• Annals of Clinical Neurophysiology
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• v.23 no.1
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• pp.35-45
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• 2021

The utility and accuracy of intraoperative neurophysiological monitoring (IONM) has evolved greatly following the recent development of new devices for neurophysiological testing and advances in anesthesiology. Until recently, the need for IONM services has been limited to large academic hospitals, but the demand for neurophysiologists with expertise in IONM has grown rapidly across diverse types of hospital. The primary goal of the Korean Society of Intraoperative Neurophysiological Monitoring (KSION) is to promote the development of IONM research groups and to contribute to the improvement of fellowship among members and human health through academic projects. These guidelines are based on extensive literature reviews, recruitment of expert opinions, and consensus among KSION board members. This version of the guidelines was fully approved by the KSION, Korean Association of EMG Electrodiagnostic Medicine, the Korean Society of Clinical Neurophysiology, the Korean Academy of Rehabilitation Medicine, and the Korean Neurological Association.

• Journal of Korean Neurosurgical Society
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• v.62 no.4
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• pp.367-375
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• 2019

Hemifacial spasm (HFS) is due to the vascular compression of the facial nerve at its root exit zone (REZ). Microvascular decompression (MVD) of the facial nerve near the REZ is an effective treatment for HFS. In MVD for HFS, intraoperative neurophysiological monitoring (INM) has two purposes. The first purpose is to prevent injury to neural structures such as the vestibulocochlear nerve and facial nerve during MVD surgery, which is possible through INM of brainstem auditory evoked potential and facial nerve electromyography (EMG). The second purpose is the unique feature of MVD for HFS, which is to assess and optimize the effectiveness of the vascular decompression. The purpose is achieved mainly through monitoring of abnormal facial nerve EMG that is called as lateral spread response (LSR) and is also partially possible through Z-L response, facial F-wave, and facial motor evoked potentials. Based on the information regarding INM mentioned above, MVD for HFS can be considered as a more safe and effective treatment.

• Korean Journal of Clinical Laboratory Science
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• v.45 no.2
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• pp.77-85
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• 2013

Intraoperative Neurophysiological Monitoring (INM) is very useful in monitoring the motorsensory pathway and vascular circulation system during intraspinal, or intracranial neurosurgery. Brainstem Auditory Evoked Potentials (BAEPs) are for detecting the problems along the auditory pathways including, the eighth cranial nerve and brainstem. Motor Evoked Potentials (MEPs) is a useful adjunct to conventional monitoring of Somato-sensory Evoked Potentials (SEPs) during surgery. Visual Evoked Potentials (VEPs) has been regarded as having limited significance for the preservation of visual function during neurosurgical procedures. In this paper, we propose that the most appropriate averaging of the number of inspections in the inspection of each used in the operative field, is good and efficient, functionally.

• Annals of Clinical Neurophysiology
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• v.1 no.1
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• pp.1-9
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• 1999

Since Hans Berger reported the first paper on the human electroencephalogram in 1920s, huge technological advance have made it possible to use a number of electrophysiological approaches to neurological diagnosis in clinical neurology. In majority of the neurology training hospitals they have facilities of electroencephalography(EEG), electromyography(EMG), evoked potentials(EP), polysomnography(PSG), electronystagmography(ENG) and, transcranial doppler(TCD) ete. Clinicials and electrophysiologists should understand the technologic characteristics and general applications of each electrophysiological studies to get useful informations with using them in clinics. It is generally agreed that items of these tests are selected under the clinical examination, the tests are performed by the experts, and the test results are interpretated under the clinical background. Otherwise these tests are sometimes useless and lead clinicians to misunderstand the lesion site, the nature of disease, or the disease course. In this sense the clinical utility of neurophysiological tests could be summerized in the followings. First, the abnormal functioning of the nervous system and its environments can be demonstrated when the history and neurological examinations are equivocal. Second, the presence of clinically unsuspected malfunction in the nervous system can be revealed by those tests. Finally the objective changes can be monitored over time in the patient's status. Also intraoperative monitoring technique becomes one of the important procedures when the major operations in the posterior fossa or in the spinal cord are performed. In 1996, the Korean Society for Clinical Neurophysiology(KSCN) was founded with the hope that it will provide the members with the comfortable place for discussing their clinical and academic experience, exchanging new informations, and learning new techniques of the neurophysiological tests. The KSCN could collaborate with the International Federation of Clinical Neurophysiology(IFCN) to improve the level of the clinical neurophysiologic field in Korea as will as in Asian region.1 In this paper the clinical neurophysiological tests which are commonly used in clinical neurology and which will be delt with and educated by the KSCN in the future will be discussed briefly in order of EEG, EMG, EP, PSG, TCD, ENG, and Intraoperative monitoring.

• Korean Journal of Clinical Laboratory Science
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• v.46 no.1
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• pp.38-45
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• 2014

Intraoperative Neurophysiological Monitoring (INM) inspection has a very important role. While preserving the patient's neurological function be sure to safe surgery, neurological examination should thank. Cerebello pontine angle tumor surgery, especially in the nervous system is more important to the meaning of INM. In cochlear nerve, facial nerve, trigeminal nerve, which are intricate brain surgery, doctors are only human eye and brain to the brain that it is virtually impossible to distinguish the nervous system. They receives a lot of help from INM. In this paper, we examined six kinds broadly. First, the methods of spontaneous EMG and Free-running EMG, which can instantly detect a damage inflicted on a nerve during surgery. Second, methods of triggered EMG and direct nerve electrical stimulation, which directly stimulate a nerve using electricity to distinguish between nerves and brain tumors. Third, the method of knowing a more accurate neurologic status by informing neurological surgeons about Free-running EMG wave forms that are segmetalized into four. Fourth, three ways of knowing when a patient will be awaken from intraoperative anesthesia, which happens due to a weak anesthetic. Fifth, a method of understanding the structures of a brain tumor and a facial nerve as five dividend segments. Sixth, comparisons between cases normal facial nerve recovery and occurrence of a facial nerve paralysis during the postoperative course.

• Annals of Clinical Neurophysiology
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• v.22 no.2
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• pp.104-108
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• 2020

We performed intraoperative neurophysiological monitoring (INM) during anteromesial temporal resection (AMTR) in a patient with lesional temporal lobe epilepsy. INM revealed a sudden decrease in N20 waves in somatosensory evoked potentials (SSEPs) and poor P100 waves in visual evoked potentials (VEPs). These changes developed after applying electrocoagulation in the right mesial temporal areas. Postoperative brain magnetic resonance imaging demonstrated right thalamic and medial occipital infarctions. SSEPs and VEPs monitoring can be useful for detecting posterior cerebral artery infarction in AMTR.

• Korean Journal of Clinical Laboratory Science
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• v.52 no.4
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• pp.317-326
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• 2020

Deep blocking of consciousness alone does not prevent a reaction to severe stimuli, and copious amounts of pain medication do not guarantee unconsciousness. Therefore, anesthesia must satisfy both: the loss of consciousness as well as muscle relaxation. Muscle relaxants improve the intra-bronchial intubation, surgical field of vision, and operating conditions, while simultaneously reducing the dose of inhalation or intravenous anesthesia. Muscle relaxants are also very important for breathing management during controlled mechanical ventilation during surgery. Excessive dosage of such muscle relaxants may therefore affect neurological examinations during surgery, but an insufficient dosage will result in movement of the patient during the procedure. Hence, muscle relaxation anesthesia depth and neurophysiological monitoring during surgery are closely related. Using excessive muscle relaxants is disadvantageous, since neurophysiological examinations during surgery could be hindered, and eliminating the effects of complete muscle relaxation after surgery is challenging. In the operation of neurophysiological monitoring during the operation, the anesthesiologist administers muscle relaxant based on what standard, it is hoped that the examination will be performed more smoothly by examining the trends in the world as well as domestic and global trends in maintaining muscle relaxant.

• Journal of Korean Neurosurgical Society
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• v.63 no.3
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• pp.272-278
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• 2020

Compared to any other decade, the last two decades have been the most dynamic period in terms of advances in the knowledge on spinal dysraphism. Among the several factors of rapid advancement, such as embryology during secondary neurulation and intraoperative neurophysiological monitoring, there is no doubt that Professor Dachling Pang stood high amidst the period. I review here the last two decades from my personal point of view on what has been achieved in the field of spinal dysraphism, focusing on occult tethered cord syndrome, lumbosacral lipomatous malformation, terminal myelocystocele, retained medullary cord, limited dorsal myeloschisis and junctional neural tube defect. There are still many issues to revise, add and extend. Profound knowledge of basic science is critical, as well as refined clinical analysis. I expect that young scholars who follow the footsteps of precedent giants will shed bright light on this topic in the future.

• Journal of Korean Neurosurgical Society
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• v.60 no.4
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• pp.475-480
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• 2017

Objective : The main aim of the present study is to examine the electrode configurations used to record the muscle motor evoked potential (mMEP) in the upper extremities during surgery with the goal of producing a high and stable mMEP signal, in particular among the abductor pollicis brevis (APB), abductor digiti minimi (ADM), and across the APB-ADM muscles, which have been widely used for the mMEP in the upper extremities. Methods : Thirty right-handed patients were recruited in this prospective study. No patients showed any adverse events in their mMEP signals of the upper extremities during surgery. The mMEPs were recorded independently from the signals for the APB and ADM and for those across the APB-ADM. Results : The mMEP amplitude from across the APB-ADM was statistically higher than those recorded from the APB and ADM muscles. Moreover, the coefficient of variation of the mMEP amplitude from across the APB-ADM was smaller than those of mMEP amplitude recorded from the APB and ADM muscles. Conclusion : The mMEP from across the APB-ADM muscles showed a high yield with high stability compared to those in each case from the APB and ADM muscles. The configuration across the APB-ADM muscles would be best for mMEP recordings from the upper extremities for intraoperative neurophysiological monitoring purposes.

• Annals of Clinical Neurophysiology
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• v.24 no.1
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• pp.21-25
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• 2022

The newly identified frontal aslant tract (FAT) that connects the posterior Broca's area to the supplementary motor area is known to be involved in speech and language functions. We successfully intraoperatively monitored FAT using cortico-cortical evoked potentials generated by single-pulse electrical cortical stimulation in a patient with oligodendroglioma.