Neuronet: Collaborative Intraodevative Cuidake and Control

I t has long been appreciated that a patient’s physiological status is dynamic and subject to rapid, life-threatening changes during surgery Anesthesiologists routinely use extensive physiological monitoring to maintain the patient’s homeostasis. This monitoring can be thought of as establishing a control loop between the anesthesiologist and patient for the purposes of life support. Some information from these monitoring procedures reflects stress on the central nervous system, for example, changes in heart rate related to both brainstem and vagal stimulation. However, evaluation of CNS functional status either by clinical means or by the physiological monitoring tools commonly available to anesthesiologists is relatively limited. Thus, considerable effort has gone into developing intraoperative neurophysiological monitoring to add another dimension to the assessment of patient status during surgery. Intraoperative neurophysiological monitoring can also be thought of as establishing a real-time control loop-this time between the surgeon and patient (Figure 1). The primary goals are to reduce morbidity and to dynamically assess structure-function relationships of the patient’s nervous system during surgical manipulation. This dynamic assessment can guide a surgeon by providing specific, sensitive measurements that reflect operative maneuvers and their impact on the patient’s CNS functioning. These goals require real-time measurements of CNS functions that can be closely correlated to operative manipulations within a time frame valuable to the progress of the operation. Thus, multiple types of neurophysiological data must be acquired, processed, and displayed in real time. In many instances, the proper interpretation of these data requires immediate consultation between the surgeon and a remotely located neurophysiologist. NeuroNet is a system designed to provide the tools for acquiring, processing, and displaying multiple types of neurophysiological data in real time and for facilitating communication, collaboration, and information sharing among members of a neurosurgical team (including neu-