SSEPs
Somatosensory Evoked Potentials (SSEPs) are generally used to assess the function of a patient’s spinal cord (dorsal columns) by stimulating peripheral nerves.
Highly trained personnel + state of the art equipment + focus on patient safety = better outcomes.
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HOSPITAL HOURS AND COUNTING
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EEG
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Train of Four
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SSEP
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EMG
What is Intraoperative Neuromonitoring?
Intraoperative Neuromonitoring (IONM), is the use of physiological techniques to identify and/or evaluate nervous system structures during brain, spine, ear, nose & throat, orthopedic and vascular surgical procedures. Sensors are placed on the patient to monitor electrical activity in the nerves, brain, and spinal cord. This allows the surgeon to obtain instant and reliable feedback about their patient’s nervous system, rather than after the patient wakes up. The team generally consists of an on-site neurophysiologist and a supervising physician who interacts remotely with the on-site neurophysiologist throughout surgery through a real-time secure internet connection.
Why is Intraoperative Neuromonitoring important?
- Reduces the risk of neurologic injury during surgery.
- Different surgical procedures carry different risks to different regions of the nervous system (e.g., brain, spine, nerve roots, etc.).
- Prior to the surgical procedure, our neurophysiologists consult with the surgeon to identify risks and tailor a plan to the patient’s particular needs.
- During the procedure, our neurophysiology team will perform the appropriate tests, providing constant feedback to the surgeon regarding the integrity of the nervous system.
- This helps to guide the surgeon’s decision-making process, and potentially take steps to minimize the possibility of injury to the nervous system.
Monitoring Modalities
TceMEPs
Transcranial electric Motor Evoked Potentials are used to assess the function of a patient’s spinal cord (ventral columns) during surgery. They are recorded by stimulating the motor cortex.
EMGs
Electromyography is an electroneurodiagnostic technique for evaluating and recording the electrical activity produced by skeletal muscles. Electromyography (EMG) also is used extensively during operative cases. Spontaneous EMG (sEMG) provides real-time feedback to the surgeon whenever a motor nerve is activated or irritated. Triggered EMG (tEMG) is recorded in response to direct electrical stimulation of nerves or other tissue within the surgical site.
EEGs
EEG changes are reliable guides to acute changes in cerebral blood flow that occur, for example, during carotid cross-clamping. These usually are seen within 30 seconds and indicate a need for shunting. Embolization during or after the procedure also can manifest as lateralized or localized EEG changes. Other uses of scalp EEG include during aneurysm repair when carotid clamping is required and during hypothermic circulatory arrest for cardiac surgery.
BAER
Brainstem auditory evoked response is a test that is commonly used during brainstem surgeries in which Cranial Nerve 8 (CN VIII) is at risk. Electrodes are placed on the patient’s scalp and earlobes and auditory stimuli, such as clicking noises and tones, are delivered to the intra-aural canals of the ears during surgery.
VEPs
VEPs have been performed successfully to aid in the monitoring of visual function during surgery in the hope of detecting visual impairment before it is irreversible. It has potential usefulness in assessing integrity of visual pathway structures including optic nerves.
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