title: A comparison between derivation optimization and Cz'-FPz for posterior tibial P37 somatosensory evoked potential intraoperative monitoring.
abstract: OBJECTIVE
  To compare P37 derivation optimization to Cz'-FPz.
  
  
  METHODS
  After induction in 120 patients, monitoring derivations optimized by mapping FPz, Cz, Cz', Pz, C4', C2', C1' and C3'-mastoid to determine the P37 and N37 maximums for use as inputs 1 and 2 were compared to Cz'-FPz. This was repeated later in 35 surgeries.
  
  
  RESULTS
  Eleven optimal derivations occurred and usually differed between sides. Input 1 was Cz', Pz, Cz, iCi', or Ci' and input 2 was Cc', FPz, Ci' or Pz. Even the most frequent Cz'-Cc' derivation was optimal for both sides of an individual in only 17% and this was true for Cz'-FPz in only 4%. Optimization produced higher amplitudes than Cz'-FPz (P<0.001). The ratio was [squareroot of 2] : 1 in 61% of patients and > or =2:1 in 28%, approximately halving or quartering averaging times. Optimization assessed decussation, disclosing non-decussation in one patient while Cz'-FPz did not. Alterations of P37 topography that reduced initially optimal derivation amplitude and made a different derivation optimal were demonstrated by repeat optimization in 13 of 35 patients, preventing misinterpretation in one. While also affected, Cz'-FPz neither detected nor adjusted for potentially misleading topographic changes.
  
  
  CONCLUSIONS
  Higher amplitudes, decussation assessment and topographic adjustment make P37 derivation optimization superior to Cz'-FPz for monitoring this highly variable potential.
authors.affiliation: Section of Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital and Research Center MBC 76, P.O. Box 3354, Riyadh 11211, Saudi Arabia. dmacdonald@kfshrc.edu.sa
authors.forename: D B
authors.initials: DB
authors.lastname: MacDonald
authors.forename: B
authors.initials: B
authors.lastname: Stigsby
authors.forename: Z
authors.initials: Z
authors.lastname: Al Zayed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004558:Electric Stimulation / Q000379:methods; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011446:Prospective Studies; D013979:Tibial Nerve / Q000502:physiology*