Neurophysiologisches Monitoring bei intrakraniellen und spinalen Eingriffen

  • J. Schramm
  • J. Zentner
Part of the Klinische Anästhesiologie und Intensivtherapie book series (KAI, volume 46)

Zusammenfassung

Die Verminderung perioperativer Funktionsausfälle bei Operationen am ZNS ist ein klassisches Anliegen in der Neurochirurgie. Aber neurologische Ausfälle können auch bei operativen Eingriffen in anderen Fachgebieten entstehen, wie z.B. Rückenmarkläsionen bei der Aortenchirurgie, Hirninfarkte bei endovaskulären therapeutischen Eingriffen der Neuroradiologen oder bei Karotiseingriffen der Gefäßchirurgen. Das intraoperative Monitoring mit neurophysiologischen Methoden hat seinen Anfang genommen bei orthopädischen Eingriffen an der Wirbelsäule bei intaktem Rückenmark, z. B. bei dem klassischen Eingriff der Skolioseaufrichtung [9]. Wo früher der Aufwachtest das einzige Mittel zur intraoperativen Überwachung neurologischer Funktionen war, bieten sich jetzt zusätzlich neurophysiologische Methoden an [10, 21, 52, 53, 55]. Nach diesem Einsatz ausschließlich somatosenso-risch evozierter Potentiale für das intraoperative neurophysiologische Monitoring hat eine stürmische Entwicklung eingesetzt, die neurophysiologische Methoden zur Überwachung verschiedener afferenter und efferenter Bahnensysteme in einem weiten Spektrum von Operationen umfaßt, die das Nervensystem teils direkt, teils auch indirekt betreffen. In diesem Kapitel soll versucht werden, für den primär neurophysiologisch nicht erfahrenen Anästhesisten einen Einblick über vorhandene Methoden und den gesicherten Stellenwert sowie die noch unsicheren Aspekte dieser Methodik, insbesondere auf dem Gebiet der Neurochirurgie zu geben.

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© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • J. Schramm
  • J. Zentner

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