Intraoperative Neurophysiological Monitoring

Details

Title

Intraoperative Neurophysiological Monitoring

Type

Stage One

Module code

HPS218

Requirement

Compulsory

Module objective

By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and apply knowledge with respect to diseases of the spine, cranial nerves and central nervous system where a surgical procedure is undertaken. They will be able to perform and critically evaluate a range of techniques and clinical skills in a range of settings, and demonstrate the attitudes and behaviours necessary to undertake the role of a Consultant Clinical Scientist.

Knowledge and understanding

By the end of this module the Clinical Scientist in HSST will analyse, synthesise, critically evaluate and apply their knowledge with respect to diseases of the spine, cranial nerves, peripheral and central nervous system where a surgical procedure is indicated, including:

• pathophysiology of conditions where neurophysiological monitoring is indicated during surgery, including spinal cord disease;
• scoliosis, kyphoscoliosis and other diseases of the spine with relevance to spinal monitoring neurophysiological tests used in intraoperative monitoring;
• working in an operating theatre environment and associated health and safety precautions and restrictions;
• personalising monitoring techniques, including single versus combination;
• technological aspects of recording equipment spanning recording, saving and reviewing data; editing new programs; and customised montages;
• indications/limitations/methodology/troubleshooting/interpretation for:
  • electrocorticography
  • functional cortical mapping
  • EEG monitoring
  • somatosensory evoked potentials monitoring
  • motor evoked potentials monitoring
  • brainstem auditory evoked potentials monitoring
  • other cranial nerves monitoring
  • free running and triggered EMG monitoring
• routine monitoring/mapping of the nervous system during certain types of surgical procedures, including:
  • epilepsy surgery
  • supratentorial tumour resection
  • intramedullary spinal cord tumour resection
  • decompressive surgery of the spine
  • spinal deformity surgery
  • thoracic aortic aneurysms (TAA) repair
  • surgery of the brachial plexus
  • resection of tumours of the peripheral nervous system
  • posterior fossa surgery, including vestibular schwannomas, microvascular decompressive surgery
• infection control and safe working in a theatre environment;
• communication with surgical and anaesthesia teams;
• anaesthetic regimens and their impact on the neurophysiology of the central and peripheral nervous system;
• intraoperative neuromonitoring in theatre during a highly specialised neurosurgical monitoring, including selective dorsal rhizotomy (SDR) and other sacral nerve monitoring;
• anaesthesia techniques during surgical procedures requiring intraoperative neurophysiological monitoring, including potential effects on physiological signals.

Clinical scientific research topics:

• • stem cell biology;
  • vascular biology;
• • genomics

Technical and clinical skills

By the end of this module the Clinical Scientist in HSST, with respect to intraoperative neurophysiological monitoring, will be able to perform a range of specialised neurophysiological investigations in routine and non-routine patients. They will be required to demonstrate a critical understanding of current research and its application to intraoperative neurophysiological monitoring. They will also be expected to contribute to the supervision, teaching and assessment of colleagues.

By the end of this module the Clinical Scientist in HSST will be expected to critically reflect and apply in practice an appropriate range of clinical and communication skills to and will:

• perform the appropriate investigations, taking into account special circumstances, contraindications, confounding factors and risks;
• explain results simply and effectively to both clinicians and, where appropriate, patients;
• advise and communicate effectively with patients, relevant clinicians and the public, and other healthcare professionals working within the multidisciplinary team.