Intraoperative neuromonitoring in the management of patients with conditions associated with the nervous system
Keywords:
Monitoring, Physiologic, Intraoperative, Nervous System, Nervous System Physiological Phenomena, Surgery, Nerve TissueAbstract
Introduction: the introduction of new technologies in the medical field brings great benefits for the health of patients with nervous system conditions, where neuromonitoring plays an important role
Objective: to describe the methods of intraoperative neuromonitoring, its application and benefits.
Method: a bibliographic search was carried out in the databases of Web of Science, Scopus, SciELO, Dialnet and AmeliCA. Thirty articles were selected regarding the different modalities of intraoperative neuromonitoring, its application, benefits and anesthetic and non-anesthetic factors that influence its effectiveness.
Development: Intraoperative neuromonitoring has emerged as a powerful tool for the study of nerve functions during surgery. Among its modalities is electroencephalogram, electroneuromyography, evoked potentials (somatosensory, visual, motor and auditory of the brainstem) and intraoperative cortical and subcortical stimulation. The drugs used, as well as factors associated with hemodynamics and hemostasis affect their efficacy and interpretation of these tests. Intraoperative neuromonitoring allows real-time detection of functional and structural alterations, reducing complications and improving the patient's quality of life.
Conclusions: the use of intraoperative neuromonitoring provides great advantages to the surgical team during the performance of procedures by offering real-time information on the functional integrity of the nervous structures involved in the procedure. This allows reducing the occurrence of complications, damage or injury. Pharmacological and hemodynamic variables must be controlled to achieve better neuromonitoring efficiency, which translates into improvements for the patient's quality of life.
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References
1. Appel S, Biron T, Goldstein K, Ashkenazi E. Effect of Intra- and Extraoperative Factors on the Efficacy of Intraoperative Neuromonitoring During Cervical Spine Surger. World Neurosurg [Internet]. 2019 [citado 24 Dic 2019]; 123(3):646-651. Disponible en: https://doi.org/10.1016/j.wneu.2018.11.244
2. Rijs K, Klimek M, Scheltens-de Boer M, Biesheuvel K, Harhangi BS. Intraoperative Neuromonitoring in Patients with Intramedullary Spinal Cord Tumor: A Systematic Review, Meta-Analysis, and Case Series. World Neurosurg [Internet]. 2019 [citado 24 Dic 2019]; 125(5):498-510. Disponible en: https://doi.org/10.1016/j.wneu.2019.01.007
3. Thomas B, Guo D. The Diagnostic Accuracy of Evoked Potential Monitoring Techniques During Intracranial Aneurysm Surgery for Predicting Postoperative Ischemic Damage: A Systematic Review and Meta-Analysis. World Neurosurg [Internet]. 2017 [citado 24 Dic 2019]; 103:829-840. Disponible en: http://dx.doi.org/10.1016/j.wneu.2017.04.071
4. Norma E. Mena, Luke Sorrick. Monitoreo Neurofisiológico Intraoperatorio: Utilidad y Ventajas en cirugía de columna. Rev Ecuat Neurol [Internet]. 2013 [citado 24 Dic 2019]; 22: 1-3, 2013. Disponible en: http://revecuatneurol.com/wp-content/uploads/2015/06/12-MonitoreoNeurofisiol-Intraoperatorio.pdf
5. Yang S, Zhou L, Lu Z, Ma B, Ji Q, Wang Y. Systematic review with meta-analysis of intraoperative neuromonitoring during thyroidectomy. International Journal of Surgery [Internet]. 2017 [citado 12 Sep 2019]; 39: 104-113. Disponible en: https://www.sciencedirect.com/science/article/pii/S1743919117300900
6. Martínez F, Salle F, Moragues R, G Bertullo. Utilidad de la estimulación intraoperatoria en cirugía de procesos expansivos intracraneanos bajo anestesia general. Rev Urug Med Inter [Internet]. 2017 [citado 24 Dic 2019]; 1: 58-63. Disponible en: http://www.scielo.edu.uy/pdf/rumi/v2n1/2993-6797-rumi-2-01-00058.pdf
7. Rodríguez Aceves CA, Collado Ortiz MÁ, Correa Márquez LI. Monitoreo intraoperatorio multimodal y su aplicación en cirugía de nervios periféricos. An Med (Mex) [Internet]. 2016 [citado 24 Dic 2019]; 61(2): 123-131. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=66299
8. Alberto García Giró, Manuel Sánchez Castillo, Tania Aznielle Rodríguez, Vivian Martín Reyes. Desarrollo de un estimulador eléctrico trans-craneal para monitoreo intra-operatorio. RIELAC [Internet]. 2019 [citado 24 Dic 2019]; 40(1): 1-17. Disponible en: http://rielac.cujae.edu.cu/index.php/rieac/article/download/625/322
9. Walter Daniel J, Vieira Botelho R, Buzetti Milano J, Rolemberg Dantas F, Jooji Onishi F, Rusafa Neto E, et al. Intraoperative Neurophysiological Monitoring in Spine Surgery. A Systematic Review and Meta-Analysis. Spine [Internet]. 2018 [citado 13 Dic 2019]; 43(16): 1154–1160. Disponible en: https://journals.lww.com/spinejournal/Abstract/2018/08150/Intraoperative_Neurophysiological_Monitoring_in.10.aspx
10. Gertsch JH, Moreira JJ, Lee GR, Hastings JD, Ritzl E, Eccher MA. Practice guidelines for the supervising professional: intraoperative neurophysiological monitoring. Journal of Clinical Monitoring and Computing [Internet]. 2019 [citado 13 Nov 2019]; 33:175–183. Disponible en: https://doi.org/10.1007/s10877-018-0201-9
11. De la Maza-Krzeptowsky LC, Romero-Esquiliano G, Ramírez-Segura EH, De Obieta-Cruz E, Vega-Sosa A, Cárdenas-Mejía A, et al. Implementación del monitoreo neurofisiológico intraoperatorio en niños y adultos en el segundo y tercer nivel de atención. Cir Cir [Internet]. 2018 [citado 24 Dic 2019]; 86 (2): 132-139. Disponible en: https://www.medigraphic.com/pdfs/circir/cc-2018/cc182c.pdf
12. López-Rodríguez JJ. Monitoreo neurofisiológico intraoperatorio en cirugía de columna. Rev Mex Anest [Internet]. 2017 [citado 24 Dic 2019]; 40(S1); 31-32. Disponible en: https://www.medigraphic.com/pdfs/rma/cma-2017/cmas171l.pdf
13. León-Álvarez E. Neuromonitoreo. Rev Mex Anest [Internet]. 2017 [citado 24 Dic 2019]; 40(S1): 240-242. Disponible en: https://www.medigraphic.com/pdfs/rma/cma-2017/cmas171bt.pdf
14. Michels P, Bräuer A, Bauer M, et al. Neurophysiological monitoring during surgical procedures. Der Anaesthesist [Internet]. 2017 [citado 24 Dic 2019]; 66(9): 645–659. Disponible en: https://doi.org/10.1007/s00101-017-0356-7
15. Yu T, Li QJ, Zhang XW, Wang Y, Jiang QY, Zhu XJ, et al. Multimodal intraoperative monitoring during surgical correction of scoliosis to avoid neurologic damage. Medicine [Internet]. 2019 [citado 24 Dic 2019]; 98(15): e15067. Disponible en: http://dx.doi.org/10.1097/MD.0000000000015067
16. Jameson LC. Transcranial motor-evoked potentials. In: Kohta A, Sloan TB, Toleikis JR, editors. Monitoring the nervous system for anesthesiologists and other healthcare professionals, 2nd ed. Cham: Springer; 2017. Disponible en: https://link.springer.com/content/pdf/10.1007/978-1-4614-0308-1.pdf
17. Dias Anderson A, Lanna Rachel AB, Ferreira Junior MA, Duarte Marcelo G, Falcon Roberto S, Porto Filho MA, et al Electromyography and instrumentation in patients with idiopathic scoliosis. Coluna/Columna [Internet]. 2017 [citado 24 Dic 2019]; 16(1): 29–32. Disponible en: http://www.scielo.br/scielo.php?pid=S1808-8512017000100029&script=sci_arttext
18. Nunes RR, Bersot CDA, Garritano JG. Intraoperative neurophysiological monitoring in neuroanesthesia. Curr Opin Anesthesiol [Internet]. 2018 [citado 13 Dic 2019]; 31(5): 532–538. Disponible en: https://journals.lww.com/co-anesthesiology/Abstract/2018/10000/Intraoperative_neurophysiological_monitoring_in.8.aspx
19. Ney JP, Kessler DP. Neurophysiological monitoring during cervical spine surgeries: Longitudinal costs and outcomes. Clinical Neurophysiology [Internet]. 2018 [citado 24 Dic 2019]; 129(11): 2245–2251. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S138824571831188X
20. Morales León N, Gómez Ramírez Y, Agramante Rodríguez MA, Domínguez Pérez B, Nieda Rojas M. Neuromonitoreo en pacientes sometidos a cirugía cerebral. Gac Méd Espirit [Internet]. 2007 [citado 24 Dic 2019]; 9(3): [aprox. 9 p.]. Disponible en: http://www.revgmespirituana.sld.cu/index.php/gme/article/view/810/672
21. MacDonald DB. Overview on criteria for MEP monitoring. J Clin Neurophysiol [Internet]. 2017 [citado 24 Dic 2019]; 34(1): 4–11. Disponible en: https://journals.lww.com/clinicalneurophys/Abstract/2017/01000/Overview_on_Criteria_for_MEP_Monitoring.2.aspx
22. MacDonald DB, Dong C, Quatrale R, Sala F, Skinner S, Soto F, et al. Recommendations of the International Society of Intraoperative Neurophysiology for intraoperative somatosensory evoked potentials. Clinical Neurophysiology [Internet]. 2019 [20 Oct 2019]; 130(1): 161-179. Disponible en: https://doi.org/10.1016/j.clinph.2018.10.008
23. Thirumala PD, Crammond DJ, Loke YK, Cheng HL, Huang J, Balzer JR. Diagnostic accuracy of motor evoked potentials to detect neurological deficit during idiopathic scoliosis correction: a systematic review. J Neurosurg Spine [Internet]. 2016 [citado 24 Dic 2019]; 26(3): 374–383. Disponible en: https://thejns.org/spine/view/journals/j-neurosurg-spine/26/3/article-p374.xml
24. Park SK, Joo BE, Lee S, Lee JA, Hwang JH, Kong DS, et al. The critical warning sign of real-time brainstem auditory evoked potentials during microvascular descompression for hemifacial spasm. Clin Neurophysiol [Internet]. 2018 [citado 24 Dic 2019]; 129(5): 1097–1102. Disponible en: https://www.sciencedirect.com/science/article/pii/S138824571731221X
25. Szelényi A. Intraoperative neurophysiological monitoring under general anesthesia. In: Duffau H (Ed): Brain Mapping: from neural basis of cognition to surgical applications. Viena: Springer, 2011.
26. Duffau H. Surgery for diffuse low grade gliomas. Functional considerations. In: Duffau H (Ed): Difuse low grade gliomas in adults. London: Springer, 2017. Disponible en: https://link.springer.com/content/pdf/10.1007/978-3-319-55466-2.pdf
27. Martinez F, Moragues R. Cirugía tumoral con despertar intraoperatorio: es posible en Uruguay? Opción
Médica 2016;64:4-8
28. Benuska J, Plisova M, Zabka M, Horvath J, Tisovsky P, Novorolsky K. The influence of anesthesia on intraoperative neurophysiological monitoring during spinal surgeries. Bratisl Med J [Internet]. 2019 [citado 24 Dic 2019]; 120 (10): 794–801. Disponible en: http://www.elis.sk/download_file.php?product_id=6404&session_id=2ca8h5pfcicv2pgbv7pji6pa57
29. Traynelis VC, Abode‒Iyamah KO, Leick KM, Bender SM, Greenlee JD. Cervical decompression and reconstruction without intraoperative neurophysiological monitoring. Neurosurg Spine [Internet]. 2012 [citado 24 Dic 2019]; 16(2): 107‒113. Disponible en: https://doi.org/10.3171/2011.10.SPINE11199
30. Marafona AF, Machado HS. Intraoperative evoked potentials: a review of clinical impact and limitations. J Anesth Clin Res [Internet]. 2018 [citado 24 Dic 2019]; 9(1): [aprox. 9 p.]. Disponible en: www.anestesiologiachp.com/DevPort/modules/dGC/files/artigos/Intraoperative%20Evoked%20Potentials%20A%20Review%20of%20Clinical%20Impact%20and%20Limitations.pdf
2. Rijs K, Klimek M, Scheltens-de Boer M, Biesheuvel K, Harhangi BS. Intraoperative Neuromonitoring in Patients with Intramedullary Spinal Cord Tumor: A Systematic Review, Meta-Analysis, and Case Series. World Neurosurg [Internet]. 2019 [citado 24 Dic 2019]; 125(5):498-510. Disponible en: https://doi.org/10.1016/j.wneu.2019.01.007
3. Thomas B, Guo D. The Diagnostic Accuracy of Evoked Potential Monitoring Techniques During Intracranial Aneurysm Surgery for Predicting Postoperative Ischemic Damage: A Systematic Review and Meta-Analysis. World Neurosurg [Internet]. 2017 [citado 24 Dic 2019]; 103:829-840. Disponible en: http://dx.doi.org/10.1016/j.wneu.2017.04.071
4. Norma E. Mena, Luke Sorrick. Monitoreo Neurofisiológico Intraoperatorio: Utilidad y Ventajas en cirugía de columna. Rev Ecuat Neurol [Internet]. 2013 [citado 24 Dic 2019]; 22: 1-3, 2013. Disponible en: http://revecuatneurol.com/wp-content/uploads/2015/06/12-MonitoreoNeurofisiol-Intraoperatorio.pdf
5. Yang S, Zhou L, Lu Z, Ma B, Ji Q, Wang Y. Systematic review with meta-analysis of intraoperative neuromonitoring during thyroidectomy. International Journal of Surgery [Internet]. 2017 [citado 12 Sep 2019]; 39: 104-113. Disponible en: https://www.sciencedirect.com/science/article/pii/S1743919117300900
6. Martínez F, Salle F, Moragues R, G Bertullo. Utilidad de la estimulación intraoperatoria en cirugía de procesos expansivos intracraneanos bajo anestesia general. Rev Urug Med Inter [Internet]. 2017 [citado 24 Dic 2019]; 1: 58-63. Disponible en: http://www.scielo.edu.uy/pdf/rumi/v2n1/2993-6797-rumi-2-01-00058.pdf
7. Rodríguez Aceves CA, Collado Ortiz MÁ, Correa Márquez LI. Monitoreo intraoperatorio multimodal y su aplicación en cirugía de nervios periféricos. An Med (Mex) [Internet]. 2016 [citado 24 Dic 2019]; 61(2): 123-131. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=66299
8. Alberto García Giró, Manuel Sánchez Castillo, Tania Aznielle Rodríguez, Vivian Martín Reyes. Desarrollo de un estimulador eléctrico trans-craneal para monitoreo intra-operatorio. RIELAC [Internet]. 2019 [citado 24 Dic 2019]; 40(1): 1-17. Disponible en: http://rielac.cujae.edu.cu/index.php/rieac/article/download/625/322
9. Walter Daniel J, Vieira Botelho R, Buzetti Milano J, Rolemberg Dantas F, Jooji Onishi F, Rusafa Neto E, et al. Intraoperative Neurophysiological Monitoring in Spine Surgery. A Systematic Review and Meta-Analysis. Spine [Internet]. 2018 [citado 13 Dic 2019]; 43(16): 1154–1160. Disponible en: https://journals.lww.com/spinejournal/Abstract/2018/08150/Intraoperative_Neurophysiological_Monitoring_in.10.aspx
10. Gertsch JH, Moreira JJ, Lee GR, Hastings JD, Ritzl E, Eccher MA. Practice guidelines for the supervising professional: intraoperative neurophysiological monitoring. Journal of Clinical Monitoring and Computing [Internet]. 2019 [citado 13 Nov 2019]; 33:175–183. Disponible en: https://doi.org/10.1007/s10877-018-0201-9
11. De la Maza-Krzeptowsky LC, Romero-Esquiliano G, Ramírez-Segura EH, De Obieta-Cruz E, Vega-Sosa A, Cárdenas-Mejía A, et al. Implementación del monitoreo neurofisiológico intraoperatorio en niños y adultos en el segundo y tercer nivel de atención. Cir Cir [Internet]. 2018 [citado 24 Dic 2019]; 86 (2): 132-139. Disponible en: https://www.medigraphic.com/pdfs/circir/cc-2018/cc182c.pdf
12. López-Rodríguez JJ. Monitoreo neurofisiológico intraoperatorio en cirugía de columna. Rev Mex Anest [Internet]. 2017 [citado 24 Dic 2019]; 40(S1); 31-32. Disponible en: https://www.medigraphic.com/pdfs/rma/cma-2017/cmas171l.pdf
13. León-Álvarez E. Neuromonitoreo. Rev Mex Anest [Internet]. 2017 [citado 24 Dic 2019]; 40(S1): 240-242. Disponible en: https://www.medigraphic.com/pdfs/rma/cma-2017/cmas171bt.pdf
14. Michels P, Bräuer A, Bauer M, et al. Neurophysiological monitoring during surgical procedures. Der Anaesthesist [Internet]. 2017 [citado 24 Dic 2019]; 66(9): 645–659. Disponible en: https://doi.org/10.1007/s00101-017-0356-7
15. Yu T, Li QJ, Zhang XW, Wang Y, Jiang QY, Zhu XJ, et al. Multimodal intraoperative monitoring during surgical correction of scoliosis to avoid neurologic damage. Medicine [Internet]. 2019 [citado 24 Dic 2019]; 98(15): e15067. Disponible en: http://dx.doi.org/10.1097/MD.0000000000015067
16. Jameson LC. Transcranial motor-evoked potentials. In: Kohta A, Sloan TB, Toleikis JR, editors. Monitoring the nervous system for anesthesiologists and other healthcare professionals, 2nd ed. Cham: Springer; 2017. Disponible en: https://link.springer.com/content/pdf/10.1007/978-1-4614-0308-1.pdf
17. Dias Anderson A, Lanna Rachel AB, Ferreira Junior MA, Duarte Marcelo G, Falcon Roberto S, Porto Filho MA, et al Electromyography and instrumentation in patients with idiopathic scoliosis. Coluna/Columna [Internet]. 2017 [citado 24 Dic 2019]; 16(1): 29–32. Disponible en: http://www.scielo.br/scielo.php?pid=S1808-8512017000100029&script=sci_arttext
18. Nunes RR, Bersot CDA, Garritano JG. Intraoperative neurophysiological monitoring in neuroanesthesia. Curr Opin Anesthesiol [Internet]. 2018 [citado 13 Dic 2019]; 31(5): 532–538. Disponible en: https://journals.lww.com/co-anesthesiology/Abstract/2018/10000/Intraoperative_neurophysiological_monitoring_in.8.aspx
19. Ney JP, Kessler DP. Neurophysiological monitoring during cervical spine surgeries: Longitudinal costs and outcomes. Clinical Neurophysiology [Internet]. 2018 [citado 24 Dic 2019]; 129(11): 2245–2251. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S138824571831188X
20. Morales León N, Gómez Ramírez Y, Agramante Rodríguez MA, Domínguez Pérez B, Nieda Rojas M. Neuromonitoreo en pacientes sometidos a cirugía cerebral. Gac Méd Espirit [Internet]. 2007 [citado 24 Dic 2019]; 9(3): [aprox. 9 p.]. Disponible en: http://www.revgmespirituana.sld.cu/index.php/gme/article/view/810/672
21. MacDonald DB. Overview on criteria for MEP monitoring. J Clin Neurophysiol [Internet]. 2017 [citado 24 Dic 2019]; 34(1): 4–11. Disponible en: https://journals.lww.com/clinicalneurophys/Abstract/2017/01000/Overview_on_Criteria_for_MEP_Monitoring.2.aspx
22. MacDonald DB, Dong C, Quatrale R, Sala F, Skinner S, Soto F, et al. Recommendations of the International Society of Intraoperative Neurophysiology for intraoperative somatosensory evoked potentials. Clinical Neurophysiology [Internet]. 2019 [20 Oct 2019]; 130(1): 161-179. Disponible en: https://doi.org/10.1016/j.clinph.2018.10.008
23. Thirumala PD, Crammond DJ, Loke YK, Cheng HL, Huang J, Balzer JR. Diagnostic accuracy of motor evoked potentials to detect neurological deficit during idiopathic scoliosis correction: a systematic review. J Neurosurg Spine [Internet]. 2016 [citado 24 Dic 2019]; 26(3): 374–383. Disponible en: https://thejns.org/spine/view/journals/j-neurosurg-spine/26/3/article-p374.xml
24. Park SK, Joo BE, Lee S, Lee JA, Hwang JH, Kong DS, et al. The critical warning sign of real-time brainstem auditory evoked potentials during microvascular descompression for hemifacial spasm. Clin Neurophysiol [Internet]. 2018 [citado 24 Dic 2019]; 129(5): 1097–1102. Disponible en: https://www.sciencedirect.com/science/article/pii/S138824571731221X
25. Szelényi A. Intraoperative neurophysiological monitoring under general anesthesia. In: Duffau H (Ed): Brain Mapping: from neural basis of cognition to surgical applications. Viena: Springer, 2011.
26. Duffau H. Surgery for diffuse low grade gliomas. Functional considerations. In: Duffau H (Ed): Difuse low grade gliomas in adults. London: Springer, 2017. Disponible en: https://link.springer.com/content/pdf/10.1007/978-3-319-55466-2.pdf
27. Martinez F, Moragues R. Cirugía tumoral con despertar intraoperatorio: es posible en Uruguay? Opción
Médica 2016;64:4-8
28. Benuska J, Plisova M, Zabka M, Horvath J, Tisovsky P, Novorolsky K. The influence of anesthesia on intraoperative neurophysiological monitoring during spinal surgeries. Bratisl Med J [Internet]. 2019 [citado 24 Dic 2019]; 120 (10): 794–801. Disponible en: http://www.elis.sk/download_file.php?product_id=6404&session_id=2ca8h5pfcicv2pgbv7pji6pa57
29. Traynelis VC, Abode‒Iyamah KO, Leick KM, Bender SM, Greenlee JD. Cervical decompression and reconstruction without intraoperative neurophysiological monitoring. Neurosurg Spine [Internet]. 2012 [citado 24 Dic 2019]; 16(2): 107‒113. Disponible en: https://doi.org/10.3171/2011.10.SPINE11199
30. Marafona AF, Machado HS. Intraoperative evoked potentials: a review of clinical impact and limitations. J Anesth Clin Res [Internet]. 2018 [citado 24 Dic 2019]; 9(1): [aprox. 9 p.]. Disponible en: www.anestesiologiachp.com/DevPort/modules/dGC/files/artigos/Intraoperative%20Evoked%20Potentials%20A%20Review%20of%20Clinical%20Impact%20and%20Limitations.pdf
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Published
2020-02-24
How to Cite
1.
Guillén-Cánovas EJ, Linares-Cánovas LP, Romero-Valdés Y de la C. Intraoperative neuromonitoring in the management of patients with conditions associated with the nervous system. Univ. Méd. Pinareña [Internet]. 2020 Feb. 24 [cited 2025 Apr. 29];16(1):392. Available from: https://revgaleno.sld.cu/index.php/ump/article/view/392
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