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Intraoperative Neurophysiologic Monitoring During Surgery for Supratentorial Mass Lesions

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Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals

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Abstract

The resection of supratentorial mass lesions is associated with considerable functional morbidity, particularly when the lesions are located near blood vessels or near the eloquent cortices (e.g., motor cortex). New paresis is of particular concern due to the extended course of the motor system in the brain and the lack of clearly identifiable primary corticospinal pathways. New functional deficits during tumor resections are frequently caused by ischemic insult rather than mechanical injuries of the fiber tracts. Therefore, motor preservation requires both mapping of the motor cortex (cortical stimulation, somatosensory evoked potential [SSEP] phase reversal) and continuous monitoring by motor evoked potential (MEP) recordings, which can be performed with the patient under general anesthesia. Other functions such as language, vision, and somatosensory perception may be mapped and monitored in awake procedures or by other neurophysiologic and imaging methods. Stable MEP recordings allow for safe completion of surgery whereas deterioration due to surgical causes should lead to early surgical intervention. Restoration of the MEP signals may prevent the occurrence of permanent new deficits.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital, RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany

    Georg Neuloh M.D.

  2. Departments of Anesthesiology, Neurological Surgery and Neurology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, F-5-704, Chicago, IL, 60611, USA

    Antoun Koht M.D.

  3. Department of Neurological Surgery, Northwestern Memorial Hospital, 676 North Saint Clair Street, Suite 2210, Chicago, IL, 60611, USA

    Matthew C. Tate M.D., Ph.D.

Authors
  1. Georg Neuloh M.D.
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  2. Antoun Koht M.D.
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  3. Matthew C. Tate M.D., Ph.D.
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Correspondence to Georg Neuloh M.D. .

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Editors and Affiliations

  1. Departments of Anesthesiology, Neurological Surgery and Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Antoun Koht

  2. Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA

    Tod B. Sloan

  3. Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA

    J. Richard Toleikis

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Neuloh, G., Koht, A., Tate, M.C. (2017). Intraoperative Neurophysiologic Monitoring During Surgery for Supratentorial Mass Lesions. In: Koht, A., Sloan, T., Toleikis, J. (eds) Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals. Springer, Cham. https://doi.org/10.1007/978-3-319-46542-5_23

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  • DOI: https://doi.org/10.1007/978-3-319-46542-5_23

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  • Online ISBN: 978-3-319-46542-5

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