An Overview on Intraoperative Neurophysiological Monitoring
Keywords:
Intraoperative neurophysiological monitoring; Somatosensory evoked potentials; Motor evoked potentials; Electromyography; Neurosurgery; Total intravenous anesthesia.Abstract
Intraoperative neurophysiological monitoring (IONM) has become an essential adjunct in modern neurosurgery and complex surgical procedures for preserving neural function and minimizing postoperative neurological deficits. It encompasses multiple modalities including somatosensory evoked potentials, motor evoked potentials, electromyography, electroencephalography, brainstem auditory evoked potentials, and visual evoked potentials, each targeting specific neural pathways. This review highlights the anatomical and physiological basis, basic principles, clinical applications, anesthetic considerations, perioperative factors affecting monitoring accuracy, limitations, complications, and current evidence-based indications of IONM in neurosurgical practice. Multimodal IONM, particularly when integrated with optimized anesthetic techniques such as total intravenous anesthesia, enhances surgical safety by facilitating early detection of neural compromise and allowing timely intraoperative intervention. Despite technical limitations and susceptibility to physiological and pharmacological influences, IONM remains a cornerstone in reducing morbidity and improving outcomes in neurosurgery..
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