A Practical Approach to Neurophysiologic Intraoperative Monitoring

Since the publication of the first edition of A Practical Approach to Neurophysiologic Intraoperative Monitoring in 2008, there have been significant advances in the field. The second edition provides a helpful update to neurophysiologic intraoperative monitoring (NIOM) with an expanded discussion of monitoring modalities and their applications.

This edition is divided into three sections. The first section reviews the basic principles of NIOM, including a primer on the sights, sounds, customs, major players, and etiquette in the operating room environment. The remaining chapters detail the basic modalities of NIOM, namely, somatosensory evoked potentials, motor evoked potentials, brainstem auditory evoked potentials, electroencephalography, and electromyography. In the first edition, each NIOM modality was discussed within a single chapter; in the revised edition, each modality has its own chapter, offering much more detail. Each chapter includes figures and discussion of the anatomical and physiological substrate of each modality, clinical applications, appearance of normal and abnormal waveforms, and potential mechanisms which produce abnormal tracings and suggested methods for trouble shooting if signal abnormalities arise. Shortcomings and safety issues associated with each modality are also discussed.

The second section details specific intraoperative applications of the monitoring modalities described in earlier chapters. Methods of intraoperative monitoring for multiple procedures are covered: vertebral column surgery, spinal cord surgery, lumbosacral surgery, tethered cord surgery, selective dorsal rhizotomy, peripheral nerve surgery, cerebellopontine angle surgery, brainstem surgery, aortic surgery, carotid surgery, intracranial vascular surgery, epilepsy surgery, and cortical mapping and movement disorders surgery. Monitoring paradigms are specified for each type of surgery. Normative values are presented along with tracings of expected or ideal responses.

The third section pertains to administrative issues and the technical aspects of developing and maintaining a NIOM program, including a technical guide to NIOM machines and remote monitoring. Coding and billing as well as ethical and legal aspects are expanded here. New to this edition is a suggested training curriculum and proposed standards for monitoring technicians as well as physicians with expertise in study interpretation. This latter chapter is particularly helpful given the growth of institutional interest in NIOM over the past decade. The final chapter describes policies and procedures for a NIOM laboratory, with sample checklists and algorithms for setting up and troubleshooting various NIOM modalities.

The second edition of A Practical Approach to Neurophysiologic Intraoperative Monitoring can function as both an educational manual and a day-to-day guide to the myriad situations encountered in NIOM. The volume is accessible at all levels of skill and training, serving as both an entry point for new practitioners and a reference manual for experienced ones, making this an essential book for the NIOM library.