Neuromonitoring supports complex surgical interventions in neurosurgery

Neurosurgery

Neurosurgery surgically identifies and treats diseases, injuries and malformations of the central and peripheral nervous system. Neurosurgery is one of the most complex surgical procedures, as the surgical field is located in the neural control centre of the human body. The aim of treatment in neurosurgery is primarily to remove lesions and tumours without affecting healthy tissue.

Perioperative injury to the brain or central nervous system can lead to serious consequential damage such as memory loss, loss of vision or hearing, speech or movement disorders, paresis and paralysis, and even death of the patients.

Relevance of neuromonitoring for neurosurgery

For this reason, intraoperative neuromonitoring (IONM) is of central importance, especially in neurosurgery. Intraoperative neuromonitoring is used to continuously monitor important functions of the nervous system during a neurosurgical intervention. This helps to better ensure the integrity of the neuronal structures in the patients’ brain and thus significantly reduce the risk of injury.

Neuromonitoring also enables the neurosurgeons to perform a function-controlled tumour resection and thus preserve the function of brain areas, connected nervous conduction systems, the spinal cord and peripheral nerve structures.

Application of IONM in neurosurgery

Neurosurgical interventions in the posterior cranial fossa and the cerebellopontine angle are limited by the nuclei and intramedullary fibres of 10 of the 12 cranial nerves, which are located close to each other. In this area, the function of the nerves and the brainstem can be monitored during neurosurgical interventions. Vestibular schwannomas are the most frequent tumours in this area.

Mapping is also very important in neurosurgery during removal of gliomas and other brain tumours. By using mapping, areas relevant for e.g. speech or motor function can be localised and protected during tumour resection.

Neurosurgery also includes surgery for spinal tumours and scoliosis treatment, which can lead to spinal cord damage and corresponding paresis or paralysis. Neuromonitoring at the spine monitors mainly efferent and afferent spinal cord pathways by means of EMG, SEP and MEP recording.

Application fields of IONM in neurosurgery

>> Vestibular schwannomas
>> Cerebral aneurysms
>> Interventions in the brainstem
>> Interventions in the posterior cranial fossa, such as vestibular schwannomas
>> Interventions in supratentorial areas, such as glioma surgery
>> Spinal stabilisation
>> Spinal tumours and malformations
>> Selective dorsal rhizotomy
>> Drezotomy
>> Peripheral nerve surgery, such as plexus surgery