Intraoperative Neurophysiological Monitoring helps Neurosurgeons, Orthopedics and Anesthesiologists to achieved better post-surgical outcomes. Here I encompass some very important aspects that in my opinion Neurosurgeons should not be missed if a correct monitoring is expected. Some variables that can enrich Intraoperative Neurophysiological Monitoring are mentioned, like Communication, Video surgery, Neuronavigation, Tractography and Wave classification criteria. Particularities, strength and weakness of neurophysiologic modalities are considered. I also considered what I have learned working inside operating room.

Intraoperative Neurophysiological Monitoring evaluates nervous system responses during surgery and classifies data as normal or abnormal. However it has been difficult to standardize Intraoperative Neurophysiological Monitoring results and to link intraoperative data to post-surgical outcomes, with alert criteria and concepts that contrast through laboratories and guidelines. Clinical Randomized Trials have not been applied for investigation because of ethical issues, but still more investigation is needed. Neuroethics and Intraoperative Neurophysiological Monitoring are related because the latter encompass patient’s post-surgical outcome and life quality. In this paper investigation methods proposed for Intraoperative Neurophysiological Monitoring are reviewed with consequent opinions. Moreover a quasi-experimental design for investigation is proposed, which is closer to Neuroethics and patients wellbeing.

The purpose of this paper is to estimate the association between quantitative electroencephalogram frequency composition (QEEGC) and post-surgical evolution in patients with pharmacoresistant temporal lobe epilepsy (TLE) and to evaluate the predictive value of QEEGC before and after surgery. A prospective, longitudinal study was made at International Neurological Restoration Center, Havana, Cuba. Twenty-nine patients with TLE submitted to epilepsy surgery were evaluated before surgery, and six months and two years after. They were classified as unsatisfactory and satisfactory post-surgical clinical evolution using the Modified Engels Scale. Eighty-seven electroencephalograms with quantitative narrow- and broad-band measures were analyzed. A Mann Whitney test (p > 0.05) showed that QEEGC before surgery was similar between groups independently of two years post-surgical evolution. A Mann Whitney test (p ˂ 0.05) showed that subjects with two years satisfactory post-surgical evolution had greater alpha power compared to subjects with two years unsatisfactory post-surgical evolution that showed greater theta power. A Wilcoxon test (p ˂ 0.05) showed that alpha and theta power increased for two groups from pre-surgical state to post-surgical state. Logit regression (p ˂ 0.05) showed that six months after surgery, quantitative electroencephalogram frequency value with the greatest power at occipital regions shows predictive value for two years evolution. QEEGC can be a tool to predict the outcome of epilepsy surgery.

Due to the existence of papers that propose quantitative techniques [1-5] for Intraoperative Neurophysiologic Monitoring (IONM), the lack of concern about which could be right to refine the work of Neurophysiologist and Neurosurgeons and their great importance during and after surgical intervention