Author/Editor		Sala, F; Kržan, MJ; Deletis, V
Title		Intraoperative neurophysiological monitoring in pediatric neurosurgery: why, when, how?
Type		članek
Source		Childs Nerv Syst
Vol. and No.		Letnik 18, št. 6-7
Publication year		2002
Volume		str. 264-87
Language		eng
Summary		Intruduction. This review is primarily based on peer-reviewed scientific publications and on the authors' experience in the field of intraoperative neurophysiology. The purpose is a critical analysis of the role of intraoperative neurophysiological monitoring (INM) during various neurosurgical procedures, emphasizing the aspects that mainly concern the pediatric population. Original papers related to the field of intraoperative neurophysiology were collected using medline. INM consists in monitoring (continuous "on-line" assessment of the functional integrity of neural pathways) and mapping (functional identification and preservation of anatomically ambiguous nervous tissue) techniques. We attempted to delineate indications for intraoperative neurophysiological techniques according to their feasibility and reliability (specificity and sensitivity).Discussion / conclusions. In compiling this review, controversies about indications, methodologies and the usefulness of some INM techniques have surfaced. These discrepancies are often due to lack of familiarity with new techniques in groups from around the globe. Accordingly, internationally accepted guidelines for INM are still far from being established. Nevertheless, the studies reviewed provide sufficient evidence to enable us to make the following recommendations. (1) INM is mandatory whenever neurological complications are expected on the basis of a known pathophysiological mechanism. INM becomes optional when its role is limited to predicting postoperative outcome or it is used for purely research purposes. (2) INM should always be performed when any of the following are involved: supratentorial lesions in the central region and language-related cortex; brain stem tumors; intramedullary spinal cord tumors; conus-cauda equina tumors; rhizotomy for relief of spasticity; spina bifida with tethered cord. (Abstract truncated at 2000 characters).
Descriptors		MONITORING, PHYSIOLOGIC INTRAOPERATIVE PERIOD NEUROSURGERY CHILD TIME FACTORS BRAIN MAPPING ELECTRIC STIMULATION EVOKED POTENTIALS, MOTOR EVOKED POTENTIALS, SOMATOSENSORY