SYLLABUS

COURSE: HCS 6374 INTRAOPERATIVE MONITORING

PART II SPRING 2005

Instructor: Aage R. Moller Ph.D.

E-mail: AMOLLER@UTDALLAS.EDU

Location: CALLIER SOUTH

J204
Tuesday, 9:30AM-12:15PM

Recordings of electrical potentials from the nervous system and

from muscles can provide information about the function of sensory
and motor systems and such tests are important for clinical diagnosis
and for intraoperative monitoring. 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. Interpretation of such
recordings requires knowledge about the physiology and anatomy of
the systems involved, and how the recorded electrical potentials
change as a result of injuries.
The aim of the course is to provide the anatomical and
physiological basis for the use of electrophysiologic techniques in
intraoperative neurophysiologic monitoring and in diagnosis of
disorders affecting the nervous system. The course provides the basis
for interpretation of such potentials when used in the clinic and in the
operating room

1
 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.

OUTLINE

1. Review of the principles for generation of nearfield and

farfield evoked potentials from nerves and nuclei.

2. The auditory nervous system

A. Anatomy of the ascending auditory pathway.
B. Generation of sound evoked potentials in the auditory
nervous system
a. Near field potentials
b. Farfield potentials
c. The brainstem auditory evoked potentials (BAEP).

2
 3. The somatosensory nervous system.
A. Anatomy of the ascending somatosensory pathway.
B. Generation of evoked potentials from the somatosensory
nervous system.
a. Nearfield potentials.
b. Farfield evoked potentials.
c. Somatosensory evoked potentials (SSEP).
d.
4. The motor nervous system
A. Anatomy of spinal and cranial motor systems
B. Physiology of motor control
C. Spinal and cranial nerve reflexes

5. The visual nervous system

A. Anatomy of the visual pathway
B. Generation of visual evolved potentials.
a. Nearfield potentials.
b. Farfield evoked potentials.
c. Visual evoked potentials (VEP).

6. The cranial nerves

A. Anatomy and physiology
B. Symptoms and signs of change in function of cranial nerves.

7. Recording farfield sensory evoked potentials.

1. Signal averaging.
2. Filtering.
3. Recording parameters.
4. Identification of different components.
5. Labeling of components.

3
 8. Intraoperative monitoring of spinal motor system
A. Stimulation of motor cortex
a. Electrical stimulation
b. Magnetic stimulation
c. Importance of descending facilitatory input to motoneurons
B. Recording techniques
a. Electromyographic recordings
b. Recordings from the spinal cord
c. Recordings from motor nerves
C. Effect of anesthesia

9. Monitoring of cranial motor nerves

A. The facial nerve
B. Other cranial motor nerves

6. Intraoperative recordings that can guide the surgeon in an

operation.
A. Localization of specific neural tissue.
7. B, Hyperactive motor disorders.
a. Guidance for implantation of thalamic electrodes (deep
brain stimulation)

10. 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.

4
 11. Practical aspect of doing electrophysiologic
recordings in the operating room.
A. Electrophysiologic recordings in an electrical hostile
environment.
B. Electrophysiologic recordings in an anesthetized patients.
C. The need to obtain interpretable records in a short time.
D. What changes to report and what not to report?
E. Communication with the surgeon.
F. Relations with other members of the operating room team.
G. Writing the final report

Required book:

Aage R. Møller: Intraoperative Neurophysiologic Monitoring.

Harwood Academic Publishers, Luxembourg, 1995.
Note: This book will be provided by the Instructor to a
discounted price

Handouts will be provided.

1/13/05