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Front Cover
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Neurophysiology in Neurosurgery: A Modern Intraoperative Approach
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Copyright Page
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Contents
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Contributors
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Preface
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Acknowledgments
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Part I: Motor Evoked Potentials/Neurophysiological Base (Background)
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Chapter 1. Animal and Human Motor System Neurophysiology Related to Intraoperative Monitoring
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1 Introduction
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2 Corticospinal Responses
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3 Muscle Responses
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Chapter 2. Intraoperative Neurophysiology and Methodologies Used to Monitor the Functional Integrity of the Motor System
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1 Intraoperative Monitoring of the Motor System: A Brief History
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2 New Methodologies
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3 Methodological Aspects of TES During General Anesthesia
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4 Recording of MEPs over the Spinal Cord (Epidural and Subdural Space) Using Single Pulse Stimulation Technique
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5 Recording of MEPs in Limb Muscles Elicited by a Multipulse Stimulating Technique
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6 Conclusion
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Part II: Intraoperative Neurophysiology of the Spinal Cord (Spinal Cord Monitoring)
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Chapter 3. Spinal Cord Surgery
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1 Introduction
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2 Epidemiology and Histology
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3 Clinical Presentation
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4 Diagnostic Studies
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5 Surgical Management
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6 Outcome Following Surgery
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7 Surgical Complications
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8 Conclusion
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Chapter 4. Motor Evoked Potential Monitoring for Intramedullary Spinal Cord Tumor Surgery
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1 Introduction
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2 Neurophysiology
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3 Anesthesia
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4 Safety
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5 Clinical Assessment and Correlation
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6 Practical Surgical Application of Intraoperative Neurophysiological Information
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7 Illustrative Cases
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8 Summary
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Chapter 5. Selective Spinal Cord Lesioning Procedures for Spasticity and Pain
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Part I: Selective Lesioning Procedures in Spinal Roots and Spinal Cord for Treatment of Spasticity
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Part II: Selective Spinal Cord Lesioning Procedures for Treatment of Pain: DREZ Lesions
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Chapter 6. Neurophysiological Monitoring During Endovascular Procedures on the Spine and the Spinal Cord
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1 Spinal Cord Vascularization and Ischemia
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2 Neurophysiological Monitoring
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3 Endovascular Treatment of Vascular Malformations and Tumors of the Spine and the Spinal Cord
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4 Conclusions
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Chapter 7. Intraoperative Neurophysiological Mapping of the Spinal Cord’s Dorsal Columns
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1 Introduction
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2 Methods of Intraoperative Recording of SEPs with Miniature Electrodes
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3 Results
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4 Discussion
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5 Conclusion
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Part III: Intraoperative Neurophysiology of Peripheral Nerves, Nerve Roots and Plexuses
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Chapter 8. Intraoperative Neurophysiology of the Peripheral Nervous System
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1 Background
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2 Nerve Regeneration
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3 Equipment for Intraoperative Recording
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4 Electrodes for Intraoperative Recording and Stimulation
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5 Anesthetic Considerations
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6 Recording CNAPs Intraoperatively
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7 Criteria for Appraising a CNAP
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8 Operative Results
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9 Troubleshooting
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10 Conclusions
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Chapter 9. Intraoperative Neurophysiological Monitoring of the Sacral Nervous System
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1 Introduction
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2 Functional Anatomy
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3 Clinical Neurophysiological Tests in Diagnostics
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4 Intraoperative Clinical Neurophysiology
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5 Discussion and Conclusions
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Chapter 10. Sensory Rhizotomy for the Treatment of Childhood Spasticity
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1 Introduction
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2 Modern Development of Selective Dorsal Rhizotomy
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3 Physiologic Basis of Current Techniques
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4 Outcome
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5 Conclusion
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Chapter 11. Neurophysiological Monitoring During Pedicle Screw Placement
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1 Introduction
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2 Techniques for Assessing Nerve Root Function and Pedicle Screw Placement
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3 Personal Experience
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4 Conclusions
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Part IV: Intraoperative Neurophysiology of Cranial Nerves and Brainstem
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Chapter 12. Surgery of Brainstem Lesions
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1 Introduction
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2 Patient Selection and Rationale for Surgery
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3 General Principles of the Surgical Strategy
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4 Postoperative Care
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5 Neurophysiological Monitoring
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6 Conclusion
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Chapter 13. Monitoring and Mapping the Cranial Nerves and the Brainstem
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1 Introduction
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2 Monitoring Cranial Motor Nerves
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3 Monitoring Sensory Cranial Nerves
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4 Monitoring the Brainstem
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5 Mapping the Floor of the Fourth Ventricle
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6 Monitoring That Can Guide the Surgeon During an Operation
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7 Conclusions
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Chapter 14. Brainstem Mapping
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1 Introduction
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2 Methodology of BSM
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3 Results of BSM
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4 Surgical Implications of BSM
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5 Clinical Limitations of BSM
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6 Representative Case of BSM
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7 Clinical Application of BSM
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8 Summary
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Part V: Intraoperative Neurophysiology of Supratentorial Procedures
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Chapter 15. Intraoperative Neurophysiological Mapping and Monitoring for Supratentorial Procedures
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1 Introduction
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2 Somatosensory Evoked Potentials
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3 Intraoperative and Perioperative Neurophysiological Functional Mapping
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4 MEP Monitoring
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5 Safety and Anesthesia
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6 Value and Limitations from a Clinical Perspective
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Part VI: Intraoperative Neurophysiology During Stereotactic Neurosurgery for Movement Disorders
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Chapter 16. Neurophysiological Monitoring During Neurosurgery for Movement Disorders
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1 Introduction
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2 History and Theory
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3 Operating Room Environment and Basic Equipment
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4 Technique for Movement Disorder Surgery
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5 Conclusion
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Part VII: Intraoperative Neurophysiology and Anesthesia Management
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Chapter 17. Anesthesia and Motor Evoked Potential Monitoring
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1 Introduction
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2 Overview
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3 Effects of Specific Anesthetic Agents
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4 Conclusion: Anesthetic Choice for Motor Tract Monitoring
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Index
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