Neuromonitoring
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Neuromonitoring
Intraoperative neurophysiological monitoring (IONM) or intraoperative neuromonitoring is the use of electrophysiological methods such as electroencephalography (EEG), electromyography (EMG), and evoked potentials to monitor the functional integrity of certain neural structures (e.g., nerves, spinal cord and parts of the brain) during surgery. The purpose of IONM is to reduce the risk to the patient of iatrogenic damage to the nervous system, and/or to provide functional guidance to the surgeon and anesthesiologist. Methods Neuromonitoring employs various electrophysiologic modalities, such as extracellular single unit and local field recordings, SSEP, transcranial electrical motor evoked potentials (TCeMEP), EEG, EMG, and auditory brainstem response (ABR). For a given surgery, the set of modalities used depends in part on which neural structures are at risk. Transcranial Doppler imaging (TCDI) is also becoming more widely used to detect vascular emboli. TCDI can be used in ...
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Evoked Potential
An evoked potential or evoked response is an electrical potential in a specific pattern recorded from a specific part of the nervous system, especially the brain, of a human or other animals following presentation of a Stimulus (physiology), stimulus such as a light flash or a pure tone. Different types of potentials result from stimuli of different Stimulus modality, modalities and types. Evoked potential is distinct from spontaneous potentials as detected by electroencephalography (EEG), electromyography (EMG), or other electrophysiology, electrophysiologic recording method. Such potentials are useful for electrodiagnostic medicine, electrodiagnosis and monitoring (medicine), monitoring that include detections of disease and drug-related sensory dysfunction and intraoperative monitoring of sensory pathway integrity. Evoked potential amplitudes tend to be low, ranging from less than a microvolt to several microvolts, compared to tens of microvolts for EEG, millivolts for EMG, and ...
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Motor Evoked Potentials
An evoked potential or evoked response is an electrical potential in a specific pattern recorded from a specific part of the nervous system, especially the brain, of a human or other animals following presentation of a stimulus such as a light flash or a pure tone. Different types of potentials result from stimuli of different modalities and types. Evoked potential is distinct from spontaneous potentials as detected by electroencephalography (EEG), electromyography (EMG), or other electrophysiologic recording method. Such potentials are useful for electrodiagnosis and monitoring that include detections of disease and drug-related sensory dysfunction and intraoperative monitoring of sensory pathway integrity. Evoked potential amplitudes tend to be low, ranging from less than a microvolt to several microvolts, compared to tens of microvolts for EEG, millivolts for EMG, and often close to 20 millivolts for ECG. To resolve these low-amplitude potentials against the background of ongo ...
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Somatosensory Evoked Potentials
An evoked potential or evoked response is an electrical potential in a specific pattern recorded from a specific part of the nervous system, especially the brain, of a human or other animals following presentation of a stimulus such as a light flash or a pure tone. Different types of potentials result from stimuli of different modalities and types. Evoked potential is distinct from spontaneous potentials as detected by electroencephalography (EEG), electromyography (EMG), or other electrophysiologic recording method. Such potentials are useful for electrodiagnosis and monitoring that include detections of disease and drug-related sensory dysfunction and intraoperative monitoring of sensory pathway integrity. Evoked potential amplitudes tend to be low, ranging from less than a microvolt to several microvolts, compared to tens of microvolts for EEG, millivolts for EMG, and often close to 20 millivolts for ECG. To resolve these low-amplitude potentials against the background of o ...
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Clinical Neurophysiology
Clinical neurophysiology is a medical specialty that studies the central and peripheral nervous systems through the recording of bioelectrical activity, whether spontaneous or stimulated. It encompasses both research regarding the pathophysiology along with clinical methods used to diagnose diseases involving both central and peripheral nervous systems. Examinations in the clinical neurophysiology field are not limited to tests conducted in a laboratory. It is thought of as an extension of a neurologic consultation. Tests that are conducted are concerned with measuring the electrical functions of the brain, spinal cord, and nerves in the limbs and muscles. It can give the precise definition of site, the type and degree of the lesion, along with revealing the abnormalities that are in question. Due to these abilities, clinical neurophysiology is used to mainly help diagnose diseases rather than treat them. In some countries it is a part of neurology or psychiatry, for example the U ...
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Electrode
An electrode is an electrical conductor used to make contact with a nonmetallic part of a circuit (e.g. a semiconductor, an electrolyte, a vacuum or air). Electrodes are essential parts of batteries that can consist of a variety of materials depending on the type of battery. The electrophore, invented by Johan Wilcke, was an early version of an electrode used to study static electricity. Anode and cathode in electrochemical cells Electrodes are an essential part of any battery. The first electrochemical battery made was devised by Alessandro Volta and was aptly named the Voltaic cell. This battery consisted of a stack of copper and zinc electrodes separated by brine-soaked paper disks. Due to fluctuation in the voltage provided by the voltaic cell it wasn't very practical. The first practical battery was invented in 1839 and named the Daniell cell after John Frederic Daniell. Still making use of the zinc–copper electrode combination. Since then many more batteries have be ...
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Death
Death is the irreversible cessation of all biological functions that sustain an organism. For organisms with a brain, death can also be defined as the irreversible cessation of functioning of the whole brain, including brainstem, and brain death is sometimes used as a legal definition of death. The remains of a former organism normally begin to decompose shortly after death. Death is an inevitable process that eventually occurs in almost all organisms. Death is generally applied to whole organisms; the similar process seen in individual components of an organism, such as cells or tissues, is necrosis. Something that is not considered an organism, such as a virus, can be physically destroyed but is not said to die. As of the early 21st century, over 150,000 humans die each day, with ageing being by far the most common cause of death. Many cultures and religions have the idea of an afterlife, and also may hold the idea of judgement of good and bad deeds in one's life ( h ...
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Neurophysiology
Neurophysiology is a branch of physiology and neuroscience that studies nervous system function rather than nervous system architecture. This area aids in the diagnosis and monitoring of neurological diseases. Historically, it has been dominated by electrophysiology—the electrical recording of neural activity ranging from the molar (the electroencephalogram, EEG) to the cellular (intracellular recording of the properties of single neurons), such as patch clamp, voltage clamp, extracellular single-unit recording and recording of local field potentials. However, since the neurone is an electrochemical machine, it is difficult to isolate electrical events from the metabolic and molecular processes that cause them. Thus, neurophysiologists currently utilise tools from chemistry (calcium imaging), physics (functional magnetic resonance imaging, Functional magnetic resonance imaging, fMRI), and molecular biology (site directed mutations) to examine brain activity. The word originates f ...
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Otolaryngology
Otorhinolaryngology ( , abbreviated ORL and also known as otolaryngology, otolaryngology–head and neck surgery (ORL–H&N or OHNS), or ear, nose, and throat (ENT)) is a surgical subspeciality within medicine that deals with the surgical and medical management of conditions of the head and neck. Doctors who specialize in this area are called otorhinolaryngologists, otolaryngologists, head and neck surgeons, or ENT surgeons or physicians. Patients seek treatment from an otorhinolaryngologist for diseases of the ear, nose, throat, base of skull, base of the skull, head, and neck. These commonly include functional diseases that affect the senses and activities of eating, drinking, speaking, breathing, swallowing, and hearing. In addition, ENT surgery encompasses the surgical management of cancers and benign tumors and reconstruction of the head and neck as well as plastic surgery of the face and neck. Etymology The term is a combination of New Latin classical compound, combini ...
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Carotid Endarterectomy
Carotid endarterectomy is a surgical procedure used to reduce the risk of stroke from carotid artery stenosis (narrowing the internal carotid artery). In endarterectomy, the surgeon opens the artery and removes the plaque. The plaque forms and thickens the inner layer of the artery, or ''intima'', hence the name of the procedure which simply means removal of part of the internal layers of the artery. An alternative procedure is carotid stenting, which can also reduce the risk of stroke for some patients. Medical uses Carotid endarterectomy is used to reduce the risk of strokes caused by carotid artery stenosis over time. Carotid stenosis can either have symptoms (i.e., be symptomatic), or be found by a doctor in the absence symptoms (asymptomatic) - and the risk-reduction from endarterectomy is greater for symptomatic than asymptomatic patients. Carotid endartectomy itself can cause strokes, so to be of benefit in preventing strokes over time, the risks for combined 30-day mo ...
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Vascular Surgery
Vascular surgery is a surgical subspecialty in which diseases of the vascular system, or arteries, veins and lymphatic circulation, are managed by medical therapy, minimally-invasive catheter procedures and surgical reconstruction. The specialty evolved from general and cardiac surgery and includes treatment of the body's other major and essential veins and arteries. Open surgery techniques, as well as endovascular techniques are used to treat vascular diseases. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system excluding the coronaries and intracranial vasculature. Vascular surgeons often assist other physicians to address traumatic vascular injury, hemorrhage control, and safe exposure of vascular structures. History Early leaders of the field included Russian surgeon Nikolai Korotkov, noted for developing early surgical techniques, American interventional radiologist Charles Theodore Dotter who is credited wit ...
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Vestibulocochlear Nerve
The vestibulocochlear nerve or auditory vestibular nerve, also known as the eighth cranial nerve, cranial nerve VIII, or simply CN VIII, is a cranial nerve that transmits sound and equilibrium (balance) information from the inner ear to the brain. Through olivocochlear fibers, it also transmits motor and modulatory information from the superior olivary complex in the brainstem to the cochlea. Structure The vestibulocochlear nerve consists mostly of bipolar neurons and splits into two large divisions: the cochlear nerve and the vestibular nerve. Cranial nerve 8, the vestibulocochlear nerve, goes to the middle portion of the brainstem called the pons (which then is largely composed of fibers going to the cerebellum). The 8th cranial nerve runs between the base of the pons and medulla oblongata (the lower portion of the brainstem). This junction between the pons, medulla, and cerebellum that contains the 8th nerve is called the cerebellopontine angle. The vestibulocochlear nerv ...
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