We are glad we can provide additional safety during your surgery through our state-of-the-art care. If you have questions about our services, you may find the answers in our list of Intraoperative Neuromonitoring FAQs. Or, you can email us or call 201-862-9900 for more information.
Only those that pose potential risks to the neurological stability of the patient. IONM is a useful tool to assist surgeons in determining the neurological status of their patients, even under anesthesia. IONM employs sophisticated electrophysiologic testing procedures when surgery involves structures that are potentially at risk for post-operative neurological compromise.
Before surgery, the surgeon and neurophysiologist review each case to determine the optimal monitoring techniques to be utilized. These decisions are customized for each patient depending on the risk factors. The information obtained by our highly trained neurophysiologists is transmitted to the surgical team on a contemporaneous basis, allowing the surgeon to intervene immediately, if necessary, to reduce the risk of permanent neurologic compromise. IONM has proven to reduce surgical neurologic compromise. It is a sensitive tool that can potentially detect changes in a patient’s neurologic status before the end of a surgical procedure, giving the surgeon an opportunity to make any needed modifications. In our experience, this sensitivity has been demonstrated time and again during numerous surgical procedures. Our intervention and diligence have undoubtedly improved the neurologic outcome for many individuals.
The use of IONM is very individual, depending on the type of surgery, what is at risk and the surgeon’s preference. It varies greatly in different hospitals and different parts of the country. Over the past two decades, IONM has become the gold standard for at-risk surgical procedures. As in any area of medicine, it’s important to be selective in the use of any technique. Those that involve the brain, spinal cord, nerve root manipulation, clamping of major vessels and any others that put the neurologic system at risk should be considered for IONM services.
On a practical note, you should consider the relatively inexpensive cost of IONM services against the high cost of postoperative and rehabilitative long term care for a patient who experiences neurologic complications as a result of surgery.
While there are different opinions, we participate most in the following:
- Craniotiomies for tumor removal
- Spinal Cord Neoplasms
- Microvascular DecompressionIntra/Extramedullay Spinal cord tumors
- Peripheral nerve injury
- Brachial Plexus nerve injury
- Selective Dorsal Rhizotomies
- Posterior Fossa Decompression for Arnold Chiari Malformations
- Acoustic Neuroma/ Vestibular Schwanoma
- Spinal Laminectomies and Fusion
- Spinal Diskectomies
- Acetabular Fractures and revision
- Hip lenghthening & replacements
- Thoracoabdominal Aneurysms
- Carotid Endartectomies
- Radical Prostatectomies
- Evoked Potentials
- Somatosensory Upper/Lower (SSEP)
- Auditory (BAER)
- Visual (VEP)
- Motor (NMEP/TCMEP/MEP)
- Brain and Peripheral Nerve Mapping
- Sensory ornare.
Each procedure is unique and treated individually, but some basic rules apply to the use of IONM. As has been mentioned many times, the structures at risk are the primary determination as to the type of monitoring. It is also dictated by a combination of other factors — surgeon and anesthesiologist preferences, health limitations of the patient, and the accessibility of structures to place electrodes.
Systemic and vital statistic changes can markedly affect the data, particularly with Somatosensory Upper/Lower (SSEP) and Visual (VEP) monitoring. The anesthetic use of volatile agents, narcotics and neuro-muscular blockades can also affect the data, so it’s important to assess each patient’s medical status to determine whether the use of these agents is necessary for the patient’s general well-being.
The following chart lists IONM procedures for some of the more common surgical procedures we monitor:
|IONM procedure||Limitations||Surgical Procedure(s)|
|SSEP||Limited use of volatile agents||Brain, spine, orthopedic, vascular|
|TcMEP||No volatile agents, muscle relaxants or benzodiazipines||Brain, spine|
|EEG (CSA, DSA, etc.)||Limited use of volatile agents||Brain, cerebrovascular|
|Motor Strip Phase Reversal||Limited use of volatile agents||Brain/motor strip tumor|
|EMG||No muscle relaxant||All involving nerve root|
|BAER (BSER)||None||Brain CPA/brainstem|
|VEP||Limited use of volatile agents and narcotics||Brain-occipital|
If you have questions not in our list of Intraoperative Neuromonitoring FAQs, email us or call 201-862-9900 for more information.