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Kobylarz et al. Plast Aesthet Res 2023;10:2 Plastic and
DOI: 10.20517/2347-9264.2022.38
Aesthetic Research

Review Open Access

Pre-operative electrodiagnostic studies and
intraoperative neurophysiologic monitoring: power

and pitfalls

1
1
Erik J. Kobylarz 1,2,3 , Jason Randhawa , Stephen Mason , Victoria H. Lawson 1,2
1
Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
2
Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA.
3
Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA.
Correspondence to: Dr. Victoria Lawson, Department of Neurology, Dartmouth-Hitchcock Medical Center, One Medical Center
Drive, Lebanon, NH 03756, USA. E-mail: Victoria.H.Lawson@dartmouth.edu
How to cite this article: Kobylarz EJ, Randhawa J, Mason S, Lawson VH. Pre-operative electrodiagnostic studies and
intraoperative neurophysiologic monitoring: power and pitfalls. Plast Aesthet Res 2023;10:2. https://dx.doi.org/10.20517/2347-
9264.2022.38

Received: 15 Apr 2022 First Decision: 14 Sep 2022 Revised: 14 Oct 2022 Accepted: 10 Jan 2023 Published: 29 Jan 2023
Academic Editors: Joseph M. Rosen, Christopher S. Crowe, Raymund E. Horch Copy Editor: Ying Han Production Editor: Ying
Han

Abstract
Outpatient electrodiagnostic studies and intraoperative monitoring are essential tools for the surgical management
of nerve injury. Decisions are based on the diagnostic certainty afforded by outpatient electrodiagnostic studies,
which are more sensitive and specific than clinical examinations regarding the nature and localization of a nerve
lesion. Intraoperative neurophysiologic monitoring detects changes in neurologic function during surgery. It
provides significantly better information than visual inspection of the operative field, minimizing postoperative
neurologic deficits due to surgical manipulation (e.g., stretching, compression, heating from electrocauterization,
constriction, or clamping of local blood vessels). These techniques exploit similar neurophysiologic principles to
afford enhanced diagnostic and real-time functional data during surgery. However, an understanding of their
limitations is critical for the interpretation of these data. This review discusses these techniques, including their
use, advantages, and disadvantages in diagnosing and managing three essential nerve lesions amenable to surgical
management-radiculopathy, mononeuropathy, and brachial plexopathy.

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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