Intraoperative Neuromonitoring, 1st ed. 2024
Fundamentals, Possibilities, Limitations

Intraoperative neurophysiological monitoring (IONM) has gained increasing interest during the past decades and is now an integral part of various surgical disciplines, especially in neurosurgery, but also in otolaryngology, orthopedics, vascular surgery and general surgery. With expanding applications and evolving techniques, the monitoring team is faced with increasingly complex tasks and responsibilities. Despite its importance and significance in modern surgical medicine and the expectations associated with it, IONM is still not a regular part of the training program of medical professionals. Although knowledge on monitoring is imparted in basic courses offered by a few professional societies, systematic training of medical and non-medical staff according to a standardized curriculum is still lacking.This book aims to contribute to closing this gap. It provides a practical guide to help medical, nursing, and technical personnel get familiar with intraoperative neuromonitoring. The basic tenor is to combine theoretical and practical knowledge and thus to systematically convey essential skills about fundamentals, possibilities, but also limitations of IONM to a broad circle of readers. In order to achieve this goal, the text has been reduced to the absolutely necessary length in favor of numerous illustrations and tables.

After an introduction to the tasks, the significance, and the historical development of IONM, the anatomical, physiological and physical basics are presented. This is followed by a presentation of various modalities as well as stimulation and recording techniques. The intraoperative part begins with some information on the organizational processes in the operating room, the presentation of safety aspects, and a description of the influences of anesthesia on monitoring, including the special aspects of awake surgery. This is followed by some basic remarks on the interpretation of monitoring results and a rough overview of the application fields of IONM in various disciplines including representative case examples. The manual concludes with an evaluation of the efficiency of monitoring and practical recommendations for the detection and elimination of intraoperative sources of error. Self-tests in individual chapters are intended to give readers the opportunity to determine their level of knowledge.

1  Introduction: 1.1 Why neuromonitoring.- 1.2 Historical aspects.- 1.3  Monitoring concept.- 1.4 Monitoring team.- 2  Anatomical and Physiological Fundamentals: 2.1  Positional and directional designations.- 2.2  The nervous system.- 2.3  Musculoskeletal system: 2.4 Test questions.- 3  Measurement Technique: 3.1  Physical parameters.- 3.2  Stimulation.- 3.3  Signal acquisition.- 3.4  Test questions.- 4  Technical Accessoires: 4.1  Stimulation and recording electrodes.- 4.2  Special  accessories.- 5  Modalities and Methods: 5.1  Electroencephalography (EEG).- 5.2  Electromyography (EMG).- 5.3  Electroneurography (ENG).- 5.4  Evoked potentials (EP).- 5.5   Functional-topographic mapping.- 5.6  Cranial nerves.- 5.7  Spinal nerves.- 5.8  Reflexes.- 5.9  Autonomic nervous system.- 5.10 Test questions .- 6  Perioperative Management: 6.1. Patient preparation.- 6.2. System preparation.- 6.3. General conduct rules in the operating room (OR).- 6.4. Measurement processes.- 7  Anesthesia and IONM: 7.1  Effect of anesthetics on the nervous system.- 7.2  Anesthetics and electrophysiology.- 7.3  Awake craniotomy.- 7.4  Test questions.- 8  Application of Intraoperative Neuromonitoring: 8.1  Interpretation of  the potential findings.- 8.2  IONM in Neurosurgery.- 8.3  IONM in Orthopedic surgery.- 8.4. IONM in Vascular surgery.- 8.5. IONM in General surgery.- 8.6 IONM in Otolaryngology.- 9  Efficiency of Intraoperative Neuromonitoring.- 10  Safety: 10.1 Introduction.- 10.2 Electrical safety.-  10.2.4 Fire.- 10.3 Procedure-specific safety.- 10.3.5 Other procedures.- 10.4 Infection control.- 10.5 Essential performance.- 10.6  Conclusions.- 10.7  Test questions.- 11 Troubleshooting.- 12 Addendum:        12.1 List of figures.- 12.2 List of tables.- 12.3 Glossary.- 12.4 Literature.

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