Intraoperative neurophysiological monitoring

Under neuromonitoring refers to the visual and acoustic representation of the neurophysiological activity of one or more nerves. With the help of intraoperative neuromonitoring surgeons have continuous control over neural pathways that are compromised by surgery. Macroscopically not sure visible nerves can be identified by means of neuro-monitoring. The first application in humans was published by Flisberg 1969.

Principle of operation

The manipulation of a motor peripheral nerves leads to the release of action potentials, which in turn lead to the contraction of the muscle supplied by that nerve. These contractions are identified by fine, in the muscles or the electrodes introduced based on the occurring electric potentials, amplified electronically and acoustically presented through a speaker and / or visually on a display ( electromyographic derivation ). Alternatively, the nerve directly by means of a probe through a tiny impulse may be stimulated ( 0.2 mA to 2 mA ), which in intact nerves also leads to muscle contraction. The signal generated is directly proportional to the intensity of nerve stimulation.

Areas of application

The use of nerve monitoring during surgery is useful, if the violation of a specific motor nerves appears to be possible because of the anatomical complexity of the operation area or irregular anatomical conditions. Irregular circumstances may arise in particular for recurrent operations in scar areas or in the range of tumors.

Examples

  • Monitoring of the facial nerve during resection of the auditory - Neurinoms, ear surgery and operations on the parotid gland.
  • Monitoring of the nerves of the brachial plexus in neurosurgical operations in this area or trauma surgery (especially the radial nerve in the upper arm ).
  • Monitoring of the recurrent laryngeal nerve during surgery on the thyroid gland ( Strumaresektion, thyroidectomy ): The target muscle is the vocal cord muscles here. The variability of the course and the often heavy representability of only about 1 mm thick nerves do here especially in surgery of thyroid cancer and the Rezidivstruma nerve monitoring is essential. A further development in this field represents the Continuous Intraoperative Neuromonitoring

Swell

  • The diagnostic method in surgery
  • The diagnostic method in neurology
  • Apparative investigation procedure
Ampere Recidivism (medicine)
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