Intraoperative neuromonitoring (IONM) is an innovative technique for precisely mapping and monitoring brain function during brain tumour, aneurysm or spinal cord surgery. The aim is to preserve brain function during surgery. In this way, post-operative loss of function such as movement or speech disorders can be avoided.
Common conditions for which intraoperative neuromonitoring is used include tumours in the cerebrum in regions that control movement and sensory functions, tumours in the brainstem and base of the skull, and certain diseases of the spinal cord.
Intraoperative neuromonitoring of central and peripheral nervous system brain function allows precise localisation of brain function, as the location and extent of function in brain tissue often cannot be defined visually. Intraoperative monitoring also allows continuous monitoring of brain function. For example, it can be checked whether the signal transmission in the nerve pathways between the hand and the brain is functioning properly. The main methods used for intraoperative neuromonitoring are:
Electromyography (EMG) allows continuous monitoring of muscle activity in specific muscles, for example in the arms or legs, and in muscles supplied by the cranial nerves. This provides continuous information during surgery as to whether muscle control by the central nervous system is intact. The EMG can also be used to localise motor function, for example of the cranial nerves, or to identify specific brainstem areas responsible for motor function. This provides important information during the operation about which regions should be spared, e.g. during brain tumour surgery, in order to avoid the risk of post-operative movement deficits.
Evoked potentials can be used to locate and monitor brain function:
In selected cases, we perform surgery while the patient is awake in order to avoid post-operative speech and movement disorders (see also Diagnostic & surgical procedures).
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