Neurophysiology in Neurosurgery (eBook)

Front Cover 1
Neurophysiology in Neurosurgery: A Modern Intraoperative Approach 4
Copyright Page 5
Contents 6
Contributors 12
Preface 14
Acknowledgments 16
Part I: Motor Evoked Potentials/Neurophysiological Base (Background) 18
Chapter 1. Animal and Human Motor System Neurophysiology Related to Intraoperative Monitoring 20
1 Introduction 21
2 Corticospinal Responses 22
3 Muscle Responses 35
Chapter 2. Intraoperative Neurophysiology and Methodologies Used to Monitor the Functional Integrity of the Motor System 42
1 Intraoperative Monitoring of the Motor System: A Brief History 43
2 New Methodologies 46
3 Methodological Aspects of TES During General Anesthesia 48
4 Recording of MEPs over the Spinal Cord (Epidural and Subdural Space) Using Single Pulse Stimulation Technique 51
5 Recording of MEPs in Limb Muscles Elicited by a Multipulse Stimulating Technique 58
6 Conclusion 66
Part II: Intraoperative Neurophysiology of the Spinal Cord (Spinal Cord Monitoring) 70
Chapter 3. Spinal Cord Surgery 72
1 Introduction 73
2 Epidemiology and Histology 73
3 Clinical Presentation 74
4 Diagnostic Studies 75
5 Surgical Management 77
6 Outcome Following Surgery 85
7 Surgical Complications 86
8 Conclusion 87
Chapter 4. Motor Evoked Potential Monitoring for Intramedullary Spinal Cord Tumor Surgery 90
1 Introduction 91
2 Neurophysiology 93
3 Anesthesia 96
4 Safety 97
5 Clinical Assessment and Correlation 97
6 Practical Surgical Application of Intraoperative Neurophysiological Information 98
7 Illustrative Cases 102
8 Summary 106
Chapter 5. Selective Spinal Cord Lesioning Procedures for Spasticity and Pain 110
Part I: Selective Lesioning Procedures in Spinal Roots and Spinal Cord for Treatment of Spasticity 111
Part II: Selective Spinal Cord Lesioning Procedures for Treatment of Pain: DREZ Lesions 121
Chapter 6. Neurophysiological Monitoring During Endovascular Procedures on the Spine and the Spinal Cord 136
1 Spinal Cord Vascularization and Ischemia 137
2 Neurophysiological Monitoring 141
3 Endovascular Treatment of Vascular Malformations and Tumors of the Spine and the Spinal Cord 150
4 Conclusions 164
Chapter 7. Intraoperative Neurophysiological Mapping of the Spinal Cord’s Dorsal Columns 170
1 Introduction 171
2 Methods of Intraoperative Recording of SEPs with Miniature Electrodes 173
3 Results 174
4 Discussion 177
5 Conclusion 181
Part III: Intraoperative Neurophysiology of Peripheral Nerves, Nerve Roots and Plexuses 184
Chapter 8. Intraoperative Neurophysiology of the Peripheral Nervous System 186
1 Background 187
2 Nerve Regeneration 191
3 Equipment for Intraoperative Recording 192
4 Electrodes for Intraoperative Recording and Stimulation 195
5 Anesthetic Considerations 199
6 Recording CNAPs Intraoperatively 199
7 Criteria for Appraising a CNAP 200
8 Operative Results 202
9 Troubleshooting 207
10 Conclusions 211
Chapter 9. Intraoperative Neurophysiological Monitoring of the Sacral Nervous System 214
1 Introduction 215
2 Functional Anatomy 216
3 Clinical Neurophysiological Tests in Diagnostics 219
4 Intraoperative Clinical Neurophysiology 220
5 Discussion and Conclusions 229
Chapter 10. Sensory Rhizotomy for the Treatment of Childhood Spasticity 236
1 Introduction 236
2 Modern Development of Selective Dorsal Rhizotomy 237
3 Physiologic Basis of Current Techniques 240
4 Outcome 242
5 Conclusion 245
Chapter 11. Neurophysiological Monitoring During Pedicle Screw Placement 248
1 Introduction 249
2 Techniques for Assessing Nerve Root Function and Pedicle Screw Placement 250
3 Personal Experience 272
4 Conclusions 276
Part IV: Intraoperative Neurophysiology of Cranial Nerves and Brainstem 282
Chapter 12. Surgery of Brainstem Lesions 284
1 Introduction 285
2 Patient Selection and Rationale for Surgery 286
3 General Principles of the Surgical Strategy 287
4 Postoperative Care 296
5 Neurophysiological Monitoring 302
6 Conclusion 303
Chapter 13. Monitoring and Mapping the Cranial Nerves and the Brainstem 308
1 Introduction 309
2 Monitoring Cranial Motor Nerves 309
3 Monitoring Sensory Cranial Nerves 318
4 Monitoring the Brainstem 326
5 Mapping the Floor of the Fourth Ventricle 327
6 Monitoring That Can Guide the Surgeon During an Operation 328
7 Conclusions 332
Chapter 14. Brainstem Mapping 336
1 Introduction 337
2 Methodology of BSM 339
3 Results of BSM 340
4 Surgical Implications of BSM 342
5 Clinical Limitations of BSM 344
6 Representative Case of BSM 345
7 Clinical Application of BSM 348
8 Summary 349
Part V: Intraoperative Neurophysiology of Supratentorial Procedures 354
Chapter 15. Intraoperative Neurophysiological Mapping and Monitoring for Supratentorial Procedures 356
1 Introduction 357
2 Somatosensory Evoked Potentials 359
3 Intraoperative and Perioperative Neurophysiological Functional Mapping 370
4 MEP Monitoring 384
5 Safety and Anesthesia 404
6 Value and Limitations from a Clinical Perspective 407
Part VI: Intraoperative Neurophysiology During Stereotactic Neurosurgery for Movement Disorders 420
Chapter 16. Neurophysiological Monitoring During Neurosurgery for Movement Disorders 422
1 Introduction 423
2 History and Theory 423
3 Operating Room Environment and Basic Equipment 434
4 Technique for Movement Disorder Surgery 441
5 Conclusion 456
Part VII: Intraoperative Neurophysiology and Anesthesia Management 466
Chapter 17. Anesthesia and Motor Evoked Potential Monitoring 468
1 Introduction 469
2 Overview 469
3 Effects of Specific Anesthetic Agents 472
4 Conclusion: Anesthetic Choice for Motor Tract Monitoring 485
Index 492