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Cranial Nerve Monitoring

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Cranial nerve monitoring uses EMG to monitor cranial nerves I-XII except I, II, and VIII. EMG records electrical muscle activity using surface or needle electrodes. It is used to identify nerves and test their integrity during surgery near cranial nerves. Various cranial nerves can be monitored based on the muscle they innervate during different surgical procedures. Proper anesthesia without muscle relaxants is required for EMG monitoring.

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Cranial Nerve Monitoring Brian Owens Minnesota Epilepsy Group
Cranial Nerves ,[object Object],[object Object],[object Object]
EMG (Electromyography) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Motor Unit ,[object Object],[object Object],[object Object]
Compound Muscle Action Potential (CMAP) ,[object Object],[object Object]
Recording Methods ,[object Object],[object Object],[object Object]
EMG Parameter Settings ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Direct nerve stimulation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
EMG Intraoperative Interpretation ,[object Object],[object Object]
EMG Alarm Criteria ,[object Object],[object Object],[object Object]
EMG Examples Zouridakis, Papanicolaou, 2001 (a) Baseline EMG. Note the low amplitude background activity on ch2. (b) High amplitude spikes are present on ch3 indicating irritation of the nerve corresponding to that channel.
Anesthesia Requirements (EMG) ,[object Object],[object Object],[object Object],[object Object],[object Object]
CN I (Olfactory) ,[object Object],[object Object]
CN II (Optic) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CN III, IV, & VI ,[object Object],[object Object],[object Object],[object Object],III – inferior rectus, inferior oblique IV – superior oblique VI – lateral rectus
CN V (Trigeminal) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Masseter Muscle
CN VII (Facial Nerve) ,[object Object],[object Object],[object Object],[object Object]
CN VII (Facial Nerve)
Orbicularis Oris, Oculi
CN VIII (Vestibular cochlear) ,[object Object],[object Object]
CN VIII – Surgical Procedures ,[object Object],[object Object],[object Object],[object Object]
CN VIII - Anesthesia ,[object Object],[object Object]
CN VII - Stimulation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CN VIII - Recording ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CN VIII - Generators ,[object Object],[object Object],[object Object],[object Object],[object Object]
CN VIII - Interpretation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CN IX ,[object Object],[object Object],[object Object]
CN X (Vagus) ,[object Object],[object Object]
CN XI (Spinal Accessory) ,[object Object],[object Object],[object Object]
CN XII (Hypoglossal) ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Cranial Nerve Monitoring

Editor's Notes

  1. CN I, II & VII are sensory only. All others have motor components.
  2. MUAP – Free Run EMG Muscle fibers range from 10 in the eye muscles to 3000 in larger muscles like the gastronemius.
  3. CMAP – Triggered EMG
  4. Typical peaks: N1, N2, N3; P1, P2, P3
  5. Rarefaction causes sudden excitation (ear drum moves away from ear).