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The intraoperative neurophysiological monitoring team
44.1 Introduction: airliners and operating rooms After the Institute of Medicine reported up to 98,000 annual deaths in the United States from medical errors, a new focus on error causation and its possible amelioration began . As many as two-thirds…
Evidence-based medicine and intraoperative neurophysiology
43.1 Introduction Evidence-based medicine (EBM) has been described as a search for a science of clinical care . Many of its core concepts and methods in use today can be traced to the field of epidemiology and the pioneering efforts…
Costs and benefits of intraoperative neurophysiological monitoring in spinal surgeries
42.1 Introduction Intraoperative neurophysiology (ION) evolved from existing technologies in evoked potentials, electromyography (EMG), and nerve-conduction studies to give real-time information for surgeons performing procedures that may imperil nervous system structures. The usage of ION has spread over time from…
Safety
41.1 Introduction Intraoperative neurophysiology normally improves patient safety, but like any medical procedure it can cause inadvertent harm. This chapter reviews electrical and procedure-specific safety, infection control, and essential performance in terms of potential hazards and their means of protection.…
Principles of anesthesia
40.1 Anesthesia: safety, comfort, and facilitation of the procedure The anesthesiologist is a key member of the team conducting the intraoperative neurophysiology (ION), whether the monitoring is surgical in the operating room, or procedures such as neurovascular embolization, in the…
Selective dorsal rhizotomy
39.1 History Despite clear advantages over complex repair-strategies of irreversible structural changes, selective dorsal rhizotomy (SDR) is still not recognized as an early prophylactic surgical option in most current guidelines. This striking reluctance can be understood by examining the fraught…
Neurosurgical lesioning procedures in spinal cord and dorsal root entry zone for pain
38.1 Introduction When chronic pain becomes refractory to medications and all available medical arsenal, one can have recourse to functional neurosurgery. Chronic pains are of many kinds. Main varieties include pain due to the alteration of the musculoskeletal apparatus, complex…
Neuromonitoring for spinal cord stimulation placement under general anesthesia
37.1 Introduction Spinal cord stimulation (SCS) is a common therapy used to treat medically refractory neuropathic back and other limb pain syndromes . Historically, placement of SCS leads required direct interaction with the patient to ascertain where the patient felt…
Deep brain stimulation for treatment patients in vegetative state and minimally conscious state
36.1 Introduction Persistent vegetative state (VS) (PVS) was first described as wakefulness without awareness . VS, a clinical entity known as a coma vigile , apallic syndrome , or PVS , includes complete unawareness of the self and environment, usually…