Peripherical nerve system neurosurgery includes the cure for peripherical nerve or spine tumours, spasticity with dorsal rhizotomy and selective neurotomy for the lower or upper parts of the body. Surgeons can use an IntraOperative neurostimulator or NeuroMonitoring (IONM) as a tool to determine the nerve to cut.
When visual motor muscle responses from the patient allow for the validation of stimulation effect from a targeted area, ElectroMyoGraphy (EMG) monitoring is unnecessary.
Application: upper part neurotomy.
Upper part muscles with spasticity can be treated by partial section of motor nerves. The use of an angled stimulation probe can increase the contact quality with the selected nerve (median or ulnar nerve). A visual response such as contraction from the wrist or hand will give feedback from the nerve stimulation to the surgeon.
Monitoring of muscle response during peripheral and spinal nerve surgery allows to determine the targeted nerve function, the response intensity and the diffusion grade. A monopolar probe will allow one to locate a nerve through tissue, whereas a bipolar probe will provide a refined search for a targeted nerve.
Application: selective dorsal rhizotomy.
Spasticity treatment involves dorsal and ventral roots dissection thanks to microsurgery. A bipolar probe is used for direct stimulation with the aim to confirm the sectioning quantification for the dorsal root (motor nerve).