Intraoperative neurological monitoring

Abstract

Intraoperative neurological monitoring (INM) is the evaluation of the nervous system within the operating room (OR) environment. In this paper, the INM system is tested in a clinical setting in comparison with conventional somatosensory evoked potential (SEP) monitoring. The study results demonstrate the capability of the INM system in extracting clearer and more stable SEP signals. The high SNR of SEP signals collected in various clinical environments, including the OR, makes the INM system a robust platform for continuous monitoring. While the current use of EP monitoring is limited to intermittent analysis by a highly trained clinical neurophysiologist, the authors believe in changing this paradigm by developing continuous monitoring systems, such as the INM system, capable of automated quantitative EP analysis. This noninvasive monitoring modality will allow for a wider range of use in clinical practice. Based on volunteer and clinical patient studies, the INM monitoring system demonstrates much greater reliability and accuracy via the artifact rejection and denoising strategies. It provides more strategic filtering options for different situations under which the clinical SEP response signal could be greatly contaminated and distorted. Furthermore, the INM system offers a promising approach to signal extraction in real-time monitoring during SEP research