Intra-Operative Neuro-Monitoring (IONM): A Safety Adjunct In Neurosurgery At Kenyatta National Hospital (KNH)

Abstract

Introduction: IONM is vital in neurosurgical procedures to minimize neurological morbidity from operative manipulations. Its goal is to identify changes in brain, spinal cord, or peripheral nerve function before irreversible damage occurs. It can also effectively localize anatomical structures, such as peripheral nerves and sensorimotor cortex, which guides the surgeon during dissection. Objectives: Highlight the use of IONM at KNH and demonstrate improved safety with the use of IONM during surgical cases at KNH: Methods: A retrospective record-based review of neurosurgical procedures at KNH in which IONM was used. Results: Consistent use of IONM in neurosurgical procedures at KNH, was started approximately 8 months ago. To date, 19 patients have benefitted from the facility. In over 95% of the cases, patients have infra-tentorial lesions, viz: Posterior fossa masses, Cerebello-Pontine Angle lesions, Foramen Magnum masses and spinal cord lesions. Monitoring during glioma surgery in eloquent cortex has also been employed. Modalities employed depend on location of the lesion and planned neurosurgical procedure. They include: Motor Evoked Potentials (MEPs), Somato Sensory Evoked Potentials (SSEPs), Electromyography (EMG), long tract monitoring and Direct Nerve Stimulation (DNS), especially if surgery is contemplated near Cranial Nerves or Spinal nerves. The illustrative cases indicate the utility of IONM during some of the procedures.   Conclusions: Use of IONM as a safety adjunct to neurosurgical procedures has been instrumental in improving safety to patients and obviating adverse neurological outcomes postoperatively.