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TECHNOLOGY, COMPUTING, AND SIMULATION

Evoked Potential Monitoring Identifies Possible Neurological Injury During Positioning for Craniotomy

Zirka H. Anastasian, MD^*, Brian Ramnath, EEG/EP T, CNIM, Ricardo J. Komotar, MD, Jeffrey N. Bruce, MD, Michael B. Sisti, MD, Edward J. Gallo, EEG T, CNIM, Ronald G. Emerson, MD, and Eric J. Heyer, MD, PhD^*

From the Departments of *Anesthesiology, Neurology, and Neurological Surgery, New York-Presbyterian Hospital, Columbia University, New York City, New York.

Address correspondence and reprint requests to Zirka H. Anastasian, MD, Department of Anesthesiology, Columbia University, 622 West 168th St., New York City, NY 10032. Address e-mail to zh2114{at}columbia.edu.

Somatosensory-evoked potential (SSEP) monitoring is commonly used to detect changes in nerve conduction and prevent impending nerve injury. We present a case series of two patients who had SSEP monitoring for their surgical craniotomy procedure, and who, upon positioning supine with their head tilted 30°–45°, developed unilateral upper extremity SSEP changes. These SSEP changes were reversed when the patients were repositioned. These cases indicate the clinical usefulness of monitoring SSEPs while positioning the patient and adjusting position accordingly to prevent injury.