Preprocedural Electrophysiological Monitoring in Craniofacial Surgery for a Patient with Chiari Malformation.

This article focuses on the use of intraoperative neuromonitoring (IONM) to ensure safe head and neck positioning during craniofacial reconstructive surgery in a child with Apert syndrome and concurrent Chiari I malformation (CM). The case involved extensive anterior and posterior cranial vault access requiring a modified sphinx position with significant neck extension, which posed risks due to brainstem compression from CM. IONM, including somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs), was employed to monitor neural function before and after positioning, allowing safe surgical exposure without neurologic compromise. The report highlights the potential benefits of IONM in craniofacial surgeries involving complex positioning, especially when cranio-cervical anomalies are present, and suggests broader consideration of this technique in similar cases.