Surgery involving the brain, spinal cord, or peripheral nerves often carries a significant risk of damage to neural structures that can cause new neurological deficits. Many of these can have devastating effects, including loss of sensation or paralysis. In an ongoing effort to avoid or minimize such damage, the last 30 years have seen the development and growth of a new professional field, intraoperative neurophysiological monitoring. Using state-of-the-art techniques to assess nervous system function during surgery, it is now possible to detect compromise of the nervous system in real time, allowing many potential problems to be reversed or avoided before it is too late and permanent damage has occurred.

Many of the techniques used in intraoperative monitoring are derived from similar tests routinely used in clinical diagnostic laboratories, which have been adapted for use in the operating room. Other techniques, such as transcranial motor evoked potentials (tcMEP) have been developed specifically to address issues which arise during surgery. In either case, application of these techniques in the electrically hostile and time-pressured environment of the OR requires specially trained personnel, with knowledge and experience in many fields, including neurophysiology, neuroanatomy, anesthesiology, and instrumentation, as well as an understanding of specific surgical procedures and the particular risks they entail.

There are as yet few formal training programs in intraoperative monitoring, and practitioners have typically migrated into this field from a variety of diverse backgrounds, including neurology, audiology, EEG technology, and neuroscience research. As a result, many find themselves with gaps in their knowledge, and may feel comfortable with some techniques but less confident in the application of others. This is often true of the new technique of tcMEP, which is rapidly evolving and involves the application of high currents and voltages in order to stimulate the brain through the intact scalp. It is now generally acknowledged that tcMEP represents a major advance in monitoring the function of the motor pathways of the brain and spinal cord, and has the potential for significantly reducing the incidence of post-operative paralysis.

Like any powerful tool, tcMEP monitoring is safest and most effective when used by appropriately trained professionals who have the knowledge to utilize the technique to its maximum effect. However, since the FDA has only recently (2002) approved devices for transcranial stimulation, many monitoring practitioners have not had the opportunity to gain this experience. An effective way to get started immediately in tcMEP monitoring is to engage my consulting services.