Misconceptions in IONM Part I: Interleaved Intraoperative Somatosensory Evoked Potential Stimulation

Area of Science:

• Neuroscience
• Clinical Neurophysiology

Background:

• Intraoperative neurophysiological monitoring (IONM) is crucial for preventing neurological damage during surgery.
• Somatosensory evoked potentials (SSEPs) are a key modality within IONM.
• Current practices in SSEP stimulation may not fully leverage advanced techniques.

Purpose of the Study:

• To address misconceptions hindering the adoption of continuous, multi-nerve, interleaved SSEP stimulation.
• To elucidate the advantages of this specific SSEP stimulation paradigm.
• To advocate for the broader utilization of superior IONM techniques.

Main Methods:

• Review and analysis of existing literature and clinical practices regarding SSEP stimulation.
• Comparative assessment of different SSEP stimulation paradigms.
• Identification and explanation of misunderstandings related to continuous, multi-nerve, interleaved SSEP stimulation.

Main Results:

• Continuous, multi-nerve, interleaved SSEP stimulation is demonstrably superior in most surgical scenarios.
• This method enables the fastest acquisition of SSEPs.
• It achieves this at low stimulation repetition rates, which are associated with the highest amplitude cortical responses.

Conclusions:

• Misconceptions are the primary barrier to the universal adoption of continuous, multi-nerve, interleaved SSEP stimulation.
• This stimulation technique offers significant advantages in speed and response amplitude for IONM.
• Clinicians should reconsider and adopt this superior SSEP stimulation paradigm for enhanced patient safety.