Intraoperative motor evoked potential monitoring: overview and update.
Amidst controversy about methodology and safety, intraoperative neurophysiology has entered a new era of increasingly routine transcranial and direct electrical brain stimulation for motor evoked potential (MEP) monitoring. Based on literature review and illustrative clinical experience, this tutorial aims to present a balanced overview for experienced practitioners, surgeons and anesthesiologists as well as those new to the field. It details the physiologic basis, indications and methodology of current MEP monitoring techniques, evaluates their safety, explores interpretive controversies and outlines some applications and results, including aortic aneurysm, intramedullary spinal cord tumor, spinal deformity, posterior fossa tumor, intracranial aneurysm and peri-rolandic brain surgeries. The many advances in motor system assessment achieved in the last two decades undoubtedly improve monitoring efficacy without unduly compromising safety. Future studies and experience will likely clarify existing controversies and bring further advances.
Macdonald
David B
DB
Department of Neurosciences, King Faisal Specialist Hospital & Research Center, MBC 76, PO Box 3354, Riyadh 11211, Saudi Arabia. dbmacdon@yahoo.com
D000818:Animals; D004566:Electrodes; D004569:Electroencephalography; D019054:Evoked Potentials, Motor; D006801:Humans; D016343:Monitoring, Intraoperative / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D012449:Safety; D004561:Transcutaneous Electric Nerve Stimulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000639:trends