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Intraoperative Neurophysiologic Monitoring ACN & HCS 6373 Spring 2006

Spring 2006
Instructor: Aage R. Moller Ph.D.

Class schedule: Main Campus

Mondays 2:00-4:45
January 9, 2006
GR 4.208

Class text:
Møller, A.R.: Intraoperative Neurophysiologic Monitoring, 2 Edition. Humana Press
Inc 2006. ISBN 1-58829-703-9
Note: the instructor will be provide this book at a discounted price.

Supplementary readings:
Gray’s Anatomy

Brodal P. The Central Nervous System 3 ed
New York, Oxford University Press, 2004 ISBN 0-19-516560-8

1. Midterm Exam: Covers the first section to February 27th,
2. Final Exam April 24th

Course purpose: The purpose of this class is to develop an understanding of the

basic principle of intraoperative neurophysiologic monitoring and understand the
anatomy and physiology of the systems that can be monitored.

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Intraoperative Neurophysiologic Monitoring ACN & HCS 6373 Spring 2006

General objectives:
Students will:
1. Understand the purpose and general principle of intraoperative
neurophysiological monitoring for reducing the risk of postoperative
neurological deficits and for guiding the surgeon in specific neurosurgical
2. Get to know the anatomy of sensory and motor systems that can be monitored
during neurosurgical, orthopedic, and otolaryngological operations
3. Understand the general principles for generation of electrical potentials by
nerves, nuclei and muscles
4. Know the general principles of electrophysiologic recordings of different kinds
of electrical potentials from the nervous system and from muscles
5. Understand the difference between far field and near field evoked potentials
6. Understand different ways to stimulate neural tissue
7. Understanding how such recordings can provide information about changes in
function of sensory and motor systems
8. Learn to interpret changes in neuroelectric potentials as signs of injuries to
nerves and nuclei
9. Understand how recording of neuroelectric potentials can assist surgeons in
some surgical operations
10. Understand the principles for recordings from deep brain structures for guiding
implantation of stimulating electrodes or for making selective lesions

Course layout:
Intraoperative neurophysiologic monitoring makes it possible to detect surgically
induced injuries before they reach a level where permanent neurologic deficits occur
and that can reduce the risk of neurological deficits as complications to operations
that involve nervous tissue. Interpretation of such recordings requires knowledge
about the physiology and anatomy of the systems involved, and how the recorded
electrical potentials change as a result of injuries.

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Intraoperative Neurophysiologic Monitoring ACN & HCS 6373 Spring 2006

The course includes neuroanatomy of sensory and motor systems, the basis for
generation of neuroelectric potentials and it describes the practical aspects of
recording and interpreting neuroelectric data in the clinic and in the operating room.
Description of the use of electrical and magnetic stimulation of the brain and motor
nerves for testing of motor system is also included. Recordings of auditory,
somatosensory, and visual evoked potentials are described. The effect of different
pathologies on these sensory evoked potentials is discussed.

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Intraoperative Neurophysiologic Monitoring ACN & HCS 6373 Spring 2006


1. Generation of compound action potentials from a long nerve

A. Monopolar and bipolar recordings
B. Signs of pathology

2. Generation of near field evoked potentials from nuclei and fiber tracts.
A. Responses to transient stimuli
B. Responses to continuous stimuli

3. Generation of far field evoked potentials.

A. From a long nerve or fiber tract.
B. From nuclei.
C. The dipole concept.

4. The auditory nervous system

A. Anatomy of the ascending auditory pathway.
B. Generation of sound evoked potentials in the auditory nervous system
a. Near field potentials
b. Fairfield potentials
c. The brainstem auditory evoked potentials (BAEP).

5. The somatosensory nervous system.

A. Anatomy of the ascending somatosensory pathway.
B. Generation of evoked potentials from the somatosensory nervous system.
a. Near field potentials.
b. Fairfield evoked potentials.
c. The somatosensory evoked potentials (SSEP).

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Intraoperative Neurophysiologic Monitoring ACN & HCS 6373 Spring 2006

6. The visual nervous system

A. Anatomy of the visual pathway
B. Generation of visual evolved potentials.
a. Near field potentials.
b. Fairfield evoked potentials.
c. Visual evoked potentials (VEP).

7. The cranial nerves

A. Anatomy and physiology
B. Symptoms and signs of change in function of cranial nerves.

8. Recording far field sensory evoked potentials.

A. Signal averaging.
B. Filtering.
C. Recording parameters.
D. Identification of different components.
E. Labeling of components.

9. Intraoperative monitoring of motor nerves, especially cranial motor nerves.

A. The facial nerve
B. Other cranial motor nerves

10. Intraoperative recordings that can guide the surgeon in an operation.

A. Localization of specific neural tissue.
B, Hyperactive motor disorders.

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11. Interpretation of pathologic changes.

A. The value of changes in latency and amplitude.
B. Non-pathologic causes of changes.
C. Artifacts.
D. False positives and false negatives.

12. Practical aspect of doing electrophysiological recordings in the operating

A. Electrophysiological recordings in an electrical hostile environment.
B. Electrophysiological recordings in an anesthetized patient.
C. The need to obtain interpretable records in a short time.
D. What changes to report and what not to report?
E. Communication with the surgeon.
F. Relations with other members of the operating room team.


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