Abstract Details

Title Case Series: Intraoperative Neurophysiologic Monitoring (IONM) Changes during Presumably "Non-Critical" Periods of Surgery

Topic Clinical Neurophysiology

Presentation(s) S39 - (-)

Poster/Presentation
Number 001

Objective

Background There is currently no clear definition or consensus guideline regarding when IONM should be initiated or concluded for a given surgical procedure. At our institution, standard IONM protocol indicates that multimodality monitoring begin prior to first incision, with acquisition of data at frequent intervals throughout surgical exposure, the planned surgical intervention, and until the end of surgical closure.

Design/Methods We present a series of nine diverse cases during a two-year period, which include cerebrovascular (5), endovascular (2), and spine (2) procedures where significant IONM changes occurred during non-interventional periods. Conventional techniques for acquisition of potentials were utilized. Multimodality IONM was employed in all cases, including transcranial motor evoked potentials, somatosensory evoked potentials, electroencephalography, and when appropriate, electromyography.

Results All IONM changes occurred either during surgical exposure (2 cases) or surgical closure (7 cases), periods that may be perceived as "non-critical." Identification of IONM changes, usually involving only one modality, uniformly resulted in rapid surgical assessment and subsequent intervention, which resolved these changes and correlated with good postoperative clinical outcomes.

Conclusions This spectrum of clinical cases emphasizes not only the importance of utilizing multimodality IONM techniques, but also the necessity of frequent monitoring throughout the entire duration of surgery, from surgical exposure to the end of surgical closing. It remains of utmost importance to maintain effective communication between the IONM team, surgeons, and anesthesiologists, as critical changes may potentially occur at any time during the procedure. Without such an approach, a potential window of opportunity to intervene and facilitate timely surgical intervention to improve patient outcomes may otherwise be missed, as significant IONM changes could occur unexpectedly, during presumably "non-critical" periods of surgery.

Authors/Disclosures
Leslie H. Lee, MD, FAAN PRESENTER	Dr. Lee has nothing to disclose.
Charles Cho	No disclosure on file
Viet Nguyen, MD	Dr. Nguyen has received personal compensation for serving as an employee of Biogen. Dr. Nguyen has stock in Biogen.
	No disclosure on file
	No disclosure on file
Gary Steinberg, MD, PhD (Stanford Univ Hosp Dept of Neurosurgery)	Dr. Steinberg has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for SanBio. Dr. Steinberg has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Zeiss. Dr. Steinberg has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Surgical Theater. Dr. Steinberg has received research support from National Institutes of Health. Dr. Steinberg has received research support from California Institute of Regenerative Medicine. Dr. Steinberg has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
	No disclosure on file
Jaime R. Lopez, MD (Stanford University School of Medicine)	An immediate family member of Dr. Lopez has received personal compensation for serving as an employee of AbbVie. Dr. Lopez has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Neurophysiology. Dr. Lopez has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for medical-legal consulting.
	No disclosure on file

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