Telemedicine in neurosurgery: peri-operative management

Despite the growing interest and use of telemedicine, few studies have examined the clinical efficacy and reliability of telemedicine, and none have looked specifically at the role of telemedicine in neurosurgery. This prospective, observational study evaluates the effectiveness of telemedicine in the management of perioperative neurosurgical patients. A PC based compressed video media-conferencing system with high-resolution image transmission and retrieval is used. All transmissions are via point-to-point integrated services data network (ISDN 3) at 384kbps. Patients are examined by an on-site physician and remotely by a second physician using telemedicine. Examination data, assessment and recommendations are recorded on a standardized data collection form. The results of a pilot study of ten patients are presented. Correlation between the on-site and remote examiner was 100% for the following parameters: mental status, cranial nerves, sensory examination and wound evaluation. Correlation between observers was 89% for reflexes and 80% for speech, motor, and gait abnormalities. Sensitivity for detection of neurological abnormalities using telemedicine was 86%. Assessment and management decisions were identical for the on-site and remote physicians. Telemedicine provides an effective means to evaluate and manage neurosurgical patients in the peri-operative period.