Electrophysiological recording (IONM) during neurosurgical, orthopedic, and vascular surgery are gradually becoming part of standard medical practice, mainly because it provides information regarding the functional integrity of the nervous system. The merits of IONM have been extensively reported in the literatures worldwide, in terms of its high sensitivity, specificity and prognostic value in surgical outcome.
Currently, multimodal methodology include monitoring of electroencephalogram (EEG)/ electrocorticography (ECoG), evoked potentials (EPs), electromyography (EMG), nerve conduction velocity (NCV), and spinal reflex are employed together in many types of major neurosurgical procedures. It serves to avert damage (e.g. ischaemia and mechanical injury) of neural tissues that are at risk during surgical maneuvers, and to identify specific neural structures and landmark (e.g. central sulcus mapping, motor & speech cortex mapping, cranial & spinal nerves functional mapping and integrity check etc). Continuous measurement of electrophysiological signal changes allows one to objectively assess, detect and quantify the variations of the functional integrity of neural structures over time. The real-time information also enables the assessment of efficacy of surgeon’s corrective effort upon the alert of potential damage and effectiveness of surgical intervention.
In Hong Kong, IONM programme has been developing in each neurosurgical centre since 1996. Staffing of the monitoring team usually include Neurosurgery Nurse Consultant (NC) or Advanced practice nurse (APN) with related training at local or overseas, and under supervision of reading surgeon during the course of monitoring. Most of the local practice guidelines are adopted from overseas professional Neurodiagnostic Society (e.g. the American Electroencephalographic Society, American Clinical Neurophysiology Society), in terms of monitoring technique, equipment, personnel competency, and documentation etc. In our review, the overall outcome of those critical neurosurgical procedures with IONM is comparable with the results from literatures.
The coming direction of our service will be the emphasis on advanced training, technology & skill update, research, and professional development of monitoring staff, as well as, extended applications covering wider variety of surgery.
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