Efficiency and Safety of Intraoperative Neuromonitoring

During the last decades, intraoperative neurophysiological monitoring (IONM) has become an integral part of various surgical disciplines, especially in neurosurgery, but also in otolaryngology, orthopedics, vascular surgery, and general surgery, thereby realizing the concept of a functionally guided surgery. Due to methodological constraints, only limited data are available on the value of IONM from a medical and economic perspective. However, robust data exist confirming both a medical and an economic advantage of monitoring of the facial nerve in middle ear surgery and of cranial nerves VII and VIII during interventions in the cerebellopontine angle. In addition, there is some evidence of economic benefits of monitoring in scoliosis surgery and pedicle screw implantation. IONM normally improves safety, but like any medical procedure can inadvertently harm patients or medical staff. Consequently, this chapter reviews the potential hazards and describes means of protection against them in terms of electrical safety, procedure-specific safety, infection control, and essential performance. Readers should be able to apply these means of protection to maximize the safety of IONM.