Clinical Neurophysiology Intraoperative Monitoring PDF
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Uploaded by ConciseStarfish
Universitätsklinikum des Saarlandes
2025
Karsten Schwerdtfeger
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Summary
This document is a detailed overview of intraoperative monitoring techniques used in clinical neurophysiology. It covers various methods such as electroneurography, EMG, EEG, and evoked potentials, emphasizing signal-to-noise considerations and the monitoring of skull base processes. It's aimed at neural engineering master's students.
Full Transcript
Clinical Neurophysiology Part VIII Intraoperative Monitoring Karsten Schwerdtfeger Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes. Studiengang: Neural Engineering Master WS 2024/2025 Intraoperative Monit...
Clinical Neurophysiology Part VIII Intraoperative Monitoring Karsten Schwerdtfeger Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes. Studiengang: Neural Engineering Master WS 2024/2025 Intraoperative Monitoring Methods to check functional integrity clinical electrophysiological hemodynamic metabolic Intraoperative Monitoring Modalities Electroneurography CMAP-recording – latency/amplitude Cranial nerve stimulation Brainstem stimulation Peripheral nerve stimulation Nerve conduction velocity EMG Spontaneous activity with acoustic feedback Mimic muscles Eye muscles Laryngeal muscles EEG Spontaneous activity Processed – for example power spectra depicted as Compressed Spectral Arrays (CSA) Intraoperative Monitoring Modalities Evoked Potentials SSEP Phase reversal SEP BAEP Electrocochleography Middle latency SEP and/or AEP VEP (?) Motor evoked potentials Magnetic TMS Electric TMS Cortical stimulation White matter stimulation D-waves Intraoperative Monitoring Intraoperative Monitoring Intraoperative Monitoring Signal-to-noise ratio in the OR SNR = Psignal/Pnoise Noise Technical noise Line frequency (50/60Hz) 100 Hz noise from electronic devices Amplifier Electrode Operating room: high frequency coagulators Biological noise Depends what we want to record Meaningful versus Unmeaningful signals Intraoperative Monitoring A B Kunststoffüberzug Intraoperative Monitoring Intraoperative Monitoring Ce2 C3‘ 10:20 10:25 10:30 10:35 10:40 10:45 10:50 10:55 A B P40 P40 ? ? 2 uV 10 ms Reizung links Reizung rechts Intraoperative Monitoring I V A B 100 nV 1 ms N20 C 1 uV D 5 ms Intraoperative Monitoring Monitoring of skull base processes Intraoperative Monitoring N. oculomotorius N. abducens Intraoperative Monitoring N. vagus Intraoperative Monitoring N.VII EMG Intraoperative Monitoring A B 2 1 N.VII EMG Intraoperative Monitoring A B 2 1 C D N.VII EMG Intraoperative Monitoring (MEP Monitoring) A B C 100 uV 20 ms To be continued with
