IOM Services
Better Neuromonitoring. Better Care. Better Outcomes.
By combining the expertise of board-certified neurologists, neurophysiologists and technologists to monitor a variety of surgical procedures, our “team” approach to care helps us to equip you to handle cases from simple to complex.
We offer surgeons several core neurophysiologic techniques to ensure the correct identification of risk to a patient’s brain, spinal cord or nerves during neurosurgical procedures. Our collaborative approach to monitoring is designed to significantly enhance a practice’s surgical risk management capabilities. The result: Better surgical outcomes. Happier patients.
Some of these techniques are listed below:
Somatosensory Evoked Potentials for spine and brain surgery
SSEP
Somatosensory Evoked Potentials
- Presynaptic and postsynaptic responses recorded over the limbs, spine, and scalp following the stimulation of peripheral nerves, trunks or cutaneous nerve.
- Evaluate the integrity of the somatosensory pathways by recording obtained from all levels of the nervous system: peripheral nerve, spinal cord, brain.
- Standard of care/practice for scoliosis, cervical or thoracic surgeries, vascular surgeries, brainstem tumors.
Electromyography for spinal fusion
EMG
Electromyography
- Provides a recording of electrical activity in muscle, providing information about the corresponding nerve roots responsible for muscle innervation.
- Useful in Spinal Surgeries and ENT cases
- Activity observed from surgical manipulation such as pulling or stretching as well as compression of nerve roots.
Triggered Electromyography (Pedicle Screw Stimulation)
Triggered EMG
Triggered Electromyography (Pedicle Screw Stimulation)
- Technique which sends current through from a monopolar electrode through the top of a screw at increasingly different levels of intensity. The level of current required for electrical conduction of a CMAP from the corresponding nerve root relates to the amount of bone insulation
- Used to determine whether screws have breached the medial or inferior pedicle wall
- Critical for Lumbar, Sacral, or LumboSacral Fusions
Motor Evoked Potentials for spine and brain surgery
MEP
Motor Evoked Potentials
- Monitors the integrity of the corticospinal motor pathways and the anterior spinal artery
- Useful in Spinal surgeries including scoliosis, cervical and thoracic level procedures, stenosis, trauma, or tumor resections.
- Also critical in monitoring Cerebrovascular Surgery, Aortic cross-clamping, and Brachial Plexus procedures
Brainstem Auditory Evoked Responses for brainstem surgery
BAER
Brain Auditory Evoked Responses
- Elicited by auditory stimulation and represent activity generated by the CN VIII and brainstem.
- Sensitive to conditions such as Cerebellar retraction, Manipulation of auditory nerve, Tumor dissection & debulking, Patient repositioning, Hypocarbia, Lumbar drainage and dural opening.
- Useful for Trigeminal neuralgia, Vestibular schwannoma resections, Vertebrobasilar aneurysms, Vascular malformation repairs, Microvascular cranial nerve decompressions, Skull based – especially posterior fossa, CPA tumor resections.
Electroencephalography for brain surgery and carotid endarterectomy
EEG
Electroencephalography
- Provides monitoring of cerebral function
- First outward sign of neuronal ischemia, useful for Carotid Endarterectomy, Intracranial aneurysm surgery, Arteriovenous malformation surgery, Intracranial tumor resection, Coronary artery bypass surgery.
Electrocorticogram for epilepsy surgery
EcoG
Electrocorticography
- Uses electrodes placed directly on brain to record electrical activity from cerebral cortex
- Useful technique to be employed in surgical treatment of medically intractable epilepsy in temporal lobe
Speech for brain surgeries affecting eloquent cortex
Eloquent Cortex Surgeries
Speech for brain surgeries affecting eloquent cortex
- Sensory cortical Mapping utilized as a reliable and safe method for the functional localization of the central sulcus.
- Identification of the somatosensory cortex for both the upper and lower limbs helps preventing any postoperative neurological deficits for procedures performed near eloquent brain tissue.
Monitoring: Phase Reversal, Direct Cortical & Subcortical Stimulation
Functional Brain Mapping
Functional Brain Mapping and Monitoring
- Used to detect eloquent tissues of speech and/or motor functions to prevent deficits
- SEP phase reversal used to identify central sulcus.
- Continuous MEP monitoring using Direct Cortical Stimulation enables real-time evaluation of the functional integrity of pyramidal track
Motor Cortex Stimulation and Spinal Cord Stimulator Placement
Pain Management
Motor Cortex Stimulation and Spinal Cord Stimulator Placement for Pain Management
- SEP Collision test and sEMG used for assessment of dorsal paddle stimulators
- sEMG used for placement of Dorsal Root Ganglion Lead Placement
Deep Brain Stimulation for microelectrode placement
Deep Brain Stimulation
Deep Brain Stimulation
- Neuromodulation therapy utilized to restore function in patients with neurological disorders such as Parkinson’s Disease.
- Skilled Neurophysiologists provide reliable interpretation of microelectrode and stimulation mapping results
D-wave monitoring for resection of intramedullary spinal cord tumors
D-wave
D-wave monitoring for resection of intramedullary spinal cord tumors
- Critical for Spinal Cord Tumors
- Single electrical pulse applied transcranially over the motor cortex with the descending volley of the cortiospinal tract recorded over the spinal cord.
Special monitoring procedures for cranial nerves IX and X
Cranial Nerves
Special monitoring procedures for cranial nerves IX and X
- Critical for lower brainstem surgeries
- Performed by utilizing sEMG and tEMG of the stylopharyngeious (IX) and vocalis (X)
Monitoring of other cranial nerves
Other Cranial Nerves
Monitoring of other cranial nerves
- Critical for ENT procedures such as thyroidectomies and parotidectomies; skull-based surgeries such as Microvascular Decompression
- Trigeminal Nerve (CN V) – Monitor motor function with sEMG via mandibular nerve branch
- Facial Nerve (CN VII) – Monitor and Map 5 motor root branches (Temporal, Zygomatic, Buccal, Marginal Mandibular, Cervical) with tEMG and sEMG
- Accessory Nerve (CN XI) – Monitor and Map nerve using sEMG and tEMG via the trapezius or sternocleidomastoid
- Hypoglossal Nerve (CN XII) – Monitor and Map nerve using sEMG and tEMG via the tongue
Lateral Spread Responses for Microvascular Decompression (MVD)
Hemifacial Spasms
Lateral Spread Responses for Microvascular Decompression (MVD) for hemifacial spasms
- Neuromonitoring useful for Microvascular Decompression Surgery
- Utilizes Brain Auditory Evoked Potentials for assessing stretching, damage, or ischemia of the cochlear nerve
- Spontaneous EMG leveraged as warning against excessive manipulation of facial nerve
Pudendal Nerve and Bulbocarvenosus reflex monitoring
Sacral Nerve Roots
Sacral Nerve Roots (Pudendal Nerve and Bulbocarvenosus)
- Bulbocavernosus Reflex monitors the pudendal nerve up through the sacral roots
- Polysnpatic reflex by stimulating the glans results in contraction of the anal sphincter
- Useful in surgeries such as prostatectomy or anterior hip arthroscopic repair
Abnormal Muscle Responses for Selective Dorsal Rhizotomies
Dorsal Rhizotomies
Abnormal Muscle Responses for Selective Dorsal Rhizotomies
- Utilized in surgeries such as children suffering from spasticity as a result of Cerebral Palsy
- Triggered EMG used to determine which rootlets are chiefly responsible for patient’s spasticity and which are not.
Recurrent Laryngeal Nerve Monitoring for thyroidectomy
Nerve Monitoring
Recurrent Laryngeal Nerve Monitoring for thyroidectomy
- Useful for identifying and monitoring during Lobectomies, Thyroidectomies and Parathyroidectomies
- Performed by placing an endotracheal tube with attached electrodes that monitor the functionality of the vocalis muscle
Spontaneous Electromyography Provides a recording of electrical activity in muscle, providing information about the corresponding nerve roots responsible for muscle
sEMG
Spontaneous Electromyography
- Provides a recording of electrical activity in muscle, providing information about the corresponding nerve roots responsible for muscle innervation.
- Useful in Spinal Surgeries and ENT cases
- Activity observed from surgical manipulation such as pulling or stretching as well as compression of nerve roots.
Brainstem Auditory Evoked Potentials (Cranial Nerve VIII) Monitors the central auditory pathway from auditory nerve to primary auditory cortex Critical
Brainstem Auditory Evoked Potentials
Brainstem Auditory Evoked Potentials (Cranial Nerve VIII)
- Monitors the central auditory pathway from auditory nerve to primary auditory cortex
- Critical for surgeries where the brainstem or Cranial VIII are at risk
- Monitors perfusion to brainstem when retraction is necessary
- Used for CPA surgeries, microvascular decompressions for trigeminal neuralgia