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TitleNeural Monitoring [electronic resource] : The Prevention of Intraoperative Injury / edited by Steven K. Salzman
ImprintTotowa, NJ : Humana Press : Imprint: Humana Press, 1990
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Descript XIV, 322 p. online resource


The symposium from which this book originates represents a sigยญ nificant watershed in the field of intraoperative neural monitoring, since the participants concluded that electrophysiologic monitoring techniques should be considered a "standard of care" for surgical proยญ cedures that place the central nervous system (CNS) at risk for injury. Specifically, it was agreed that the somatosensory-evoked potential (SEP) is a remarkably reliable and sensitive indicator of several aspects of CNS function, and should be routinely employed as an intraoperaยญ tive monitor during many neurosurgical and orthopedic procedures. The significance of this conclusion cannot be overstated, for at the time of this writing, intraoperative monitoring methods based on evoked-potential analyses are still considered experimental and are not in routine use. The reasons for this are not clear, given the accuยญ mulation of literature and expertise on this subject over the past five years. Granted, the cost of electrophysiological monitoring equipยญ ment is high, but only initially. The benefits of injury prevention far outweigh these costs, from both medical and economic viewpoints. It is our sincere hope and goal that the medical community be made aware of the value of intraoperative neural monitoring


I. Basic Aspects of Evoked Neural Activity and Spinal Trauma -- Neural Substrates of Normal Somatosenory-Evoked Potentials -- Field Theory as it Pertains to SEP Analysis -- The Generators of the Human Spinal Somatosensory-Evoked Potentials -- Pathophysiology and Pharmacology of Experimental Spinal Cord Injury -- Neurochemical and Vascular Interactions in Experimental Spinal Cord Injury -- Pharmacological Treatment of Acute, Experimental Spinal Cord Injury -- Mechanism of Evoked Potential Responses to Injury -- Axonal Morphometric Correlates of Evoked Potentials in Experimental Spinal Cord Injury -- Neurophysiological Mechanisms of Somatosensory-Evoked Potential Changes -- II. Clinical Application of Electrophysiologic Methods for Intraoperative Neural Monitoring -- Established Methodsโ{128}{148}Clinical Experience with Somatosensory-Evoked Potentials -- Neural Monitoring During Orthopaedic Spine Surgery: Rationale and Case Studies -- Reliability of Cortical Somatosensory-Evoked Potentials in Monitoring (Pediatric Orthopedic) Spinal Procedures -- Invasive Somatosensory-Evoked Potential Monitoring -- The Non-Pathological Variability of Somatosensory-Evoked Potentials -- New Methodsโ{128}{148}Cerebrocortial and Spinal Motor Monitors -- Quantified EEG Detects Ischemia: A Case Report -- Motor Evoked Potentials -- Evoked-Potential Analysis of the Protective Effect of Halothane in Experimental Spinal Cord Injury -- Anesthetic Considerations in Spinal Surgery -- III. The Present and Future of Neural Monitoring and Operative Safety -- Clinical Review: Orthopedic Surgery -- Preventing and Detecting Intraoperative Spinal Cord Injury -- Conclusion

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