SSEP/MEP, EEG, EMG Exam
Questions & Answers (Grade A+)
-provides early detection of impending or ongoing intraoperative
neurologic injury
-detects dysfunction due to ischemia, mass effect, stretch, heat, or
direct injury in real time, before permanent injury
-also provides a way to preserve neurologic structures when they
are at risk, mapping -
correct answer ✅NIEPM (Neurologic Intraoperative
Electrophysiologic Monitoring)
1: Patient is their own baseline --> intraoperative changes from
patient baseline serve as warning
2: Physiologic changes from anesthesia, temperature changes, and
OR environment (60Hz noise: electrical interference electrocautery,
electrical drills, microscopes, fluid saturation, limited access to
patient, etc.) can also impact neurologic testing
3: Experienced technicians/neurophysiologists is needed for
successful monitoring
4: Efficacy is unknown -->no blinded or randomized trials in
humans. Monitoring is accepted as standard of care in many
,SSEP/MEP, EEG, EMG Exam
Questions & Answers (Grade A+)
practices, would be ethical issues in withholding monitoring. Also,
low risk compared to procedure risk. Finally, hard to establish direct
relationship with significant monitoring changes and injury, since it
allows for early prediction and allows surgical team to avoid
permanent injury -
correct answer ✅limitations to NIEPM
Carotid endarterectomy and cerebral aneurysm can cause what
kind of injury? -
correct answer ✅stroke
Brain tumor operation can cause what kind of injury? -
correct answer ✅stroke, brain injury
Acoustic neuroma and ENT resection operations can cause what
kind of injury? -
correct answer ✅Nerve injury
Scoliosis operation can cause what kind of injury? -
correct answer ✅Spinal cord ischemia/injury
,SSEP/MEP, EEG, EMG Exam
Questions & Answers (Grade A+)
Thoracic aortic surgery and cardiac procedures can cause what kind
of injury? -
correct answer ✅Stroke, encephalopathy
Thoracoabdominal aortic procedures can cause what kind of injury?
-
correct answer ✅Stroke, spinal cord ischemia
Spinal surgeries (like lumbar fusions, ACDF, thoracic spinal surgeries
**artery of Adamkiewicz) can cause what kind of injury? -
correct answer ✅spinal cord ischemia/injury
Artery of Adamkiewicz supplies the ___ ____ of the spinal cord via
the ______ _____ artery.
Highly variable origin. in 75% of people, originates on the _____
side of aorta between ___ and ____ via intercostal artery
-sometimes on the opposite side
-sometimes from a lumbar vessel
-about 25% have 2 large anterior segmental medullary arteries -
, SSEP/MEP, EEG, EMG Exam
Questions & Answers (Grade A+)
correct answer ✅lower 2/3s
anterior spinal
left
TT8 L1
1: Detection of brain ischemia
2: Detection of seizure activity
3: Assessment of brain metabolic activity
4: Detection of stroke -
correct answer ✅Electroencephalography (EEG)
Questions & Answers (Grade A+)
-provides early detection of impending or ongoing intraoperative
neurologic injury
-detects dysfunction due to ischemia, mass effect, stretch, heat, or
direct injury in real time, before permanent injury
-also provides a way to preserve neurologic structures when they
are at risk, mapping -
correct answer ✅NIEPM (Neurologic Intraoperative
Electrophysiologic Monitoring)
1: Patient is their own baseline --> intraoperative changes from
patient baseline serve as warning
2: Physiologic changes from anesthesia, temperature changes, and
OR environment (60Hz noise: electrical interference electrocautery,
electrical drills, microscopes, fluid saturation, limited access to
patient, etc.) can also impact neurologic testing
3: Experienced technicians/neurophysiologists is needed for
successful monitoring
4: Efficacy is unknown -->no blinded or randomized trials in
humans. Monitoring is accepted as standard of care in many
,SSEP/MEP, EEG, EMG Exam
Questions & Answers (Grade A+)
practices, would be ethical issues in withholding monitoring. Also,
low risk compared to procedure risk. Finally, hard to establish direct
relationship with significant monitoring changes and injury, since it
allows for early prediction and allows surgical team to avoid
permanent injury -
correct answer ✅limitations to NIEPM
Carotid endarterectomy and cerebral aneurysm can cause what
kind of injury? -
correct answer ✅stroke
Brain tumor operation can cause what kind of injury? -
correct answer ✅stroke, brain injury
Acoustic neuroma and ENT resection operations can cause what
kind of injury? -
correct answer ✅Nerve injury
Scoliosis operation can cause what kind of injury? -
correct answer ✅Spinal cord ischemia/injury
,SSEP/MEP, EEG, EMG Exam
Questions & Answers (Grade A+)
Thoracic aortic surgery and cardiac procedures can cause what kind
of injury? -
correct answer ✅Stroke, encephalopathy
Thoracoabdominal aortic procedures can cause what kind of injury?
-
correct answer ✅Stroke, spinal cord ischemia
Spinal surgeries (like lumbar fusions, ACDF, thoracic spinal surgeries
**artery of Adamkiewicz) can cause what kind of injury? -
correct answer ✅spinal cord ischemia/injury
Artery of Adamkiewicz supplies the ___ ____ of the spinal cord via
the ______ _____ artery.
Highly variable origin. in 75% of people, originates on the _____
side of aorta between ___ and ____ via intercostal artery
-sometimes on the opposite side
-sometimes from a lumbar vessel
-about 25% have 2 large anterior segmental medullary arteries -
, SSEP/MEP, EEG, EMG Exam
Questions & Answers (Grade A+)
correct answer ✅lower 2/3s
anterior spinal
left
TT8 L1
1: Detection of brain ischemia
2: Detection of seizure activity
3: Assessment of brain metabolic activity
4: Detection of stroke -
correct answer ✅Electroencephalography (EEG)
