Intraoperative Neuromonitoring: Improving Surgical Safety and Efficacy
Intraoperative neuromonitoring is a technique which is used to consistently monitor central nervous system of patient during surgery. Most intraoperative neuromonitoring is utilized by neuro & spine surgeons, and vascular, otolaryngologists, orthopedic, & urology surgeons as well. Intraoperative neuromonitoring technology has been successfully incorporated with various surgical procedures, which have decreased the mortality rate of patients, post-surgery.
Over the years, technological developments in healthcare industry have saved countless patients and are constantly enhancing our quality of life. The technology in medical field is also massively impacting on nearly all practices and processes of healthcare professionals. Intraoperative neuromonitoring system is one such equipment in medical field that is helping medical professionals to perform high-risk complicated surgeries.
What is Intraoperative Neuromonitoring?
Intraoperative neuromonitoring is a technique which is used to consistently monitor central nervous system of patient during surgery. It has now become a part of millions of operations performed all over the world. Intraoperative neuromonitoring helps a surgeon examine the condition of the nervous system where he has to operate. Interpreting physicians and neurophysiologists are present if the surgeon elects to use intraoperative neuromonitoring system during surgery. The physicians or neurophysiologists focus on the nervous system of patient during the procedure. Having neurophysiologists during surgery helps in improving response and recognition and facilitates effective communication among caregivers.
Intraoperative neuromonitoring system’s goal is to notice changes in the peripheral nerve function prior to any damage and it is used to minimize neurological morbidity in surgical operations. As per Research Dive analyst review, since intraoperative neuromonitoring has been introduced to the medical field, it has reduced the chance of hearing loss, paralysis, muscle weakness, and loss of other body functions. Today, the intraoperative neuromonitoring field is rapidly mounting for neurosurgery and persistently gaining interest by both researchers and doctors.
Where there is a risk to patient’s nervous system during certain surgical procedures, the patients are benefitted from intraoperative neuromonitoring. Most intraoperative neuromonitoring is utilized by neuro & spine surgeons, and vascular, otolaryngologists, orthopedic, and urology surgeons as well.
The most common applications of intraoperative neuromonitoring are in brain surgery, spinal surgery; ENT procedures such as resection, acoustic neuroma, nerve surgery, & paratidectomy, and carotid endarterectomy. Intraoperative neuromonitoring is used:
- To test function neutral structures
- To localize these structures, for instance to locate cranial nerves in the course of skull base surgery,
- In early detection of intraoperative neural injury, which allows for speedy corrective measures.
Applications of Intraoperative Monitoring
Intraoperative neuromonitoring technology has been successfully incorporated with various surgical procedures, which have decreased the mortality rate of patients, post-surgery. It was possible with help of growing awareness amongst people regarding intraoperative neuromonitoring. The availability of widespread computer networks has also played a major role in saving patients’ life.
Intraoperative neuromnitoring technique has a wide range of applications and is used alongside many surgeries to discover important neural structures all through the surgery. Few of these modalities consist of electromyography, motor evoked potentials (MEPs), somatosensory evoked potentials (SSEPs), brainstem auditory evoked potentials (BAEPs), visual evoked potentials (VEPs), and electroencephalography (EEG). The uses of few applications are:
- Electromyography (EMG)
EMG helps in detecting the electrical activities, which are produced by skeletal muscles. It is possible to detect mechanical or metabolic irritation in the nerves with the help of free-running EMG.
- Visual evoked potential (VEP)
VEP induces brief visual stimuli to detect electrical potentials that are noted from the scalp over the visual cortex. The intraoperative neuromoitoring system’s visual pathway offers in-depth information on different surgeries such as transsphenoidal surgery and aneurysm surgeries.
A surgeon is able to observe electrical activities from the scalp with electroencephalography technique. This technique is used extensively for assessing the degree of cerebral perfusion and monitoring anesthesia during vascular surgery. Mostly, EEG is used to observe the states of diffuse hypoperfusion through CEA. However, during CEA, there is a little possibility where it won’t be able to detect micro-emboli.
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