Neuromonitoring

Neuromonitoring is the collection and interpretation of techniques that assess the functional integrity of the nervous system and brain physiology in real time or near real time. It is used in neurosurgery, anesthesiology, and critical care to detect early signs of neural injury, guide treatment, and improve patient safety.

Intraoperative neuromonitoring, or IONM, uses electrophysiological signals to monitor motor and sensory pathways during procedures that place neural structures at risk. Common modalities include somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), electromyography of specific muscles, and continuous electroencephalography (EEG). These data help surgeons and anesthesiologists respond to impending injury such as compromised blood flow or traction on neural tissue.

Noninvasive monitoring outside the operating room includes EEG for detecting seizures or assessing depth of anesthesia, transcranial Doppler to estimate cerebral blood flow velocity, and near-infrared spectroscopy to track regional brain oxygenation. In critical care, monitoring may also include intracranial pressure, brain tissue oxygen tension, and metabolic indicators to guide management of cerebral perfusion and metabolism.

Interpretation of neuromonitoring data requires trained personnel. Artifacts from movement, electrical interference, or hemodynamic changes can confound results. Findings must be integrated with the clinical context, imaging findings, and other data. Limitations include potential false positives or negatives and the need for baseline measurements and ongoing expertise.

Overall, neuromonitoring aims to preserve neural function by providing timely information to clinicians during high-risk procedures and in critically ill patients.