Syllabus Intraoperative monitoring part II, 2008

SYLLABUS

HCS 6374 12370 ACN 6374 12293 INTRAOPERATIVE MONITORING

PART II

FALL 2008

Instructor: Aage R. Møller Ph.D.

E-mail: AMOLLER@UTDALLAS.EDU

Class room: GR4.301

Friday 2:30-5:30PM
August 25, 2008

Class text: Aage R. Møller: Intraoperative Neurophysiologic Monitoring.

Second Edition, Humana Press, 2006 ISBN 1-58829-703-9
Note: This book will be provided by the Instructor to a discounted price

Supplementary readings:

Brodal P. The Central Nervous System 3nd ed

New York, Oxford University Press, 2004 ISBN 0-19-516560-8

Grading:
1. Midterm Exam October 10: Covers the first section to October 1st
2. Final Exam November 28
Results of midterm and final exam will count equally to the final grade.

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Syllabus Intraoperative monitoring part II, 2008

Course purpose: The purpose of this class is to further develop the

understanding of the anatomical and functional basis for Intraoperative
neurophysiological monitoring of the peripheral and central nervous system. The
course will provide understanding of the special techniques that are used in the
operating room for intraoperative monitoring. The course will include reading
assignments from a book.

General objectives:

Students will:
1. Understand the anatomical and physiological basis for monitoring the
integrity of nerves and the central nervous system during surgical manipulations
2. Understand the anatomical and physiological basis for pathologies of
peripheral nerves.
3. Understand how to detect changes in function that are signs of injuries.
4. Specifically understand the organization of normal motor system.
5. Understand how to monitor the motor system in operations of the spinal
cord.
6. Understand the normal function of cranial nerves and their disorders.
7. Specifically understand how to monitor the function of cranial nerves during
operations of the skull base.

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. This course is part II of 2 courses the
anatomical and physiological basis for Intraoperative neurophysiologic monitoring. It
covers techniques for recordings of electrical potentials from the nervous system and
from muscles that can provide information about the function of sensory and motor
systems. Interpretation of such recordings requires knowledge about the physiology

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Syllabus Intraoperative monitoring part II, 2008

and anatomy of the systems involved, and how the recorded electrical potentials
change as a result of injuries.
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.
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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Syllabus Intraoperative monitoring part II, 2008

OUTLINE

History of neurophysiological monitoring

Review of the principles for generation of nearfield and farfield evoked
potentials from nerves and nuclei and monitoring of sensory systems.
Monitoring of cranial nerves
a. Anatomy and physiology
b. Symptoms and signs of change in function of cranial nerves.
c. Tumors of the cochlear-vestibular nerve
Monitoring of motor systems
a. Anatomy of spinal and cranial motor systems
b. Physiology of motor control
c. Spinal and cranial nerve reflexes
Intraoperative monitoring of spinal motor system
a. Stimulation of motor cortex
Electrical stimulation
Magnetic stimulation
Importance of descending facilitatory input to
motoneurons
b. Recording techniques
Electromyographic recordings
Recordings from the spinal cord
Recordings from motor nerves
c. Effect of anesthesia

Intraoperative recordings that can guide the surgeon in an operation.

a. Localization of specific neural tissue.
b Hyperactive motor disorders.
Guidance for implantation of thalamic electrodes (deep brain stimulation)

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Syllabus Intraoperative monitoring part II, 2008

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.

Techniques of stimulation and recording

a. Recording farfield sensory evoked potentials.
Signal averaging.
Filtering.
Recording parameters.
Electrophysiologic recordings in an electrical hostile environment. Practical
aspect of doing electrophysiologic recordings in the operating room.
a. Electrophysiologic recordings in anesthetized patients.
b. The need to obtain interpretable records in a short time.
c. What changes to report and what not to report?
d. Communication with the surgeon.
e. Relations with other members of the operating room team.
f. Writing the final report
g. Legal aspects of intraoperative monitoring
7/24/08

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