Neurophysiologic intraoperative monitoring of pediatric cerebrovascular surgery.

The surgical and endovascular treatment of cerebrovascular disorders (CVDs) in children, such as cerebral arteriovenous malformations, cavernous malformations, and moyamoya disease, have become commonplace and routine in many centers. As in the adult population, these procedures carry the risk of intraoperative cerebral ischemia. Therefore, similar strategies used to reduce the risk of cerebral ischemia in adults should be used in children. Unfortunately, there are no published studies on the intraoperative use of available techniques to identify, prevent, or potentially reverse cerebral ischemia. The goal of this article is to review the neurophysiologic techniques that may be useful and applicable in the surgical and endovascular treatment of pediatric CVDs, to describe the rationale and physiologic basis of their utility, to describe our experience in managing these cases, to present some of our results, and finally, to show the clinical utility of these techniques in the intraoperative management of CVDs.