By Aage R. Møller
The most appropriate authority on intraoperative neurophysiological tracking (IOM) offers in a brand new version a entire, updated reference on IOM recommendations and their anatomical and physiological foundation. Dr. M?ller deals theoretical and useful tips concerning electrophysiological recordings within the working room, the best way to interpret the implications, and the way to offer them to the doctor. additionally, the writer has additional new fabric at the tracking of the spinal motor process, of sensory platforms, of peripheral nerves, and in cranium base surgical procedure. integrated are tools for steering the health practitioner in operations, equivalent to microvascular decompression, implantation of electrodes for deep mind stimulation, fix of peripheral nerves and for placement of electrodes for auditory prostheses.
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Extra info for Intraoperative Neurophysiological Monitoring
7B). The initial fast potentials are generated by the termination of the dorsal column fibers in the nucleus and this component can be recorded with similar waveform from the entire surface of a nucleus (Fig. 7A). The size and the polarity of the slow potential, however, depends on the location on a nucleus from which it is recorded (Fig. 7A). The slow potential is assumed to be generated by dendrites and it has the property of a dipole. An electrode placed on one side of a nucleus will record a negative slow potential (top recording in Fig.
A malfunctioning electrode has a higher than normal impedance. Adverse effects of using needle electrodes in the form of infection or postoperative marks on the skin are very rare. Within a few days after the operation, it is usually impossible to identify the sites where the needle electrodes had been placed. When using needle electrodes during operations, it is important that the electrocautery equipment used during the procedure be of high quality and an efficient return electrode pad be placed on the patient (usually the thigh).
Such stimulation can only be used in anesthetized patients because of the excessive pain that it would cause in an awake individual. In operations where the motor cortex is exposed, direct stimulation can be applied, which requires much less voltage. Recordings from the exposed cerebral cortex are done for identifying the location of the central sulcus. For that purpose, plastic strips with a string of four to eight electrodes or fields of 4 × 4 or 8 × 8 electrodes are used and placed directly on the exposed cerebral cortex (Chap.