Neurophysiology in Neurosurgery - A Modern Intraoperative Approach

Front Cover

Neurophysiology in Neurosurgery: A Modern Intraoperative Approach

Copyright Page

Contents

Contributors

Preface

Acknowledgments

Part I: Motor Evoked Potentials/Neurophysiological Base (Background)

Chapter 1. Animal and Human Motor System Neurophysiology Related to Intraoperative Monitoring

1 Introduction

2 Corticospinal Responses

3 Muscle Responses

Chapter 2. Intraoperative Neurophysiology and Methodologies Used to Monitor the Functional Integrity of the Motor System

1 Intraoperative Monitoring of the Motor System: A Brief History

2 New Methodologies

3 Methodological Aspects of TES During General Anesthesia

4 Recording of MEPs over the Spinal Cord (Epidural and Subdural Space) Using Single Pulse Stimulation Technique

5 Recording of MEPs in Limb Muscles Elicited by a Multipulse Stimulating Technique

6 Conclusion

Part II: Intraoperative Neurophysiology of the Spinal Cord (Spinal Cord Monitoring)

Chapter 3. Spinal Cord Surgery

1 Introduction

2 Epidemiology and Histology

3 Clinical Presentation

4 Diagnostic Studies

5 Surgical Management

6 Outcome Following Surgery

7 Surgical Complications

8 Conclusion

Chapter 4. Motor Evoked Potential Monitoring for Intramedullary Spinal Cord Tumor Surgery

1 Introduction

2 Neurophysiology

3 Anesthesia

4 Safety

5 Clinical Assessment and Correlation

6 Practical Surgical Application of Intraoperative Neurophysiological Information

7 Illustrative Cases

8 Summary

Chapter 5. Selective Spinal Cord Lesioning Procedures for Spasticity and Pain

Part I: Selective Lesioning Procedures in Spinal Roots and Spinal Cord for Treatment of Spasticity

Part II: Selective Spinal Cord Lesioning Procedures for Treatment of Pain: DREZ Lesions

Chapter 6. Neurophysiological Monitoring During Endovascular Procedures on the Spine and the Spinal Cord

1 Spinal Cord Vascularization and Ischemia

2 Neurophysiological Monitoring

3 Endovascular Treatment of Vascular Malformations and Tumors of the Spine and the Spinal Cord

4 Conclusions

Chapter 7. Intraoperative Neurophysiological Mapping of the Spinal Cord’s Dorsal Columns

1 Introduction

2 Methods of Intraoperative Recording of SEPs with Miniature Electrodes

3 Results

4 Discussion

5 Conclusion

Part III: Intraoperative Neurophysiology of Peripheral Nerves, Nerve Roots and Plexuses

Chapter 8. Intraoperative Neurophysiology of the Peripheral Nervous System

1 Background

2 Nerve Regeneration

3 Equipment for Intraoperative Recording

4 Electrodes for Intraoperative Recording and Stimulation

5 Anesthetic Considerations

6 Recording CNAPs Intraoperatively

7 Criteria for Appraising a CNAP

8 Operative Results

9 Troubleshooting

10 Conclusions

Chapter 9. Intraoperative Neurophysiological Monitoring of the Sacral Nervous System

1 Introduction

2 Functional Anatomy

3 Clinical Neurophysiological Tests in Diagnostics

4 Intraoperative Clinical Neurophysiology

5 Discussion and Conclusions

Chapter 10. Sensory Rhizotomy for the Treatment of Childhood Spasticity

1 Introduction

2 Modern Development of Selective Dorsal Rhizotomy

3 Physiologic Basis of Current Techniques

4 Outcome

5 Conclusion

Chapter 11. Neurophysiological Monitoring During Pedicle Screw Placement

1 Introduction

2 Techniques for Assessing Nerve Root Function and Pedicle Screw Placement

3 Personal Experience

4 Conclusions

Part IV: Intraoperative Neurophysiology of Cranial Nerves and Brainstem

Chapter 12. Surgery of Brainstem Lesions

1 Introduction

2 Patient Selection and Rationale for Surgery

3 General Principles of the Surgical Strategy

4 Postoperative Care

5 Neurophysiological Monitoring

6 Conclusion

Chapter 13. Monitoring and Mapping the Cranial Nerves and the Brainstem

1 Introduction

2 Monitoring Cranial Motor Nerves

3 Monitoring Sensory Cranial Nerves

4 Monitoring the Brainstem

5 Mapping the Floor of the Fourth Ventricle

6 Monitoring That Can Guide the Surgeon During an Operation

7 Conclusions

Chapter 14. Brainstem Mapping

1 Introduction

2 Methodology of BSM

3 Results of BSM

4 Surgical Implications of BSM

5 Clinical Limitations of BSM

6 Representative Case of BSM

7 Clinical Application of BSM

8 Summary

Part V: Intraoperative Neurophysiology of Supratentorial Procedures

Chapter 15. Intraoperative Neurophysiological Mapping and Monitoring for Supratentorial Procedures

1 Introduction

2 Somatosensory Evoked Potentials

3 Intraoperative and Perioperative Neurophysiological Functional Mapping

4 MEP Monitoring

5 Safety and Anesthesia

6 Value and Limitations from a Clinical Perspective

Part VI: Intraoperative Neurophysiology During Stereotactic Neurosurgery for Movement Disorders

Chapter 16. Neurophysiological Monitoring During Neurosurgery for Movement Disorders

1 Introduction

2 History and Theory

3 Operating Room Environment and Basic Equipment

4 Technique for Movement Disorder Surgery

5 Conclusion

Part VII: Intraoperative Neurophysiology and Anesthesia Management

Chapter 17. Anesthesia and Motor Evoked Potential Monitoring

1 Introduction

2 Overview

3 Effects of Specific Anesthetic Agents

4 Conclusion: Anesthetic Choice for Motor Tract Monitoring

Index