Skip to main content

Advertisement

SpringerLink
Log in

Intraoperative Monitoring Using Somatosensory Evoked Potentials

A Position Statement by the American Society of Neurophysiological Monitoring

  • Published:
Journal of Clinical Monitoring and Computing Aims and scope Submit manuscript

Abstract

Objective: To provide an educational service to the intraoperative neurophysiologist community by publishing a position statement by the American Society of Neurophysiological Monitoring on the recommended appropriate and correct use of somatosensory evoked potentials as an intraoperative neurophysiological monitoring tool to protect patient well-being during surgery. This position statement presents the somatosensory evoked potential utilization basis, relevant anatomy, patient preparation, important systemic factors, anesthesia considerations, safety and technical considerations, documentation requirements, neurophysiologist credentials and staffing practice patterns, and monitoring applications for protecting brain, spinal nerve root, peripheral nerve, plexus and spinal cord function. In conclusion, a summary of major recommendations regarding the use of somatosensory evoked potentials in intraoperative neurophysiological monitoring is presented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Larson SJ, Sances A Jr. Evoked potentials in man: Neurosurgical applications. Am J Surg 1966; 111: 857–861.

    Article  PubMed  Google Scholar 

  2. McCallum JE, Bennett MH. Electrophysiologic monitoring of spinal cord function during intraspinal surgery. Surg Forum 1975; 26: 469–471.

    PubMed  Google Scholar 

  3. Nash CL, Long RA, Schatzinger LA, Brown RH. Spinal cord monitoring during operative treatment of the spine. Clin Orthop 1977; 126: 100–105.

    PubMed  Google Scholar 

  4. American Electroencephalographic Society Guidelines for Intraoperative Monitoring of Sensory Evoked Potentials. J Clin Neurophysiol 1987; 4: 397–416.

    Google Scholar 

  5. American Electroencephalographic Society Guidelines for Intraoperative Monitoring of Sensory Evoked Potentials. J Clin Neurophysiol 1994; 11: 77–87.

    Google Scholar 

  6. American Society of Electroneurodiagnostic Technologists (ASET). Position statement on electroneurodiagnostic technologists in the operating room, (1998).

  7. Erwin AC, Erwin CW. Intraoperative evoked potential monitoring – A historical perspective. Am J END Technol 2000; 40: 98–120.

    Google Scholar 

  8. International Organization of Societies for Electrophysiological Technology (OSET). Guidelines for performing EEG and evoked potential monitoring during surgery. Am J END Technol 1999; 39: 257–277.

    Google Scholar 

  9. Neuromonitoring during surgery. Report of an EFCN committee. Electroenceph Clin Neurophysiol 1993; 87: 263–276.

  10. Mahla ME, Long DM, McKennett J, Green C, McPherson RW. Detection of brachial plexus dysfunction by somatosensory evoked potential monitoring – A report of two cases. Anesthesiology 1982; 60: 248–252.

    Google Scholar 

  11. Nercessian OA, Gonzalez EG, Stinchfield FE. The use of somatosensory evoked potentials during revision or reoperation for total hip arthroplasty. Clin Orthop 1991; 262: 170–177.

    PubMed  Google Scholar 

  12. Pitman MI, Nainzadeh N, Ergas E, Springer S. The use of somatosensory evoked potentials for detection of neuropraxia during shoulder arthroscopy. Arthroscopy 1988; 4: 250–255.

    PubMed  Google Scholar 

  13. Porter SS, Black DJ, Reckling FW, Mason J. Intraoperative cortical somatosensory evoked potentials for detection of sciatic neuropathy during total hip arthroplasty. J Clin Anesth 1989; 1: 170–176.

    Article  PubMed  Google Scholar 

  14. Prielipp RC, Morell RC, Walker FO, Santos CC, Bennett J, Butterworth J. Ulnar nerve pressure. Anesthesiology 1999; 91: 345–354.

    Article  PubMed  Google Scholar 

  15. Jones SJ, Edgar MA, Ransford AO, Thomas NP. A system for electrophysiological monitoring of the spinal cord during operations for scoliosis. J Bone Joint Surg (Br) 1983; 65: 135–139.

    Google Scholar 

  16. Macon JB, Poletti CE. Conducted somatosensory and evoked potentials during spinal surgery. Part I: Control conduction velocity measurements. J Neurosurg 1982; 57(3): 349–353.

    PubMed  Google Scholar 

  17. Nuwer MR, Dawson E. Intraoperative evoked potential monitoring of the spinal cord: Enhanced stability of cortical recordings. Electroenceph Clin Neurophysiol 1984; 59: 318–324.

    Article  PubMed  Google Scholar 

  18. Hargadine JR, Snyder E. Brain stem somatosensory evoked potentials: application in the operating room and intensive care unit. Bull LA Neurol Soc 1982; 47: 62–75.

    Google Scholar 

  19. Friedman WA, Chadwick GM, Frank MA, Verhoeven JS, Mahla M, Day AL. Monitoring of somatosensory evoked potentials during surgery for middle cerebral artery aneurysms. Neurosurgery 1991; 29: 83–88.

    Article  PubMed  Google Scholar 

  20. Lam AM, Manninen PH, Ferguson GG, Nantau W. Monitoring electrophysiologic function during carotid endarterectomy: A comparison of somatosensory evoked potentials and conventional electroencephalogram. Anesthesiology 1991; 75: 15–21.

    PubMed  Google Scholar 

  21. Celesia GG. Somatosensory evoked potentials recorded directly from human thalamus and Sm I cortical area. Arch Neurol 1979; 36: 399–405.

    PubMed  Google Scholar 

  22. Kelly DL Jr, Goldring S, O'Leary JL. Averaged evoked somatosensory responses from exposed cortex of man. Arch Neurol 1965; 13: 1–9.

    PubMed  Google Scholar 

  23. Luders H, Lesser RP, Hahn J, Dinner DS, Klem G. Cortical somatosensory evoked potentials in response to hand stimulation. J Neurosurg 1983; 58: 885–894.

    PubMed  Google Scholar 

  24. Cohen AR, Young W, Ransohoff J. Intraspinal localization of the somatosensory evoked potential. Neurosurgery 1981; 9: 157–162.

    PubMed  Google Scholar 

  25. Cusick JF, Myklebust JF, Larson SJ, Sances A Jr. Spinal evoked potentials in the primate: neural substrate. J Neurosurg 1978; 49: 551–557.

    PubMed  Google Scholar 

  26. Larson SJ, Sances A Jr, Christenson PC. Evoked somatosensory potentials in man. Arch Neurol 1966; 15: 88–93.

    PubMed  Google Scholar 

  27. Macon JB, Poletti CE, Sweet WH, Ojemann RG, Zervas NT. Conducted somatosensory evoked potentials during spinal surgery. Part 2: Clinical applications. J Neurosurg 1982; 57(3): 354–359.

    PubMed  Google Scholar 

  28. Jones SJ, Edgar MA, Ransford AO. Sensory nerve conduction in the human spinal cord: Epidural recordings made during spinal cord surgery. J Neurol Neurosurg Psychiatry 1982; 45: 446–452.

    PubMed  Google Scholar 

  29. York DH. Somatosensory evoked potentials in man: Differentiation of spinal pathways responsible for conduction from the forelimb vs hindlimb. Prog Neurobiol 1985; 25: 1–25.

    Article  PubMed  Google Scholar 

  30. Powers SK, Bolger CA, Edwards MSB. Spinal cord pathways mediating somatosensory evoked potentials. J Neurosurg 1982; 57: 472–482.

    PubMed  Google Scholar 

  31. Simpson RK Jr, Blackburn JG, Martin HF III, Katz S. Peripheral nerve fibers and spinal cord pathway contribution to the somatosensory evoked potentials. Exp Neurol 1981; 73: 700–715.

    Article  PubMed  Google Scholar 

  32. Zornow MH, Grafe MR, Tybor C, Swenson MR. Preservation of evoked potentials in a case of anterior spinal artery syndrome. Electroenceph Clin Neurophysiol 1990; 77: 137–139.

    Article  PubMed  Google Scholar 

  33. Branston NM, Symon L. Cortical EP, blood flow, and potassium changes in experimental ischemia. In: Barber C (ed.) Evoked potentials. Baltimore: University Park Press, 1980: 527–530.

    Google Scholar 

  34. Nuwer MR. Intraoperative electroencephalography. J Clin Neurophysiol 1993; 10: 437–444.

    PubMed  Google Scholar 

  35. Prior PF. EEG monitoring and evoked potentials in brain ischemia. Br J Anaesth 1985; 57: 63–81.

    PubMed  Google Scholar 

  36. Owen JH, Toleikis JR. Nerve root monitoring. In: Bridwell KH and DeWald RH. The textbook of spinal surgery, 2nd edition. Philadelphia: Lippincott-Raven Publishers, 1997: 61–75.

    Google Scholar 

  37. Toleikis JR, Carlvin AO, Shapiro DE, Schafer MF. The use of dermatomal evoked responses during surgical procedures that use intrapedicular fixation of the lumbosacral spine. Spine 1993; 18: 2401–2407.

    PubMed  Google Scholar 

  38. Stecker MM. Generalized averaging and noise levels in evoked responses. Comput Biol Med 2000; 30: 247–265.

    Article  PubMed  Google Scholar 

  39. Nuwer, MR. Evoked potential monitoring in the operating room. New York: Raven Press, 1986.

    Google Scholar 

  40. Sonoo M. Anatomic origin and clinical application of the widespread Nl8 potential in median nerve somatosensory evoked potentials. J Clin Neurophysiol 2000; 17: 258–268.

    Article  PubMed  Google Scholar 

  41. Mauguiere F. Anatomic origin of the cervical N13 potential evoked by upper extremity stimulation. J Clin Neurophysiol 2000; 17: 236–245.

    Article  PubMed  Google Scholar 

  42. Nuwer MR, et al. IFCN recommended standards for short latency somatosensory evoked potentials. Report of an IFCN committee. Electroenceph Clin Neurophysiol 1994; 91: 6–11.

    Article  PubMed  Google Scholar 

  43. Restuccia D. Anatomic origin of P13 and P14 scalp far-field potentials. J Clin Neurophysiol 2000; 17: 246–257.

    Article  PubMed  Google Scholar 

  44. Yamada T. Neuroanatomic substrates of lower extremity somatosensory evoked potentials. J Clin Neurophysiol 2000; 17: 269–279.

    Article  PubMed  Google Scholar 

  45. Angel A, Gratton DA. The effect of anaesthetic agents on cerebral cortical responses in the rat. Br J Pharmacol 1982; 76: 541–549.

    PubMed  Google Scholar 

  46. Sloan TB. Anesthetic effects on electrophysiologic recordings. J Clin Neurophysiol 1998; 15: 217–226.

    Article  PubMed  Google Scholar 

  47. Sloan TB. Evoked potentials. In: Albin MA (ed.) Textbook of neuroanesthesia with neurosurgical and neuroscience perspectives. New York: McGraw-Hill, 1997: 221–276.

    Google Scholar 

  48. Schubert A, Licina MG, Lineberry PJ. The effect of ketamine on human somatosensory evoked potentials and its modification by nitrous oxide. Anesthesiology 1990; 72: 33–39.

    PubMed  Google Scholar 

  49. Kalkman CJ, Drummond JC, Patel PM. Effects of droperidol, pentobarbital, and ketamine on myogenic transcranial magnetic motor-evoked responses in humans. Neurosurgery 1994; 35: 1066–1071.

    PubMed  Google Scholar 

  50. Sloan TB, Fugina ML, Toleikis JR. Effects of midazolam on median nerve somatosensory evoked potentials. Br J Anaesth 1990; 64: 590–593.

    PubMed  Google Scholar 

  51. Kochs E, Treede RD, Schulte am Esch J. Increase of somatosensory evoked potentials during induction of anesthesia with etomidate. Anaesthetist 1986; 35: 359–364.

    Google Scholar 

  52. Sloan TB, Ronai AK, Toleikis JR, Koht A. Improvement of intraoperative somatosensory evoked potentials by etomidate. Anesth Analg 1988; 67: 582.

    PubMed  Google Scholar 

  53. Stecker MM, Cheung AT, Pochettino A, Kent G, Patterson T, Weiss SJ, Bavaria JE. Deep hypothermic circulatory arrest: I. Effects of cooling on electroencephalogram and evoked potentials. Ann Thorac Surg 2001; 71(1): 22–28.

    Article  PubMed  Google Scholar 

  54. American Board of Registration of Electroencephalographic and Evoked Potential Technologists (ABRET®). Code of ethics, rules, policies and procedures, and standards of practice, 1996.

  55. Brown RH, Nash CL, Berilla JA, Amaddio MD. Cortical evoked potential monitoring. A system for intraoperative monitoring of spinal cord function. Spine 1984; 9: 256–261.

    PubMed  Google Scholar 

  56. York DH, Chabot RJ, Gaines RW. Response variability of somatosensory evoked potentials during scoliosis surgery. Spine 1987; 12: 864–876.

    PubMed  Google Scholar 

  57. More RC, Nuwer MR, Dawson EG. Cortical evoked potential monitoring during spinal surgery: sensitivity, specificity, reliability, and criteria for alarm. J Spinal Disord 1988; 1(1): 75–80.

    PubMed  Google Scholar 

  58. Wiedemayer H, Fauser B, Sandalcioglu IE, Schafer H, Stolke D. The impact of neurophysiological intraoperative monitoring on surgical decisions: A critical analysis of 423 cases. J Neurosurg 2002; 96: 255–262.

    PubMed  Google Scholar 

  59. Sedgwick EM, Katifi HA, Docherty TB, Nicpon K. Dermatomal somatosensory evoked potentials in lumbar disc disease. In: Morocutti G and Rizzo PA (eds.) Evoked potentials. Neurophysiological and clinical aspects. Amsterdam-New York-Oxford: Elsevier Science Publishers B.V. (Biomedical Division), 1985: 77–88.

    Google Scholar 

  60. Toleikis JR, Skelly JP, Carlvin AO, Toleikis SC, Bernard TN, Burkus JK, Burr ME, Dorchak JD, Goldman MS, Walsh TR. The usefulness of electrical stimulation for assessing pedicle screw placements. J Spinal Disord 2000; 13: 283–289.

    Article  PubMed  Google Scholar 

  61. Apel DM, Marrero G, King J, Tolo VT, Bassett GS. Avoiding paraplegia during anterior spinal surgery: The role of somatosensory evoked potential monitoring with temporary occlusion of segmental spinal arteries. Spine 1991; 16: S365–S370.

    PubMed  Google Scholar 

  62. Coles JG, Wilson GJ, Sima AF, Klement P, Tait GA. Intraoperative detection of spinal cord ischemia using somatosensory cortical evoked potentials during thoracic aortic occlusion. Ann Thor Surg 1982; 34: 299–306.

    Google Scholar 

  63. Deletis V, Engler GL. Somatosensory evoked potentials for spinal cord monitoring. In: Bridwell KH and DeWald RL (eds.) The textbook of spinal surgery. Philadelphia: Lippincott-Raven, 1997: 85–92.

    Google Scholar 

  64. Dennis GC, Dehkordi O, Millis RM, Cole AN, Brown DS, Paul OA. Monitoring of median nerve somatosensory evoked potentials during cervical spinal cord decompression. J ClinNeurophysiol 1996; 13: 51–59.

    Google Scholar 

  65. Dinner DS, Luders H, Lesser RP, Morris HH, Barnett G, Klem G. Intraoperative spinal somatosensory evoked potential monitoring. JNeurosurg 1986; 65: 807–814.

    Google Scholar 

  66. Guerit J, Witdoeckt C, Rubay J, Matta A, Dion R. The usefulness of the spinal and subcortical components of the poster-ior tibial nerve SEPs for spinal cord monitoring during aortic coarctation repair. Electroenceph Clin Neurophysiol 1997; 104: 115–121.

    Article  PubMed  Google Scholar 

  67. Nuwer MR, Dawson EG, Carlson LG, Kanim LEA, Sherman JE. Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: Results of a large multicenter survey. Electroenceph Clin Neurophysiol 1995; 96:6–11.

    Article  PubMed  Google Scholar 

  68. Robinson LR, Slimp JC, Anderson PA, Stolov WC. The efficacy of femoral nerve intraoperative somatosensory evoked potentials during surgical treatment of thoracolumbar fractures. Spine 1993; 18: 1793–1797.

    PubMed  Google Scholar 

  69. Schramm J. Spinal cord monitoring: Current status and new developments. Central Nervous System Trauma 1985; 2: 207–227.

    PubMed  Google Scholar 

  70. Spielholz NI, Benjamin MV, Engler GL, Ransohoff J. Somatosensory evoked potentials during decompression and stabilization of the spine, methods and findings. Spine 1979; 4: 500–505.

    PubMed  Google Scholar 

  71. Spielholz NI. Intraoperative monitoring using somato-sensory evoked potentials: A brief overview. Electromyogr Clin Neurophysiol 1994; 34: 29–34.

    PubMed  Google Scholar 

  72. Young W, Mollin D. Intraoperative somatosensory evoked potential monitoring of spinal surgery. In: Desmedt JE (ed.) Neuromonitoring in surgery. Amsterdam-New York-Oxford: Elsevier Science Publishers, B.V. (Biomedical Division), 1989: 165–173.

    Google Scholar 

  73. Cheek JC. Posterior fossa intraoperative monitoring. J Clin Neurophysiol 1993; 10: 412–424.

    PubMed  Google Scholar 

  74. Shima F, Morioka T, Tobimatsu S, Kavaklis O, Kato M, Fukui M. Localization of stereotactic targets by microrecording of thalamic somatosensory evoked potentials. Neurosurgery 1991; 28: 223–230.

    Article  PubMed  Google Scholar 

  75. Carter LP, Raudzens PA, Gaines C, Crowell RM. Somatosensory evoked potentials and cortical blood flow during craniotomy for vascular disease. Neurosurgery 1984; 15: 22–28.

    PubMed  Google Scholar 

  76. Djuric S, Milenkovic Z, Klopcic-Spevak M, Spasic M. Somatosensory evoked potential monitoring during intracranial surgery. Acta Neurochir 1992; 119: 85–90.

    Article  Google Scholar 

  77. Friedman WA, Kaplan BL, Day AL, Sypert GW, Curran MT. Evoked potential monitoring during aneurysm operation: Observations after fifty cases. Neurosurgery 1987; 20: 678–687.

    PubMed  Google Scholar 

  78. Grundy BL, Nelson PB, Lina A, Heros RC. Monitoring of cortical somatosensory evoked potentials to determine the safety of sacrificing the anterior cerebral artery. Neurosurgery 1982; 11: 64–67.

    PubMed  Google Scholar 

  79. Jacobs LA, Brinkman SD, Morrell RM, Shirley JG, Ganji S. Long-latency somatosensory evoked potentials during carotid endarterectomy. Amer Surg 1983; 49: 338–344.

    Google Scholar 

  80. Schramm J. Intraoperative monitoring with evoked potentials in cerebral vascular surgery and posterior fossa surgery. In: Desmedt JE (ed.) Neuromonitoring in surgery. Amsterdam-New York-Oxford: Elsevier Science Publishers B.V. (Biomedical Division), 1989: 243–262.

    Google Scholar 

  81. Schramm J, Koht A, Schmidt G, Pechstein U, Taniguchi M, Fahlbusch R. Surgical and electrophysiological observations during clipping of 134 aneurysms with evoked potential monitoring. Neurosurgery 1990; 26: 61–70.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Associate Professor and Co-Director, IONM, Department of Anesthesiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois

    J. Richard Toleikis Ph.D., D.ABNM (Committee Chairman)

Authors
  1. J. Richard Toleikis Ph.D., D.ABNM
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Richard Toleikis Ph.D., D.ABNM.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Toleikis, J.R. Intraoperative Monitoring Using Somatosensory Evoked Potentials. J Clin Monit Comput 19, 241–258 (2005). https://doi.org/10.1007/s10877-005-4397-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10877-005-4397-0

Key Words

Search

Navigation