Exploring the utility of neuro-monitoring in neurosurgery: The users' perspective in a single center

Chulananda Goonasekera; Holly Jones; Rebekah Lawrence; John Hanrahan; Priyanka Iyer; Aditi Nijhawan

doi:10.4103/sja.SJA_862_20

Exploring the utility of neuro-monitoring in neurosurgery: The users' perspective in a single center

Saudi J Anaesth. 2021 Jan-Mar;15(1):7-13. doi: 10.4103/sja.SJA_862_20. Epub 2021 Jan 5.

Authors

Chulananda Goonasekera¹, Holly Jones², Rebekah Lawrence¹, John Hanrahan¹, Priyanka Iyer¹, Aditi Nijhawan¹

Affiliations

¹ Department of Anesthetics, King's College Hospital NHS Trust, Denmark Hill, London SE59RS, UK.
² King's College London Faculty of Life Sciences and Medicine, School of Medicine, London, UK.

Abstract

Background: The purpose of intraoperative neuro-monitoring (IONM) is to minimize injury to eloquent neural structures and optimize tumor resection.

Method: We explored the utility of IONM using a qualitative approach in a single center. Eight experienced users of its use in spinal and cranial surgery in adults and children were the informants. Using a constant comparative method, the findings were collated by thematic analysis.

Results: The user perspective is that of caution to minimize adverse effects whilst empowering the need for formal training to enhance its efficacy. The process of IONM needs standardization as practices vary amongst users. Most users expressed limited trust on its current capabilities but hoped for its advancement to achieve higher sensitivity and specificity. None were however prepared to abandon its use.

Conclusion: IONM needs optimization. Its utility depends on user vigilance, multi-disciplinary validation, and individual expertise. This study draws out key issues from the user perspective that need to be addressed in order to enhance the utility of IONM.

Keywords: Intraoperative; neuro-modulation; neuro-monitoring; neurosurgery; risk-benefit; utility.