The use of evoked potentials in intraoperative neurophysiologic monitoring

Although not universally adopted, the growing body of literature provides strong evidence of the clinical utility of IOM in a variety of cerebrovascular surgical and endovascular procedures. The Therapeutics and Technology Subcommittee of the American Academy of Neurology and Fisher et al concluded that the following are useful and noninvestigational: 1. EEG, compressed spectral array, and SSEP in CEA and brain surgeries that potentially compromise cerebral blood flow, 2. BAEP and cranial nerve monitoring in surgeries performed in the region of the brainstem or inner ear, 3. SSEP monitoring performed for surgical procedures potentially involving ischemia or mechanical trauma of the spinal cord. They also came to the conclusion that although promising, motor EPs and visual EPs are still investigational. Further investigation, especially in the area of outcomes research and cost-effectiveness, is required before IOM can become standard practice.