lntraoperativ Neurophysiologic Monitoring A Spotlight on the Egyptian Experience

Abstract

The nervous tissue is one of the human body's most irreplaceable structures. The brain and spinal cord are enclosed in the robust axial skeleton to protect it from injury at all times and indeed it does. In only very few instances, the central nervous tissue is at serious risk of direct injury. One .of these instances is surgery, whether cranial or spinaL

Although regarded by many as a brutal way of treating diseases, surgery remains the main (and sometimes the only) form of therapy that can be provided to many patients. Those with large cranial meningiomas, neuromuscular scoliosis, cerebellopontine angle (CPA) fibromas and many others benefit significantly from surgeries that essentially relieve their problems altogether. Nevertheless, a risk of injuring "innocent" nervous structures during these procedures exists. This risk varies with the type of surgery in question but is never eliminated completely. Thus it is inevitable, for example, that a proportion of patients undergoing corrective surgery for scoliosis will come out of the operation with paraplegia and that a proportion of those undergoing carotid endarterectomies will suffer long-lasting cognitive and motor dysfunctions because of prolonged clamping. Remarkable efforts have been expended to minimize this inexcusable risk. Minimally invasive surgery was devised and alternative surgical procedures thought up. However, one of the most valuable steps taken on that path was the introduction of neurophysiology into the operating theatre.

Intraoperative Neurophysiologic Monitoring (IONM) comprises the use of a multitude of neurophysiological tools, adapted from their original utility in the diagnostic lab, to assist in minimizing the risk of injury to neural tissue during surgery. Brainstem