Evoked Responses and Electromyography in Intraoperative Monitoring in Neurosurgery


Authors: S. Ostrý;  L. Stejskal
Authors‘ workplace: Neurochirurgická klinika 1. LF UK, IPVZ a ÚVN Praha
Published in: Cesk Slov Neurol N 2010; 73/106(1): 8-19
Category: Minimonography

Overview

The requirement that perioperative morbidity decrease in neurosurgery becomes ever more pressing. A possible contribution may be made by intraoperative monitoring of conduction in important tracts during general anaesthesia. The techniques of central sulcus identification (somatosensory evoked potential, SEP phase reversal) and motor strip location by cortical stimulation are well developed. Intraoperative motor tract monitoring is advisable in the performance of resection of intramedullary tumours. Monitoring of ascendant tracts and cranial nerves is an integral part of high‑risk surgery in the cerebellopontine angle and in the brain stem. The techniques used for stimulation and recording, as well as the ways in which responses and changes are evaluated, differ from common electromyographical practice. Close teamwork among the prime movers in the operating theatre – the neurosurgeon, the anaesthesiologist and the neurophysiologist – is vital to worthwhile and reliable monitoring.

Key words:
evoked potentials – electromyography – intraoperative monitoring – general anaesthesia


Sources

1. Stejskal L. Intraoperační stimulační monitorace v neurochirurgii. Praha: Grada Publishing; 2006.

2. Urgošík D, Stejskal L, Živný B. Zásady intraoperačního sledování evokovaných odpovědí. Cesk Slov Neurol N 1993; 56/89(3): 104–107.

3. Sloan TB. Anesthesia and motor evoked potential monitoring. In: Deletis V, Shils JL (eds). Neurophy­siology in neurosurgery. A modern intraoperative approach. San Diego: Academic Press, Elsevier Science 2002: 451–474.

4. Sloan TB, Heyer EJ. Anesthesia for intraoperative neurophysiologic monitoring of the spinal cord. J Clin Neurophysiol 2002; 19(5): 430–443.

5. Yang LH, Lin SM, Lee WY, Liu CC. Intraoperative transcranial electrical motor evoked potential monitoring during spinal surgery under intravenous ketamine or etomidate anaesthesia. Acta Neurochir (Wien) 1994; 127(3–4): 191–198.

6. Porkkala T, Jäntti V, Kaukinen S, Hakkinen V. Nitrous oxide has different effects on the EEG and somatosensory evoked potentials during isoflurane anaesthesia in patients. Acta Anaesthesiol Scand 1997; 41(4): 497–501.

7. Pinto FF, Nunes L, Ferraz F, Sampayo F. Down’s syndrome: different distribution of congenital heart diseases between the sexes. Int J Cardiol 1990; 27(2): 175–178.

8. Kawaguchi M, Sakamoto T, Inoue S, Kakimoto M, Furuya H, Morimoto T et al. Low dose propofol as a supplement to ketamine‑based anesthesia during intraoperative monitoring of motor‑evoked potentials. Spine 2000; 25(8): 974–979.

9. Keller BP, Haghighi SS, Oro JJ, Eggers GW jr. The effects of propofol anesthesia on transcortical electric evoked potentials in the rat. Neurosurgery 1992; 30(4): 557–560.

10. Inoue S, Kawaguchi M, Takashi S, Kakimoto M, Sakamoto T, Kitaguchi K et al. Intraoperative monitoring of myogenic motor‑evoked potentials from the external anal sphincter muscle to transcranial electrical stimulation. Spine 2002; 27(21): E454–E459.

11. Lee WY, Hou WY, Yang LH, Lin SM. Intraoperative monitoring of motor function by magnetic motor evoked potentials. Neurosurgery 1995; 36(3): 493–500.

12. Morota N, Deletis V, Constantini S, Kofler M, Cohen H,Epstein FJ. The role of motor evoked potentials during surgery for intramedullary spinal cord tumors. Neurosurgery 1997; 41(6): 1327–1336.

13. Pechstein U, Cedzich C, Nadstawek J, Schramm J.Transcranial high‑frequency repetitive electrical stimulation for recording myogenic motor evoked potentials with the patient under general anesthesia. Neurosurgery 1996; 39(2): 335–344.

14. Pelosi L, Stevenson M, Hobbs GJ, Jardine A, Webb JK. Intraoperative motor evoked potentials to transcranial electrical stimulation during two anaesthetic regimens. Clin Neurophysiol 2001; 112(6): 1076–1087.

15. Holland NR. Intraoperative electromyography. J Clin Neurophysiol 2002; 19(5): 444–453.

16. Calancie B, Harris W, Broton JG, Alexeeva N, Green BA. „Threshold-level“ Multipulse transcranial electrical stimulation of motor cortex for intraoperative monitoring of spinal motor tracts: description of method and comparison to somatosensory evoked potential monitoring. J Neurosurg 1998; 88(3): 457–470.

17. Bala E, Sessler DI, Nair DR, McLain R, Dalton JE, Farag E.Motor and somatosensory evoked potentials are well maintained in patients given dexmedetomidine during spine surgery. Anesthesiology 2008; 109(3): 417–425.

18. Burke D, Nuwer MR, Daube J, Fischer C, Schramm J, Yingling CD et al. Intraoperative monitoring. The International Federation of Clinical Neurophysiology. Electroencephalogr Clin Neurophysiol 1999; 52 (Suppl): 133–148.

19. Legatt AD. Mechanisms of intraoperative brainstem auditory evoked potential changes. J Clin Neurophysiol 2002; 19(5): 396–408.

20. Stejskal L, Ostry S. Vaskulární versus neuronální reaktivita (stav při stenóze vnitřní karotidy a po endarterektomii). Neurol pro praxi 2007; 8(6): 371–375.

21. Allison T, McCarthy G, Wood CC, Williamson PD, Spencer DD. Human cortical potentials evoked by stimulation of the median nerve i. Cytoarchitectonic areas generating short‑latency activity. J Neurophysiol 1989; 62(3): 694–710.

22. Allison T, McCarthy G, Wood CC, Williamson PD, Spencer DD. Human cortical potentials evoked by stimulation of the median nerve II. Cytoarchitectonic areas generating long‑latency activity. J Neurophysiol 1989; 62(3): 711–722.

23. Tomás R, Haninec P, Houstava L. The relevance of the corticographic median nerve somatosensory evoked potentials (SEPs) phase reversal in the surgical treatment of brain tumors in central cortex. Neoplasma 2006; 53(1): 37–42.

24. Berger MS, Kincaid J, Ojemann GA, Lettich E. Brain mapping techniques to maximize resection, safety, and seizure control in children with brain tumors. Neurosurgery 1989; 25(5): 786–792.

25. Cedzich C, Taniguchi M, Schäfer S, Schramm J. Somatosensory evoked potential phase reversal and direct motor cortex stimulation during surgery in and around the central region. Neurosurgery 1996; 38: 962–970.

26. Wood CC, Spencer DD, Allison T, McCarthy G, Williamson PD, Goff WR. Localization of human sensorimotor cortex during surgery by cortical surface recording of somatosensory evoked potentials. J Neurosurg 1988; 68(1): 99–111.

27. Lewis SC, Warlow CP, Bodenham AR, Colam B, Rothwell PM, Torgerson D et al. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. Lancet 2008; 372(9656): 2132–2142.

28. McPherson RW, Eimerl D, Traystman RJ. Interaction of hypoxia and hypercapnia on cerebral hemodynamics and brain electrical activity in dogs. Am J Physiol 1987; 25(4): H890–H897.

29. Branston NM, Symon L, Crockard HA, Pasztor E. Relationship between the cortical evoked potential and local cortical blood flow following acute middle cerebral artery occlusion in the baboon. Exp Neurol 1974; 45(2): 195–208.

30. Stejskal L, Kramár F, Ostrý S, Benes V, Mohapl M, Limberk B. Experience of 500 cases of neurophysiological monitoring in carotid endarterectomy. Acta Neurochir (Wien) 2007; 149(7): 681–688.

31. Kramář F, Zoul J, Mohapl M, Beneš V. Monitorace nemocných během karotické endarterektomie. Cesk Slov Neurol N 1997; 62/95(4): 197–202.

32. Florence G, Guerit JM, Gueguen B. Electroencephalography (EEG) and somatosensory evoked potentials (SEP) to prevent cerebral ischaemia in the operating room. Neurophysiol Clin 2004; 34(1): 17–32.

33. Mraček J, Holečková I, Mork J, Frdlík J, Škorpil J.Postavení peroperační neuromonitorace, neuroprotekce a preventivní karotické endarterektomie u nemocných se zvýšeným rizikem mozkové ischemie indikovaných ke kardiochirurgické operaci. Rozhl Chir 2009; 88(5): 264–268.

34. Deletis V, Shils JL. Neurophysiology in neurosurgery. A modern intraoperative approach. San Diego, CA: Academic Press, Elsevier Science USA 2002.

35. Neuloh G, Schramm J. Monitoring of motor evoked potentials compared with somatosensory evoked potentials and microvascular doppler ultrasonography in cerebral aneurysm surgery. J Neurosurg 2004; 100(3): 389–399.

36. Taniguchi M, Cedzich C, Schramm J. Modification of cortical stimulation for motor evoked potentials under general anesthesia: technical description. Neurosurgery 1993; 32(2): 219–226.

37. Bricollo A, Sala F. Surgery of brainstem lesions. In: Deletis V, Shils JL (eds). Neurophysiology in neurosurgery. A modern intraoperative approach. San Diego: Academic Press, Elsevier Science 2002: 267–289.

38. Morota N, Deletis V, Epstein FJ. Brainstem mapping. In: Deletis V, Shils JL (eds). Neurophysiology in neurosurgery. A modern intraoperative approach. San Diego: Academic Press, Elsevier Science 2002: 319–335.

39. Vodusek DB, Deletis V. Intraoperative neurophysiological monitoring of the sacral nervous system. In: Deletis V, Shils JL (eds). Neurophysiology in neurosurgery. A modern intraoperative approach. San Diego: Academic Press, Elsevier Science 2002: 197–218.

40. Calancie B, Harris W, Brindle GF, Green BA, Landy HJ. Threshold‑level repetitive transcranial electrical stimulation for intraoperative monitoring of central motor conduction. J Neurosurg 2001; 95 (2 Suppl): 161–168.

41. MacDonald DB. Safety of intraoperative transcranial electrical stimulation motor evoked potential monitoring. J Clin Neurophysiol 2002; 19(5): 416–429.

42. MacDonald DB, Al Zayed Z, Khoudeir I, Stigsby B. Monitoring scoliosis surgery with combined multiple pulse transcranial electric motor and cortical somatosensory-evoked potentials from the lower and upper extremities. Spine 2003; 28(2): 194–203.

43. Galanda M, Babicová A, Petráš F, Šulaj J, Béreš A. Peroperačná elektrická stimulácia při operáciách v centrálných oblastiach mozgu a v mieche. Cesk Slov Neurol N 2001; 64/97(5): 338–343.

44. Němec M, Bednařík J, Krbec M, Mokrá M. Peroperační monitorace somatosenzorických a motorických evokovaných potenciálů u operací skolióz. Cesk Slov Neurol N 2006; 69/102(1): 45–51.

45. Ceé J, Sameš M, Bartoš R, Vachata P, Vaněk P, Kašperek J, et al. Peroperační monitorace motorických evokovaných odpovědí za užití transkraniální elektrické stimulace – naše první klinické zkušenosti. Cesk Slov Neurol N2006; 69/102(5): 365–380.

46. Cedzich C, Pechstein U, Schramm J, Schäfer S. Electrophysiological considerations regarding electrical stimulation of motor cortex and brain stem in humans. Neurosurgery 1998; 42(3): 527–532.

47. Péréon Y, Nguyen The Tich S, Delécrin J, Pham Dang C,Bodin J, Drouet JC et al. Combined spinal cord monitoring using neurogenic mixed evoked potentials and collision techniques. Spine 2002; 27(14): 1571–1576.

48. Deletis V. The “motor” inaccuracy in neurogenic motor evoked potentials. Clin Neurophysiol 2001; 112(8): 1365–1366.

49. Toleikis JR, Skelly JP, Carlvin AO, Burkus JK. Spinally elicited peripheral nerve responses are sensory rather than motor. Clin Neurophysiol 2000; 111(4): 736–742.

50. Minahan RE, Sepkuty JP, Lesser RP, Sponseller PD, Kostuik JP. Anterior spinal cord injury with preserved neurogenic “motor” evoked potentials. Clin Neurophysiol 2001; 112(8): 1442–1450.

51. Raco A, Esposito V, Lenzi J, Piccirilli M, Delfini R, Cantore G. Long‑term follow‑up of intramedullary spinal cord tumors: a series of 202 cases. Neurosurgery 2005; 56(5): 972–981.

52. Stejskal L. Rané elektrofyziologické změny v přerušeném periferním nervu u člověka. Vojenské zdravotnické listy 1983; 52(1): 72–79.

53. Zvěřina E, Stejskal L. Poranění periferních nervů. Praha: Avicenum 1979.

54. Ostrý S, Stejskal L, Plas J. Peroperační monitorování při mikrovaskulární dekompresi pro faciální hemispazmus a neuralgii trigeminu. Cesk Slov Neurol N 2003; 66/99: 404–408.

55. Eisner W, Schmid UD, Reulen HJ, Oeckler R, Olteanu-Nerbe V, Gall C et al. The mapping and continuous monitoring of the intrinsic motor nuclei during brain stem surgery. Neurosurgery 1995; 37(2): 255–265.

56. Romstöck J, Strauss C, Fahlbusch R. Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery. J Neurosurg 2000; 93(4): 586–593.

57. Happel L, Kline D. Intraoperative neurophysiology of the peripheral nervous system. In: Deletis V, Shils JL(eds). Neurophysiology in neurosurgery. A modern intraoperative approach. San Diego: Academic Press 2002: 169–195.

58. Kline DG, Hackett ER, May PR. Evaluation of nerve injuries by evoked potentials and electromyography. J Neurosurg 1969; 31(2): 128–136.

59. Kline DG, Hackett ER, May PR. Partial nerve laceration evaluated by evoked potentials. J Surg Res 1970; 10(2): 81–90.

60. Williams HB, Terzis JK. Single fascicular recordings: An intraoperative diagnostic tool for the management of peripheral nerve lesions. Plast Reconstr Surg 1976; 57(5): 562–569.

61. Toleikis RJ. Neurophysiological monitoring during pedicle screw placement. In: Deletis V, Shils JL (eds). Neurophysiology in neurosurgery. A modern intraoperative approach. San Diego: Academic Press, Elsevier Science 2002: 231–263.

62. Schlake HP, Milewski C, Goldbrunner RH, Kindgen A,Riemann R, Helms J et al. Combined intra-operative monitoring of hearing by means of auditory brainstem responses (ABR) and transtympanic electrocochleography (ecochg) during surgery of intra- and extrameatal acoustic neurinomas. Acta Neurochir (Wien) 2001; 143(10): 985–995.

63. Tonn JC, Schlake HP, Goldbrunner R, Milewski C,Helms J, Roosen K. Acoustic neuroma surgery as an interdisciplinary approach: A neurosurgical series of 508 patients. J Neurol Neurosurg Psychiatry 2000; 69(2): 161–166.

64. Møller AR, Jannetta PJ, Sekhar LN. Contributions from the auditory nerve to the brain‑stem auditory evoked potentials (BAEPs): Results of intracranial recording in man. Electroencephalogr Clin Neurophy­siol 1988; 71(3): 198–211.

65. Møller AR, Moller MB, Jannetta PJ, Jho HD. Auditory nerve compound action potentials and brain stem auditory evoked potentials in patients with various degrees of hearing loss. Ann Otol Rhinol Laryngol 1991; 100(6): 488–495.

66. Matthies C, Samii M. Management of vestibular schwannomas (acoustic neuromas): the value of neurophysiology for evaluation and prediction of auditory function in 420 cases. Neurosurgery 1997; 40(5): 919–929.

67. Møller AR, Jannetta PJ, Jho HD. Click‑evoked responses from the cochlear nucleus: A study in human. Electroencephalogr Clin Neurophysiol 1994; 92(3): 215–224.

68. Møller AR. Monitoring auditory function during operations to remove acoustic tumors. Am J Otol 1996; 17(3): 452–460.

69. Jannetta PJ, Møller AR, Moller MB. Technique of hearing preservation in small acoustic neuromas. Ann Surg 1984; 200(4): 513–523.

70. Harper CM, Harner SG, Slavit DH, Litchy WJ, Daube JR, Beatty CW et al. Effect of BAEP monitoring on hearing preservation during acoustic neuroma resection. Neurology 1992; 42(8): 1551–1553.

71. Matthies C, Samii M. Management of vestibular schwannomas (acoustic neuromas): The value of neurophysiology for intraoperative monitoring of auditory function in 200 cases. Neurosurgery 1997; 40(3): 459–468.

72. Battista RA, Wiet RJ, Paauwe L. Evaluation o three intraoperative auditory monitoring techniques in acoustic neuroma surgery. Am J Otol 2000; 21(2): 244–248.

73. Neu M, Strauss C, Romstock J, Bischoff B, Fahlbusch R. The prognostic value of intraoperative BAEP patterns in acoustic neurinoma surgery. Clin Neurophysiol 1999; 110(11): 1935–1941.

74. Sekiya T, Møller AR. Avulsion rupture of the internal auditory artery during operations in the cerebellopontine angle: A study in monkeys. Neurosurgery 1987; 21(5): 631–637.

75. Rowed DW, Nedzelski JM. Hearing preservation in the removal of intracanalicular acoustic neuromas via the retrosigmoid approach. J Neurosurg 1997; 86(3): 456–461.

76. Cueva RA, Morris GF, Prioleau GR. Direct cochlear nerve monitoring: First report on a new atraumatic, self-retaining electrode. Am J Otol 1998; 19(2): 202–207.

77. Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): Hearing function in 1000 tumor resections. Neurosurgery 1997; 40(2): 248–260.

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Paediatric neurology Neurosurgery Neurology

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