5 Choice of stimulation paradigm
9.6 Choice of stimulation probe
9.7 Subcortical mapping and distance to the corticospinal tract
9.8 Continuous subcortical mapping
9.9 Possible pitfalls
9.10 Case illustrations.
9.10.1 Case no 1, video 9.1 - Intraoperative DCS MEP monitoring, cortical mapping and continuous subcortical mapping in a c.
Neurophysiology in Neurosurgery
Copyright Page
Dedication
Reference
Contents
List of contributors
Preface
Intraoperative neurophysiological monitoring-why we need it and a personal perspective of its development
1 Introduction
2 Theoretical background
3 Detection of developing neural damage and avoidance of permanent deficits
4 Intraoperative neurophysiological monitoring as a teaching tool
5 Detection of adverse systemic or nonsurgical influences
6 Reassurance to surgeon about lack of damaging effect of specific risky maneuvers
7 Value of intraoperative neurophysiological monitoring in today's world
8 Conclusion on why we need intraoperative neurophysiological monitoring
9 A personal perspective on the development of intraoperative neurophysiological monitoring
9.1 An early period of evoked potential applications
9.2 From diagnostics to intraoperative neurophysiological monitoring
9.3 Further clinical development
9.4 The problem of motor-evoked potentials monitoring
10 Conclusion
References
I. Introduction to intraoperative neurophysiology
1 Animal and human motor system neurophysiology related to intraoperative monitoring
1.1 Introduction
1.2 Corticospinal responses
1.2.1 Configuration of corticospinal tract waves
1.2.1.1 Conducted impulses
1.2.1.2 Blocked impulses
1.2.2 Eliciting D waves
1.2.3 Eliciting I waves
1.2.3.1 Extrinsic inputs
1.2.3.2 Intrinsic inputs
1.3 Muscle responses
References
2 Intraoperative neurophysiology and methodologies used to monitor the functional integrity of the motor system
2.1 Intraoperative monitoring of the motor system: a brief history
2.1.1 Penfield's time
2.1.2 Spinal cord to spinal cord
2.1.3 Spinal cord to peripheral nerve (muscle)
2.2 New methodologies.
2.2.1 Single-pulse stimulation technique
2.2.2 Multipulse stimulation technique
2.3 Methodological aspects of transcranial electrical stimulation during general anesthesia
2.3.1 Electrode montage over the scalp for eliciting motor-evoked potentials (for single and multipulse stimulation techniques)
2.4 Recording of MEPs over the spinal cord (epidural and subdural spaces) using single-pulse stimulation technique
2.4.1 D-wave recording technique through an epidurally or subdurally inserted electrode
2.4.1.1 Choice of electrode
2.4.2 Proper placement of epidural electrodes
2.4.2.1 Percutaneous placement of catheter electrode
2.4.2.2 Placement of electrode after laminectomy/laminotomy or flavectomy/flavotomy
2.4.3 Factors influencing D- and I-wave recordings
2.4.4 Neurophysiological mechanisms leading to the desynchronization of the D-wave
2.5 Recording of motor-evoked potentials in limb muscles elicited by a multipulse stimulating technique
2.5.1 Selection of optimal muscles in upper and lower extremities for motor-evoked potential recordings
2.5.2 Neurophysiological mechanisms for eliciting muscle motor-evoked potentials using a multipulse stimulation technique
2.5.2.1 Recovery of amplitude and latency of the D-wave
2.5.2.2 Facilitation of I-wave
2.5.2.3 Total number of D- and I-waves
2.5.2.4 Generation of muscle MEPs depends on two systems: the CST and the supportive system of the spinal cord
2.5.3 Surgically induced transient paraplegia
2.5.3.1 Neurophysiological basis for surgically induced transient paraplegia
2.6 Conclusion
References
3 Monitoring somatosensory evoked potentials
3.1 Introduction
3.2 History
3.3 Methodology
3.3.1 Basic techniques
3.3.1.1 Electrodes
3.3.1.2 Stimulation
3.3.1.3 Recording
3.3.1.4 Potentials and sites.
3.3.1.4.1 Peripheral controls
3.3.1.4.2 Cortical monitors
3.3.1.4.3 Other potentials
3.3.1.5 Averaging
3.3.2 Traditional methods
3.3.3 Optimal methods
3.3.3.1 Lower limbs
3.3.3.2 Upper limbs
3.3.3.3 Optional derivations
3.3.3.4 Fallback derivations
3.3.3.5 Benefits
3.4 Warning criteria
3.4.1 Traditional criteria pitfalls
3.4.2 Recommended adaptive criterion
3.5 Cortical somatosensory evoked potential mapping
3.5.1 Median nerve
3.5.2 Tibial and trigeminal nerves
3.6 Future directions
3.7 Conclusion
References
4 Neurophysiology of the visual system: basics and intraoperative neurophysiology techniques
4.1 Introduction
4.2 Historical review
4.3 Neurophysiology of the visual pathway
4.4 Recording of intraoperative flash visual evoked potentials
4.4.1 Indication for intraoperative visual evoked potential monitoring
4.4.2 Anesthesia
4.4.3 Stimulation
4.4.4 Recording
4.4.5 Waveform acquisition
4.4.6 Intraoperative assessment of visual evoked potentials and warning criteria
4.5 Results
4.5.1 Case examples
4.6 Optic nerve action potentials and evoked potentials
4.7 Monitoring and mapping the posterior visual pathway
4.8 Conclusion
References
5 Neurophysiology of the auditory system: basics and ION techniques
5.1 The auditory nerve
5.2 History of recordings of the auditory brainstem response
5.3 Generation of far-field-evoked potentials
5.4 Intraoperative neurophysiological monitoring of the auditory brainstem response
5.4.1 Techniques for recording the auditory brainstem response
5.4.2 Getting interpretable responses in the shortest possible time
5.4.3 Optimal stimulus rate and intensity
5.4.4 Reduction of electrical and magnetic interference.
5.4.5 Optimal placement of the recording electrodes for auditory brainstem response for intraoperative monitoring
5.4.6 Filtering of the auditory brainstem response
5.4.7 Practical ways of recording auditory brainstem responses intraoperatively
5.5 Detection of signs of hearing loss from manipulations of the auditory nerve
5.6 Recording directly from the exposed auditory nerve
5.7 Recording of the response from the cochlear nucleus
5.8 What to report to the surgeon?
5.9 The neural generators of the auditory brainstem response
5.9.1 Generators of peak I and II of the auditory brainstem response
5.9.2 Contribution to the auditory brainstem response from nuclei
5.9.2.1 The cochlear nucleus
5.9.2.2 Superior olivary complex
5.9.2.3 Lateral lemniscus
5.9.2.4 Inferior colliculus
5.9.3 Lateralization of auditory-evoked potentials
5.9.4 The absence of contributions from some ascending auditory pathways
5.9.5 Summary of the neural generators of the auditory brainstem response
5.10 Use of auditory brainstem response in monitoring to detect changes in the function of the brainstem
References
6 Intraoperative neurophysiological monitoring of the sacral nervous system
6.1 Introduction
6.2 Functional anatomy
6.2.1 Neural control of the lower urinary tract
6.2.2 Anorectum
6.2.3 Sexual organs
6.3 Clinical neurophysiological tests in diagnostics
6.4 Intraoperative clinical neurophysiology
6.4.1 Basic technical aspects of stimulation for intraoperative sacral monitoring
6.4.2 Basic technical aspects of recording for intraoperative sacral monitoring
6.4.3 Specific sacral neuromuscular system monitoring procedures
6.4.3.1 Pudendal dorsal root action potentials
6.4.3.2 Pudendal spinal somatosensory evoked responses
6.4.3.3 Pudendal cerebral somatosensory evoked potentials.
6.4.3.4 Anal sphincter motor response monitoring
6.4.3.5 Bulbocavernosus reflex monitoring
6.5 Discussion and Conclusion
References
Further reading
7 Neurophysiology of language and cognitive mapping
7.1 Introduction
7.2 Language mapping
7.2.1 Current model of language organization
7.2.2 Language mapping workup
7.2.2.1 Preoperative workup
7.2.2.2 Neuropsychological evaluation
7.2.2.3 Language examination
7.2.2.4 Training to the awake phase
7.2.2.5 Intraoperative workup
7.2.2.6 Postoperative workup
7.2.3 Neurophysiological approach
7.2.4 Defining eloquent sites in language mapping
7.2.5 How to perform the mapping?
7.2.6 Besides standard language mapping
7.2.6.1 Reading and writing
7.2.6.2 Language mapping in multilingual patients
7.3 Advanced mapping: cognitive mapping
7.3.1 Brain mapping of visual system and visuospatial cognition
7.3.2 Cognitive control
7.4 Conclusion
References
8 Effects of subthreshold stimuli on the excitability of axonal membrane
8.1 Introduction
8.2 Methodology
8.2.1 Test subjects
8.2.2 Stimulation
8.2.2.1 Median nerve
8.2.2.2 Facial nerve
8.2.3 Recording
8.2.3.1 Median nerve
8.2.3.2 Facial nerve
8.2.4 Testing protocol
8.3 Results
8.4 Discussion
8.5 Conclusion
References
II. Intraoperative neurophysiology: neurophysiologic perspective
9 Cortical and subcortical brain mapping
9.1 Introduction
9.2 Brain mapping and anesthesia
9.3 Recording and documentation
9.4 Physical background
9.5 Choice of stimulation paradigm
9.6 Choice of stimulation probe
9.7 Subcortical mapping and distance to the corticospinal tract
9.8 Continuous subcortical mapping
9.9 Possible pitfalls
9.10 Case illustrations.
9.10.1 Case no 1, video 9.1 - Intraoperative DCS MEP monitoring, cortical mapping and continuous subcortical mapping in a c.