Surgical Neurophysiology & Intraoperative Monitoring
From Research to "Standard of Care"
The earliest intraoperative neurophysiology was the work of Wilder Penfield and others in the 1920’s. Penfield mapped and exposed the motor and speech cortex by electrical stimulation. Advances in modalities were made through the1970’s following the development of commercial evoked potential equipment.
Trans-cranial Motor Evoked Potentials (TcMEPs) are now used to avoid paralysis in scoliosis surgeries. Brainstem Audio Evoked Potentials (BAERs) and facial nerve Electro Myography (EMG) are used in skull base surgeries to avoid facial paralysis and hearing loss. EEG monitoring is used in carotid endarterectomies to avoid ischemic strokes during surgery. Somato-Sensory Evoked Potentials (SSEP) have become generalized to a wide variety of spinal and other surgeries.
Intraoperative neurophysiological monitoring has become the standard of care in many types of surgeries.
What is surgical neurophysiology?
Surgical neurophysiology, also known as intraoperative neurophysiological monitoring (IOM), is a growing allied health field. The surgical neurophysiologist is an integral part of the surgical team that includes the surgeon, surgical assistant, scrub tech, anesthesiologist, anesthetist, nurse, medical device technician, and others.
The surgical neurophysiologist performs testing and monitoring of the nervous system during surgery and informs the surgeon when procedural manipulations are dangerously impinging on spinal nerves. Surgical complications such as paralysis, hearing loss, or stroke (depending on the type of surgery) may be avoided or mitigated because IOM gives the surgeon this information as it happens and in time to make critical procedural decisions.