Neuromonitoring in Surgery. Clinical Neurophysiology Updates, Volume 1. J. E. Desmedt (Editor). Elsevier, Amsterdam, 1989. Pages: 377. Price: $168.
During the last 12 years, there has been increasing interest in presurgical and surgical monitoring of the sensory and motor functions of the peripheral and central nervous system pathways, with the hope that by identifying functional abnormalities, irreversible damage to the brain or spinal cord can be avoided. Neuromonitoring in Surgery is a compilation of recent experiences from major medical centers throughout the world where these techniques are used for both routine and investigative procedures during neurosurgery, orthopedic surgery, neuroradiologi-cal-vascular manipulative procedures, and evaluations by specialists in epilepsy. The editor, J. E. Desmedt, wrote the first of the 20 chapters. In it, he provides comprehensive information about the origins of various somatosensory-evoked potentials and the most appropriate methods for monitoring them. Similarly, in the second chapter, H. Sohmer thoroughly discusses the basic concepts and practical methods for monitoring auditory nerve and brain stem auditory responses. All the authors in the succeeding chapters provide detailed information about neuromonitoring methods, including variables of instrumentation settings and stimulating/recording electrode positions (and a variety of hardware), to assist those who may wish to expand their approaches to monitoring. After reading the first two chapters, I found it logical to deviate from the sequence of chapters by looking through the Table of Contents and reading the chapters that pertained to either auditory or somatosensory (or both) types of monitoring. The other chapters could be read in an order that depends on the reader's interest. The other chapters are related to motor and nonmotor brain stimulation (electric or magnetic), extraoperative monitoring of patients with intractable seizures, monitoring during implantation of permanently stimulating electrodes for relief of pain, evoked potential monitoring in intraventional neuroradiology, and monitoring of neuromuscular transmission during anesthesia.
I found that the numerous case examples illustrated with serial electrophysiological data acquired during monitoring were excellent. These case examples may be especially valuable for readers who may be faced with similar data.
A convenient feature of the book is that most of the abbreviations used in the text are listed just before the Table of Contents. At the end of the text, there is a useful bibliography of more than 800 references.
I highly recommend this book to clinical neurophysiologists, neurosurgeons, orthopedic surgeons, anesthesiologists, neuroradiologists, and technologists who are or who may become involved with neuromonitoring during invasive and noninvasive procedures. Some of the data obtained during the procedures need further documentation concerning their sensitivity, specificity, and reliability.
Although pitfalls, recent trends, and advances are discussed thoroughly in this book, I look forward to its next edition, containing the additional experience of the authors, because the field is rapidly changing and more information needs to be propagated as soon as possible.