Neuromonitoring is used during surgery to assess the functional integrity of the brain, spinal cord, brainstem, and cranial nerves. It also called electrophysiologic monitoring used to find metabolic disturbances in the brain and measurements of cerebral blood flow. The neuromonitoring techniques are used after performing neurosurgery and in patients with abnormalities such as epilepsy, subarachnoid hemorrhage, embolic stroke, etc. The main objective of monitoring is to alert the surgeon and anesthesiologist to impending injury to let modification of management in time. In some rare cases, neuromonitoring is used to map areas of the nervous system to guide procedural management. Nowadays, neuromonitoring has become comm0on during many surgical procedures. Neuromonitoring is performed by a team of specialized experts and techniques are chosen by surgeons.
The reduce neurological complications and to improve the surgical decision, the techniques used are motor evoked potentials (MEPs), Electroencephalography (EEG), brainstem auditory evoked potentials (BAEPs), electrocorticography (ECoG), somatosensory evoked potentials (SSEPs), and electromyography (EMG).
Neuromonitoring uses various neurological modalities to monitor the health conditions of the patient. The set of modalities used is based in part on which neural structures are at risk.
Transcranial Doppler Imaging (TCDI) is used to detect vascular emboli. TCDI is used along with EEG used for vascular surgery. Neuromonitoring is given to patients who are undergoing operations involving the nervous system. In common, a trained neurophysiologist attaches a computer system to the patient using recording and electrodes.
The software running on the computer system carries out two specific tasks:
The expert can document the electrophysiologic signals in real-time in the operating area during the surgery process. The electrophysiologic signals change based on various factors such as tissue temperature, surgical stage, tissue stresses, and anesthesia.
These tasks are performed with a team of surgeons, neurophysiologists, and anesthesia
Neuromonitoring is utilized by spine surgeons, but vascular, orthopedic, urology surgeons, and neurosurgeons have utilized neuromonitoring as well. Neuromonitoring finds applications are in spinal surgery: carotid endarterectomy; ENT procedures such as acoustic neuroma resection, nerve surgery; and parotidectomy.
Neuro monitoring is used to:
Cerebral Tumor Surgery: neuromonitoring for cerebral tumors can be used to identify the exact location of eloquent areas, such as the language cortex.
Brainstem Surgery: In this surgery, routine monitoring of brainstem function can be done by SSEP, BAEP, and MEP.
Spinal Surgery: Neuromonitoring can be used for predicting an increased risk of adverse outcomes, such as quadriplegia, paraparesis, and paraplegia, in spinal surgery.
Vascular Surgery: In this surgery, neurological monitoring is used to predict the risk of postoperative neurological deficits.
Thyroid, Parathyroid, And Esophagus Surgery: In thyroid and parathyroid surgery, paralysis of the vocal cord can lead to hoarseness, airway block, and voice loss. Using neuro monitoring you can detect the abnormalities.
The use of neuromonitoring has become widespread with the development of the commercial neuromonitoring machine and the availability of educational programs.