par Pandin, Pierre 
;Parvais, Maëlle ;Estruch-Pons, Isabel
Référence Peri-operative Brain Monitoring, Springer Science+Business Media, page (113-173)
Publication Publié, 2025-01
;Parvais, Maëlle ;Estruch-Pons, IsabelRéférence Peri-operative Brain Monitoring, Springer Science+Business Media, page (113-173)
Publication Publié, 2025-01
Partie d'ouvrage collectif
| Résumé : | The modalities of modern intraoperative neuromonitoring (IONM) are reviewed here one by one, concerning evoked potentials on the one hand and electromyography on the other. Unlike most other brain function monitoring modalities, which focus essentially on the brain and how it functions, these two electrophysiological modalities allow the nervous system to be investigated, from the cerebral cortex to the most peripheral endings, including even the neuromuscular junction. The neurophysiological approach of these two modalities is focused on the ‘neurological’ aspect (monitoring a neurological function) and relatively little on the ‘pharmacological’ aspect (dosage, evaluation of the effect of drugs such as anaesthetic molecules). Evoked potentials and electromyograms provide information about the state of functioning (essentially neuronal transmission) of the nervous system at a given moment or during a particular period, such as the intraoperative period. In the case of evoked potentials, the aim is to investigate one specific nerve function each time, such as vision, hearing, somatosensory transmission (centripetal, from the periphery to the cerebral cortex) and motor function (centrifugal, from the cortex to the periphery). The electromyogram also analyses motor function but focuses on a particular area more closely related to a pathological nervous system component. All these modalities approached separately, are then considered together in particular combinations to each other in the context of multimodality, i.e. combining evoked potentials and the electromyogram in the most optimal way possible concerning the neurosurgical, orthopaedic, ophthalmic, ENT, or vascular pathology to be treated. The general principles of intraoperative neuromonitoring are explained in the surgical context of the operating theatre. The effects and potential interactions of general anaesthesia and the most exhaustive possible set of molecules that may constitute it are reviewed considering the most recent literature. Finally, the probably essential element of intraoperative neuromonitoring, i.e. the multidisciplinary nature of the team (neurologist, anaesthetist, surgeon) during the operation, is described in all its most practical aspects, mainly when the monitoring detects an intraoperative complication. An optimised approach and management method are suggested. |
