Intraoperative monitoring
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215758678
2008-05-29T16:04:56Z
63.238.143.201
/* External links */
'''Intraoperative Neurophysiology Monitoring''' (IONM) is the use of [[clinical neurophysiology| electrophysiological methods]] (such as [[electroencephalography|EEG]], [[electromyography|EMG]], and [[evoked potential]]s) to monitor the functional integrity of neural structures ([[brain]], [[nerve]]s, [[spinal cord]]) during surgery.
The most common applications are in [[neurosurgery]] such as spinal surgery; some brain surgeries; [[carotid endarterectomy]]; [[ENT]] procedures such as [[Vestibulocochlear nerve|acoustic neuroma]] resection; and [[peripheral nerve]] surgery. Motor evoked potentials have also been used in surgery for [[TAAA]] (thoracic-abdominal aortic aneurysms).
Intraoperative monitoring is used * to localize neural structures, for example to locate cranial nerves during skull base surgery; * to test function of these structures; and * for early detection of intraoperative injury, allowing for immediate corrective measures.
For example, during any surgery on the [[thoracic]] or [[cervical]] spinal column, there is some risk to the spinal cord. Since the 1970's, SSEP ([[somatosensory evoked potentials]]) have been used to monitor spinal cord function by stimulating a nerve [[distal]] to the surgery, and recording from the cerebral cortex or other locations [[rostral]] to the surgery. A baseline is obtained, and if there are no significant changes, the assumption is that the spinal cord has not been injured. If there is a significant change, corrective measures can be taken; for example, the hardware can be removed.
More recently, transcranial electric [[motor evoked potential]]s (TCeMEP) have also been used for spinal cord monitoring. This is the reverse of SSEP; the motor cortex is stimulated transcranially, and recordings made from muscles in the limbs, or from spinal cord [[caudal]] to the surgery. This allows direct monitoring of motor tracts in the spinal cord.
EEG ([[electroencephalography]]) is used for monitoring of cerebral function in neurovascular cases (cerebral aneurysms, carotid endarectomy) and for defining tumor margins in [[epilepsy]] surgery and some cerebral tumors.
EMG ([[electromyography]]) is used for cranial nerve monitoring in skull base cases and for nerve root monitoring and testing in spinal surgery.
ABR ([[auditory brainstem response]], aka BSEP, BSER, BAEP, etc.) is used for monitoring of the acoustic nerve during acoustic neuroma and brainstem tumor resections.
== External links ==
* Medical Societies
** [http://abnm.uchicago.edu/ American Board of Neurophysiologic Monitoring]
** [http://www.asnm.org/ American Society of Neurophysiologic Monitoring]
** [http://www.aset.org The American Society of Electroneurodiagnostic Technologists, Inc.]
* Healthcare facilities
** VIDEO : [of equipement....]http://www.youtube.com/v/tJiWSfO3MTg]** [http://www.baptistonline.org/facilities/memphis/services/neurology.asp The Neurodiagnostics Laboratory at Baptist Memorial Hospital-Memphis]
* Vendors
** [http://www.rhythmlink.com Rhythmlink International, LLC]
** [http://www.biotronic.com Biotronic]
** [http://www.sentientmedical.com Sentient Medical Systems]
* Private Practices
** [http://www.sentientmedical.com Sentient Medical Systems]
** [http://www.impulsemonitoring.com Impulse Monitoring Inc]
** [http://www.accuratemonitoring.net Accurate Monitoring, LLC]
** [http://www.activediagnostics.com Active Diagnostics]
** [http://www.bromedicon.com Bromedicon, Inc.]
[[Category:Medical tests]]