Koht, Sloan, Toleikis's Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals

744 Pages·2022·44.571 MB·English

by  Christoph N. Seubert, Jeffrey R. Balzer

Koht, Sloan, Toleikis’s
Monitoring the Nervous
System for Anesthesiologists
and Other Health Care
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Jeff rey R. Balzer
Editors
Third Edition
123
Koht, Sloan, Toleikis's Monitoring the
Nervous System for Anesthesiologists
and Other Health Care Professionals
Christoph N. Seubert • Jeffrey R. Balzer
Editors
Koht, Sloan, Toleikis's
Monitoring the Nervous
System for
Anesthesiologists and
Other Health Care
Professionals
Third Edition
Editors
Christoph N. Seubert Jeffrey R. Balzer
Department of Anesthesiology Department of Neurological Surgery
University of Florida College of University of Pittsburgh School of
Medicine Medicine
Gainesville, FL, USA Pittsburgh, PA, USA
ISBN 978-3-031-09718-8 ISBN 978-3-031-09719-5 (eBook)
https://doi.org/10.1007/978-3-031-09719-5
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2012, 2017 and 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher,
whether the whole or part of the material is concerned, specifically the rights of translation,
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computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
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The publisher, the authors, and the editors are safe to assume that the advice and information in
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The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
I dedicate this book to my wife Marianna. I cannot think of one
person in this world that understands me like you do. Your
unwavering love and support for my career and aspirations has
never been taken for granted. Also to my children, Ben and
Barbara, who I know sacrificed tremendously secondary to my
dedication to my career. You all have made my clinical and
academic aspirations possible, and this contribution is a
testament to my thanks.
Jeffrey R. Balzer, PhD
I dedicate this book to all life-long learners in the field of
intraoperative neurophysiology and to the patients they
faithfully serve. You are a motley crew, and it is my professional
honor to be part of your tribe. My contribution to this field rests
on the sustaining support and love from my wife Charlotte.
Thank you for sharing life’s path.
Christoph N. Seubert, MD, PhD
Preface
The first edition of this book was a mission statement from the pioneer gen-
eration in intraoperative neurophysiology, comprising surgeons, anesthesiol-
ogists, neurologists, researchers, and other clinicians, who converted insights,
techniques, and perspectives into tools that provided clinical utility to assess
the nervous system in patients who could not be assessed by a standard neu-
rological examination. The second edition greatly expanded the material and
further emphasized the division of techniques/modalities and applications,
reflecting the fact that many techniques have become standardized and that
criteria for robust performance can be stated. Conversely, clinical applica-
tions frequently combine individual techniques into a monitoring approach,
in recognition that even a structure as simple as a peripheral nerve has several
functional components. This second edition departed from a technique-based
reference text, emphasizing case-based teaching of applied integrated intra-
operative neurophysiology. Because the overall structure of the previous edi-
tions was sound, this third edition retains the divided structure and updates
the material while sharpening the focus on application and clinical context.
Parts I and II provide relevant background, with a focus on prevalent tech-
niques, while Part III discusses clinical applications. The third edition contin-
ues to engage the operating room team in general, and anesthesiologists in
particular, where they are, i.e., faced with a specific type of case and offers
them practical information on how to optimize care while facilitating both
surgery and monitoring for routine clinical scenarios or typical complica-
tions. This focus enhances the book’s unique strength: communicating well
with all members of a specialized operative team who may encounter intraop-
erative neurophysiology or may be charged with aspects of its performance,
interpretation, or integration into the care of patients.
The third edition’s new editors represent a generation change away from
the pioneers in this field. This transition is also reflected in the authors, who
contributed to this edition. What has not changed is the focus on sharing
knowledge and hard-won insight to harness the potential of IONM for the
benefit of patients. The performance and the benefit of IONM depends on the
specific clinical and local context. As the saying goes: Bad monitoring is
worse than no monitoring at all. IONM as a field is still a good way away
from a shared mental model that effectively underpins the high-stakes com-
munication and collaboration among the surgical team, the IONM team, and
the anesthesia team around specific operative decisions or specific patients.
We trust that this book will continue to serve as a valuable educational
vii
viii Preface
resource to bridge the gap between what is possible and what we actually
achieve for our patients.
Gainesville, FL Christoph N. Seubert
Pittsburgh, PA Jeffrey R. Balzer
Acknowledgments
We were incredibly humbled to be asked to edit the third edition of this
already wonderful book. To follow in the footsteps of Drs. Koht, Sloan, and
Toleikis is a true honor. As an anesthesiologist and neurophysiologist, we
recognize that the anesthesia team plays a pivotal role in the success of nearly
every surgical procedure where intraoperative neuromonitoring is utilized.
That said, this project gave us the opportunity to update and enhance material
pertaining to a variety of surgical procedures utilizing intraoperative neuro-
physiology with special emphasis on current anesthetic techniques that opti-
mize these important recordings. We sincerely hope that you enjoy the
up-to-date contributions from our national and international contributors.
We would also like to thank all those who updated their previous chapters
and those who contributed new material. Without the willingness of these
individuals to share their knowledge, experience, and time, the development
of this third edition would not have been possible. Their time and effort are
not lost on us, and we sincerely appreciate all of the quality work they put into
this project making this third edition a comprehensive collection of thought,
experience, and evidence-based material.
We would also like to extend a special thanks to Lee Klein from Springer
for making our jobs as editors seamless. Lee guided us through the editorial
process with the appropriate amount of assistance and nudging to meet dead-
lines along the way. His skill and personality made our roles as editors both
educational and enjoyable.
We hope you enjoy this third Edition of Monitoring the Nervous System
for Anesthesiologists and Other Health Care Professionals as much as we did
in its preparation. Cheers!
ix
Contents
Part I Monitoring Techniques
1 Somatosensory-Evoked Potentials . . . . . . . . . . . . . . . . . . . . . . . . . 3
Corey Amlong, Whitney Fallahian, Aimee Becker,
and Deborah A. Rusy
2 Transcranial Motor-Evoked Potentials . . . . . . . . . . . . . . . . . . . . . 21
Leslie C. Jameson
3 Auditory-Evoked Potentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Basma Mohamed and Christoph N. Seubert
4 Visual-Evoked Potentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Colette Boëx, Sandra C. Toleikis, and J. Richard Toleikis
5 Deep Brain Stimulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
John J. Pearce III, Patrick King, Diana Apetauerova,
Jeffrey E. Arle, Sepehr Sani, and Jay L. Shils
6 Intraoperative Electromyography . . . . . . . . . . . . . . . . . . . . . . . . . 91
Kent S. Rice and Stanley A. Skinner
7 The Use of Spinal Reflex Responses for IOM. . . . . . . . . . . . . . . . 145
Ronald Leppanen
8 Brainstem Reflexes Under General Anesthesia . . . . . . . . . . . . . . 179
Sedat Ulkatan, Maria J. Téllez, and Jonathan Lesser
9 Brain Mapping: Asleep and Awake . . . . . . . . . . . . . . . . . . . . . . . . 189
Mirela V. Simon, Tina N. Nguyen, and Charles D. Yingling
10 Intraoperative Monitoring of EEG and Processed EEG . . . . . . . 211
Svenja Letz and Gerhard Schneider
11 Central Nervous System Near- Infrared Spectroscopic
Monitoring: Technique and Clinical Application . . . . . . . . . . . . . 227
Shirley Susana Cruz Beltran, Zasha Vazquez- Colon,
Torrey D. Baines, and Kevin J. Sullivan
12 Intracranial Pressure Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . 265
David R. Wright, Abhijit V. Lele, and Deepak Sharma
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xii Contents
13 Monitoring Cerebral Blood Flow . . . . . . . . . . . . . . . . . . . . . . . . . 275
W. Andrew Kofke and Andrea D. Creamer
14 Transcranial Doppler Ultrasonography . . . . . . . . . . . . . . . . . . . . 297
Deepak Sharma and David R. Wright
Part II From Techniques to the Operating Room: General
Considerations
15 IOM Instrumentation Layout and Electrical Interference . . . . . 313
Brett Netherton and Andrew Goldstein
16 Signal Optimization in Intraoperative Neuromonitoring . . . . . . 329
Robert E. Minahan and Allen S. Mandir
17 Optimization of Intraoperative Neurophysiological
Monitoring Through Anesthetic Management . . . . . . . . . . . . . . . 361
Ferenc Rabai, Tod B. Sloan, and Christoph N. Seubert
18 Basic Evaluation and Effective Communication of IOM
Signal Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
Christoph N. Seubert, Antoun Koht, Tod B. Sloan,
J. Richard Toleikis, and Robert N. Holdefer
Part III Clinical Applications
19 Anesthesia for Awake Neurosurgery . . . . . . . . . . . . . . . . . . . . . . . 407
Natalie Moreland, Susana Vacas,
and Barbara M. Van de Wiele
20 Intraoperative Neurophysiologic Monitoring and Mapping
of the Motor System During Surgery for Supratentorial
Lesions Under General Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . 427
Georg Neuloh and Kathleen Seidel
21 Intraoperative Neurophysiological Monitoring
for Intracranial Aneurysm Surgery . . . . . . . . . . . . . . . . . . . . . . . 437
Laura B. Hemmer, Carine Zeeni, Bernard R. Bendok,
and Antoun Koht
22 Intracranial Arteriovenous Malformation Surgery . . . . . . . . . . . 453
Laura B. Hemmer and Carine Zeeni
23 Microvascular Decompression for Cranial Nerve
Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465
Varun Shandal, Isabel Fernández-Conejero, Raymond Sekula,
Donald Crammond, Parthasarathy Thirumala,
Katherine Anetakis, Antoun Koht, and Jeffrey R. Balzer
24 Surgery for Extra-axial Infratentorial Mass and IOM . . . . . . . . 495
Andrea Szelényi, Michael J. Malcharek,
and Gerhard Schneider