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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.
Needle EMG may aid with the diagnosis of nerve compression or injury (such as carpal tunnel syndrome), nerve root injury (such as sciatica), and with other problems of the muscles or nerves. Less common medical conditions include amyotrophic lateral sclerosis , myasthenia gravis , and muscular dystrophy .
Electroneuronography or electroneurography (ENoG) is a neurological non-invasive test used to study the facial nerve in cases of muscle weakness in one side of the face (Bell's palsy). The technique of electroneuronography was first used by Esslen and Fisch in 1979 to describe a technique that examines the integrity and conductivity of ...
That is, the nerve is no longer able to send electrochemical impulses, and hence does not send signals to the brain or from the brain to muscles. There may also be demyelination (loss of the nerve's myelin sheath) and degeneration of the nerve in the affected area but it does not effect axons beyond this site. [citation needed]
The compression of the median nerve within the carpal canal of the wrist and the progression of symptoms resulting from this entrapment is known as carpal tunnel syndrome (CTS). Nerve conduction studies have been used as a control electrophysiological method in the development of better CTS diagnostic techniques. [9]
Electromyoneurography is a technique that uses surface electrical probes to obtain electrophysiological readings from nerve and muscle cells. The nerve activity is generally recorded using surface electrodes, stimulating the nerve at one site and recording from another with a minimum distance between the two.
Electrodiagnostic medicine traces its origin back to a 1791 experiment by Luigi Galvani. Galvani depolarized frog leg muscles by using metal rods to make contact with the leg muscles. The development of the oscilloscope in 1897 significantly enhanced the ability of scientists to record signals from nerve and muscle. However, it was the needs of ...
Various nerve stimulation patterns may be used in neuromuscular function monitoring and the response to these stimulation patterns is used to assess the depth of neuromuscular blockade. Some patterns of stimulation used today include, single twitch (ST), train-of four (TOF), [11] double burst stimulation (DBS), tetanic stimulation