Intraoperative neurophysiological monitoring for the anaesthetist

Intraoperative neurophysiological monitoring in paediatric neurosurgery

Intraoperative neurophysiological monitoring (IONM) is commonly used in various surgical procedures in adults, but with technological and anaesthetic advancements, its use has extended to the paediatric population. The use of IONM in children poses a unique set of challenges considering the anatomical and physiological differences in this group of patients. The use of IONM aids in the localization of neural structures and enables surgeons to preserve the functional neural structures leading to decreased incidence of postoperative neurological deficits and better patient outcomes. In this article, we review the use of IONM in paediatric patients undergoing various spinal and cranial neurosurgical procedures. We discuss the patient characteristics, type of surgeries, and technical and anaesthetic considerations about IONM in this population.

The Utility of Multimodal Intraoperative Neuromonitoring in Spine Surgery: Case Series from a Lower-Middle-Income Country Perspective

OBJECTIVE

Multimodal intraoperative neuromonitoring (IOM) using somatosensory-evoked potentials and motor-evoked potentials is a sensitive and specific tool for detecting intraoperative neurologic injury during spine surgery. This study aimed to evaluate the use of multimodal IOM in a lower-middle-income country (LMIC) during cervical and thoracic spine surgery in order to prevent and predict new postoperative neurologic deficits early on. This is the first report of multimodal IOM application in LMICs.

METHODS

The neurophysiologist raised the cutoff warning criteria of 50 patients who underwent surgery for different cervical and thoracic pathologies to decrease postoperative neurologic deficits. We retrospectively reviewed the medical charts and neuromonitoring traces of these patients followed by calculating the sensitivity, specificity, positive predictive value, and negative predictive value of combined IOM for postoperative neurologic deficit occurrence.

RESULTS

A significant relationship was found between the reversibility of alerts and the development of new postoperative deficits (P < 0.001). There was no relationship between the cause of alerts and the reversibility of those alerts after corrective measures were carried out (P = 0.455), or the frequency of alerts and the development of new deficits postoperatively (P = 0.578). Sensitivity, specificity, positive predictive value, and negative predictive value of combined somatosensory-evoked potential and motor-evoked potential monitoring were 100%, 80%, 62.5%, and 100%, respectively.

CONCLUSION

Because of the limited experience and the many technical difficulties faced in LMICs, we found that this cutoff limit resulted in more false-positive warnings but helped to avoid any false-negative results, thus enhancing the safety of surgery.