Abstract
Although the history of intraoperative neuromonitoring (IONM) dates back to the 19th century, the method did not evolve further than the mere differentiation of nerves until recently. Only the development of continuous IONM (cIONM) has allowed for non-stop analysis of excitation amplitude and latency during surgical procedures, which is nowadays integrated into the software of almost all commercially available neuromonitoring devices. The objective of cIONM is real-time monitoring of nerve status in order to recognize and prevent impending nerve injury and predict postoperative nerve function. Despite some drawbacks such as false-positive/negative alarms, technical artefacts, and rare adverse effects, cIONM remains a good instrument which is still under development. Active (acIONM) and passive (pcIONM) methods of cIONM are described in literature. The main fields of cIONM implementation are currently thyroid surgery (in which the vagal nerve is continuously stimulated) and surgery to the cerebellopontine angle (in which the facial nerve is either continuously stimulated or the discharge signal of the nerve is analyzed via pcIONM). In the latter surgery, continuous monitoring of the cochlear nerve is also established.
Highlights
The history of intraoperative neuromonitoring (IONM) began in the 1898 when Dr Fedor Krause from Berlin, Germany, used monopolar faradic stimulation during an acoustic nerve neurectomy [13]
Passive continuous IONM (cIONM) can be excluded from precaution for obvious reasons: This method relies on the pure analysis of the signal that is noted and no active stimulation takes place
The safety of active cIONM (acIONM) was demonstrated in a prospective study in which no heart rate variability and immunomodulatory effects were noted in spite of continuous stimulation of the vagus [8]
Summary
The history of IONM began in the 1898 when Dr Fedor Krause from Berlin, Germany, used monopolar faradic stimulation during an acoustic nerve neurectomy [13]. Multipulse transcranial electric stimulation (TES) of the corticobulbar pathway during posterior cranial fossa surgery is a method ofcontinuous monitoring of the functioning of the facial nerve through analysis of the muscle motor evoked potential (FNMEP). AcIONM of the vestibulocochlear nerve during posterior fossa surgery
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