Neurosurg Focus
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Spinal surgery involves a wide spectrum of procedures during which the spinal cord, nerve roots, and key blood vessels are frequently placed at risk for injury. Neuromonitoring provides an opportunity to assess the functional integrity of susceptible neural elements during surgery. The methodology of obtaining and interpreting data from various neuromonitoring modalities-such as somatosensory evoked potentials, motor evoked potentials, spontaneous electromyography, and triggered electromyography-is reviewed in this report. ⋯ Multimodality neuromonitoring relies on the strengths of different types of neurophysiological modalities to maximize the diagnostic efficacy in regard to sensitivity and specificity in the detection of impending neural injury. Thorough knowledge of the benefits and limitations of each modality helps in optimizing the diagnostic value of intraoperative monitoring during spinal procedures. As many spinal surgeries continue to evolve along a pathway of minimal invasiveness, it is quite likely that the value of neuromonitoring will only continue to become more prominent.
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Transcranial motor evoked potential (TcMEP) monitoring is frequently used in complex spinal surgeries to prevent neurological injury. Anesthesia, however, can significantly affect the reliability of TcMEP monitoring. Understanding the impact of various anesthetic agents on neurophysiological monitoring is therefore essential. ⋯ In general, selecting the appropriate anesthetic regimen with maintenance of a stable concentration of inhalational or intravenous anesthetics optimizes TcMEP monitoring.
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Intraoperative electrical stimulation of the motor cortex is a sensitive method for intraoperative mapping and monitoring of this region. Two different stimulation techniques have been established, the bipolar and monopolar techniques. ⋯ The present study is a review of the electrophysiological basis of direct cortical electrical stimulation of the motor cortex. Both methods are discussed and their field of application is presented.