Foundations of Clinical Neurophysiology

Jeffrey R. Balzer, Ph.D.: Course Director

412-648-9779

Tuesday and Thursday, 3:30-5:00 pm

Jannetta Conference Room: PUH 4th Floor, B Wing, Department Neurosurgery

Text: “Intraoperative Neurophysiological Monitoring” 2nd Edition, Möller

LectureTopicLecturer

1Course Overview Dr. Balzer

  • What is Clinical Neurophysiology?(08/28/07)

2Basic Electrical Concepts & InstrumentationDr. Sclabassi

  • Conduction(08/30/07)
  • Impedance and Resistance
  • Capacitance and Inductance
  • Amplification and Filtering of Electrical

Signals

  • Signal Averaging

3Functional Neuroanatomy Dr. Habeych

  • Brain(09/04/07)
  • Brainstem
  • Spinal Cord
  • Cerebrovasculature
  • Cranial Nerves
  • Brachial Plexus/Peripheral Nerves

4Functional NeurophysiologyDr. Balzer

  • Cerebral Metabolism(09/06/07)
  • Cerebral Blood Flow
  • AVD02
  • Autoregulation
  • CSF Dynamics
  • Blood-Brain Barrier

5Cerebral Electrical ActivityDr. Sclabassi

  • Electrical Activity of Neurons(09/11/07)
  • Synaptic Transmission
  • Electroencephalogram
  • Sensory Evoked Potentials
  • Motor Evoked Potentials

6NeuropathophysiologyDr. Balzer

  • Injury and Neuronal Responses(09/13/07)
  • Cellular Homeostasis
  • Ischemia
  • Excitatory Amino Acids

7Techniques for Electroencephalographic RecordingDr. Crammond

  • Electrodes(09/18/07)
  • International “Ten-Twenty” System
  • Equipment

8Basic Scalp ElectroencephalographyDr. Haybech

  • Origin of EEG(09/20/07)
  • Technical Considerations
  • EEG and Anesthesia
  • EEG and Surgical Procedures
  • Computer Processed EEG

9ElectrocorticographyDr. Balzer

  • Use in Epilepsy Surgery(09/25/07)
  • Technical Aspects of ECoG and Stimulation
  • Awake Craniotomy
  • Anesthetic Considerations

10Intraoperative Evoked PotentialsDr. Balzer

  • Neurophysiologic Basis(09/27/07)
  • Instrumentation
  • Technical Standards

11Somatosensory Evoked PotentialsDr. Crammond

  • Placement of Electrodes(10/02/07)
  • Sensory Tracts
  • Stimulating Electrodes
  • Phase Reversal
  • Clinical Indications for SSEP Recording

12Brainstem Auditory Evoked PotentialsDr. Crammond

  • Placement of Electrodes(10/04/07)
  • Recording Parameters
  • Auditory Pathways/Obligate Waves
  • Clinical Indications for BAEP Recording

13Visual Evoked PotentialsDr. Crammond

  • Stimulating and Recording(10/09/07)
  • Visual Pathways
  • Clinical Indications for VEP Recording
  • Electroretinogram (ERG)

14Motor Evoked PotentialsDr. Balzer

  • Stimulating and Recording(10/11/07)
  • Neurogenic vs. Myogenic
  • Transcranial Electrical Stimulation
  • Motor Pathways
  • Clinical Indications for MEP Recording
  • Anesthetic Considerations

October 16, 2007: MIDTERM EXAMINATION

15Intraoperative Electromyography (EMG)Dr. Balzer

  • Basic Principles of EMG(10/18/07)
  • Recording EMG
  • Free-Running EMG
  • Stimulus-Evoked EMG
  • Alarm Criteria

16Intraoperative Facial Nerve MonitoringDr. Balzer

  • Monitoring Methods(10/23/07)
  • Electrode Placement
  • Discharge Patterns
  • Hemifacial Spasm
  • Clinical Indications

17Other Cranial Nerve EMGDr. Habeych

  • Extra-ocular Muscle EMG(10/25/07)
  • Trigeminal Nerve EMG
  • Lower Cranial Nerve EMG

18Nerve Root Monitoring in the SpineDr. Balzer

  • Free-Run vs. Stimulus-Evoked EMG(10/30/07)
  • Pedicle Screw EMG
  • Cervical EMG
  • Thoracic EMG
  • Lumbosacral EMG

19Deep Brain StimulationDr. Crammond

  • Anatomy(11/01/07)
  • Physiology
  • Micro-Electrode Recording
  • Guiding the Surgical Placement

20Anesthesia and Evoked PotentialsDr. Balzer

  • Halogenated Anesthesia(11/06/07)
  • Intravenous Anesthetics
  • Effects on Evoked Potentials
  • Effects on EMG

21Transcranial DopplerDr. Balzer

  • Cerebrovascular Anatomy(11/08/07)
  • Anatomical Anomalies
  • Techniques and Examination
  • Clinical Application

22Magnetoencephalography (MEG)Dr. Sclabassi

  • Principles(11/13/07)
  • Techniques and Examination
  • Clinical Application

23Cerebral OximetryDr. Balzer

  • Principles(11/15/07)
  • Techniques and Examination
  • Clinical Application

24ICP/AVD02 and Closed Head InjuryDr. Okonkwo

  • Principles(11/20/07)
  • Pathophysiology
  • Evoked Potentials and Prediction of Outcome

Thanksgiving Break: No Class 11/22/07

25Quantification of Cerebral Blood FlowDr. Balzer

  • Laser Doppler Techniques(11/27/07)
  • Bedside Xe133
  • Xe-CT

26Radiology and ImagingDr. Horowitz

  • Reading a C-Spine X-Ray(11/29/07)
  • CT
  • MRI
  • Angiography

27General Principles of Data InterpretationDr. Balzer

  • Near-Field and Far-Field Potentials(12/04/07)
  • Potentials with Multiple Sources
  • Abnormalities During Monitoring
  • General Alarm Criteria

28Intraoperative Monitoring: Case ReviewsAll Faculty

  • Spine(12/06/07)
  • Vascular
  • Cranial/Tumor
  • Awake Craniotomy
  • Cranial/Microvascular Decompression
  • Brachial Plexus/Peripheral Nerve
  • Deep Brain Stimulation/Microelectrode Recording

December 15, 2007: FINAL PAPER DUE

If you have a disability for which you are or may be requesting an accommodation, you are encouraged to contact both your instructor and Disability Resources and Services, 216 William Pitt Union, 412-648-7890 (412-383-7355 (TTY)), as early as possible in the term. DRS will verify your disability and determine reasonable accommodations for this course.