Intraoperative neurophysiological monitoring

Abstract

Intraoperative neurophysiological monitoring (IONM) includes an array of modalities for a range of neurosurgical procedures to prevent neurological damage while achieving the maximum level of lesion resection or anatomical correction. Each modality is affected by anaesthesia in different ways and the anaesthetist needs to be highly cognisant of the effect physiology and their drugs have on various IONM recordings. The use of IONM requires excellent multidisciplinary working, planning, communication and teams should have a process for responding to changes in IONM signals. This chapter will describe the use of IONM in cranial and spinal surgery. The use of Electroencephalogram (EEG), processed EEG and the various EEG elements is explored in more depth with particular attention to its use and limitations in neurosurgery.