Foundations of Clinical Neurophysiology
Jeffrey R. Balzer, Ph.D.: Course Director
balzerjr@upmc.edu
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
Lecture
Topic
Lecturer
1
Course Overview
o What is Clinical Neurophysiology?
Dr. Balzer
(08/28/07)
2
Basic Electrical Concepts & Instrumentation
o Conduction
o Impedance and Resistance
o Capacitance and Inductance
o Amplification and Filtering of Electrical
Signals
o Signal Averaging
Dr. Sclabassi
(08/30/07)
3
Functional Neuroanatomy
o Brain
o Brainstem
o Spinal Cord
o Cerebrovasculature
o Cranial Nerves
o Brachial Plexus/Peripheral Nerves
Dr. Habeych
(09/04/07)
4
Functional Neurophysiology
o Cerebral Metabolism
o Cerebral Blood Flow
o AVD02
o Autoregulation
o CSF Dynamics
o Blood-Brain Barrier
Dr. Balzer
(09/06/07)
5
Cerebral Electrical Activity
o Electrical Activity of Neurons
o Synaptic Transmission
o Electroencephalogram
o Sensory Evoked Potentials
o Motor Evoked Potentials
Dr. Sclabassi
(09/11/07)
6
Neuropathophysiology
o Injury and Neuronal Responses
o Cellular Homeostasis
o Ischemia
o Excitatory Amino Acids
Dr. Balzer
(09/13/07)
7
Techniques for Electroencephalographic Recording
o Electrodes
o International “Ten-Twenty” System
o Equipment
Dr. Crammond
(09/18/07)
8
Basic Scalp Electroencephalography
o Origin of EEG
o Technical Considerations
o EEG and Anesthesia
o EEG and Surgical Procedures
o Computer Processed EEG
Dr. Haybech
(09/20/07)
9
Electrocorticography
o Use in Epilepsy Surgery
o Technical Aspects of ECoG and Stimulation
o Awake Craniotomy
o Anesthetic Considerations
Dr. Balzer
(09/25/07)
10
Intraoperative Evoked Potentials
o Neurophysiologic Basis
o Instrumentation
o Technical Standards
Dr. Balzer
(09/27/07)
11
Somatosensory Evoked Potentials
o Placement of Electrodes
o Sensory Tracts
o Stimulating Electrodes
o Phase Reversal
o Clinical Indications for SSEP Recording
Dr. Crammond
(10/02/07)
12
Brainstem Auditory Evoked Potentials
o Placement of Electrodes
o Recording Parameters
o Auditory Pathways/Obligate Waves
o Clinical Indications for BAEP Recording
Dr. Crammond
(10/04/07)
13
Visual Evoked Potentials
o Stimulating and Recording
o Visual Pathways
o Clinical Indications for VEP Recording
o Electroretinogram (ERG)
Dr. Crammond
(10/09/07)
14
Motor Evoked Potentials
o Stimulating and Recording
o Neurogenic vs. Myogenic
o Transcranial Electrical Stimulation
o Motor Pathways
o Clinical Indications for MEP Recording
o Anesthetic Considerations
Dr. Balzer
(10/11/07)
October 16, 2007: MIDTERM EXAMINATION
15
Intraoperative Electromyography (EMG)
o Basic Principles of EMG
o Recording EMG
o Free-Running EMG
o Stimulus-Evoked EMG
o Alarm Criteria
Dr. Balzer
(10/18/07)
16
Intraoperative Facial Nerve Monitoring
o Monitoring Methods
o Electrode Placement
o Discharge Patterns
o Hemifacial Spasm
o Clinical Indications
Dr. Balzer
(10/23/07)
17
Other Cranial Nerve EMG
o Extra-ocular Muscle EMG
o Trigeminal Nerve EMG
o Lower Cranial Nerve EMG
Dr. Habeych
(10/25/07)
18
Nerve Root Monitoring in the Spine
o Free-Run vs. Stimulus-Evoked EMG
o Pedicle Screw EMG
o Cervical EMG
o Thoracic EMG
o Lumbosacral EMG
Dr. Balzer
(10/30/07)
19
Deep Brain Stimulation
o Anatomy
o Physiology
o Micro-Electrode Recording
o Guiding the Surgical Placement
Dr. Crammond
(11/01/07)
20
Anesthesia and Evoked Potentials
o Halogenated Anesthesia
o Intravenous Anesthetics
o Effects on Evoked Potentials
o Effects on EMG
Dr. Balzer
(11/06/07)
21
Transcranial Doppler
o Cerebrovascular Anatomy
o Anatomical Anomalies
o Techniques and Examination
o Clinical Application
Dr. Balzer
(11/08/07)
22
Magnetoencephalography (MEG)
o Principles
o Techniques and Examination
o Clinical Application
Dr. Sclabassi
(11/13/07)
23
Cerebral Oximetry
o Principles
o Techniques and Examination
o Clinical Application
Dr. Balzer
(11/15/07)
24
ICP/AVD02 and Closed Head Injury
o Principles
o Pathophysiology
o Evoked Potentials and Prediction of Outcome
Dr. Okonkwo
(11/20/07)
Thanksgiving Break: No Class 11/22/07
25
Quantification of Cerebral Blood Flow
o Laser Doppler Techniques
o Bedside Xe133
o Xe-CT
Dr. Balzer
(11/27/07)
26
Radiology and Imaging
o Reading a C-Spine X-Ray
o CT
o MRI
o Angiography
Dr. Horowitz
(11/29/07)
27
General Principles of Data Interpretation
o Near-Field and Far-Field Potentials
o Potentials with Multiple Sources
o Abnormalities During Monitoring
o General Alarm Criteria
Dr. Balzer
(12/04/07)
28
Intraoperative Monitoring: Case Reviews
All Faculty
o Spine
(12/06/07)
o Vascular
o Cranial/Tumor
o Awake Craniotomy
o Cranial/Microvascular Decompression
o Brachial Plexus/Peripheral Nerve
o 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.