SYLLABUS

SPRING 2005

HCS 6373-001 INTRAOPERATIVE MONITORING PART I

Instructor: Aage R. Moller PhD

E-mail: AMOLLER@UTDALLAS.EDU

Thursday 9:30AM -12:15PM

Location:
To be announced

Recordings of various 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

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nervous system. The course provides the basis for interpretation of such
potentials when used in the clinic and in the operating room
The course includes basic 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.
Recordings of auditory, somatosensory, evoked potentials are
described. The effect of different pathologies on these sensory evoked
potentials is discussed.

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 OUTLINE

1. General about the use of neuroelectric potentials in

intraoperative monitoring and in diagnosis of disorders of the nervous
system.

2. Generation of nearfield evoked potentials.

A. From a long nerve.
B. From nuclei.
C. Monopolar and bipolar recordings.

3. Generation of farfield evoked potentials.

A. From a long nerve or fiber tract.
B. From nuclei.
C. The dipole concept.

4. 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).

5. 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.

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c. The somatosensory evoked potentials (SSEP).

6. Interpretation of pathologic changes in evoked potentials.

A. Changes in latency and amplitude.
B. Non-pathologic causes of changes.
C. Artifacts.
D. False positives and false negatives.

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

8. Intraoperative monitoring of cranial motor nerves.

A. The facial nerve
B. Other cranial motor nerves

9. Techniques of recording farfield sensory evoked potentials.

A. Signal averaging.
B. Filtering.
C. Recording parameters.
D. Identification of different components.

10. 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. Preparation of final report

Required book:

Aage R. Moller: Intraoperative Neurophysiologic Monitoring.

Harwood Academic Publishers, Luxembourg, 1995.
ISBN 3-7186-0593-7

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 Note: This book will be provided by the Instructor to a
discounted price

Handouts will be provided.

11/30/04