Historical Perspective on Nerve Monitoring During Head and Neck Surgery

The history of intraoperative neuromonitoring in head and neck surgery is highlighted by some of the most recognizable figures in medical science. Rising from the birth of electrophysiology, intraoperative neuromonitoring evolved to aid the surgeon’s quest for safe identification and preservation of the nervous system. Specific to head and neck surgery, protection of the cranial nerves remains the Holy Grail, the crux of surgical technique, and the driving force behind the evolution of neurophysiologic monitoring in the head and neck. This chapter reviews the beginnings of electrophysiology, landmark discoveries in neurophysiology, and the last 50 years of technological advancements culminating in the salient intraoperative neuromonitoring used today. We begin with the scholars of antiquity and the discovery of the cranial nerves leading up to the current anatomical classification. Over 250 years ago, Luigi Galvani discovered “animal electricity” marking the beginning of a saga of scientific discovery foundational to nerve monitoring. The last two centuries are highlighted with groundbreaking advancements in electrophysiology, including the discoveries of EEG, EMG, nerve stimulation, and others, many of which were awarded the Nobel Prize. Poised with technological advancements, notable physicians in the late nineteenth century experimented with the medical uses of peripheral nerve stimulation. Nerve monitoring in head and neck surgery became a reality in the 1960s with successful monitoring of the facial and recurrent laryngeal nerves. Since then, nerve monitoring continues to rapidly evolve to provide the surgeon and patient a path toward consistent identification, reliable protection, and ultimate preservation of the cranial nerves.