Koht, Sloan, Toleikis’s Monitoring the Nervous System for Anesthesiologists and Other Health Care PPPrrrooofffeeessssssiiiooonnnaaalllsss CChhrriissttoopphh NN.. SSeeuubbeerrtt 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, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, 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 exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG 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 xi 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