If PTN cortical responses attenuate over three hours while subcortical responses remain stable, what action should be taken?

When cortical responses, particularly the PTN (Posterior Tibial Nerve) responses, show a significant attenuation over time while subcortical responses remain stable, it indicates that there may be an issue with the cortical pathways, but the integrity of the subcortical pathways appears intact. Intraoperative monitoring is critical for assessing the functional status of the nervous system, and it is especially important to continue monitoring channels that are stable, such as those measuring subcortical activity.

Continuing to monitor the subcortical channels allows the neurophysiologic technologist to observe any changes that may occur in those signals. This information can be valuable in assessing the overall situation and understanding if there might be further implications for the surgical procedure taking place. The stability of subcortical responses can provide reassurance that while the cortex may be experiencing issues, communication from deeper structures of the brain is still maintained.

This choice supports patient safety and optimal surgical outcomes by allowing for ongoing assessment of the neural function that could influence surgical decisions.