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What is Intraoperative Neurophysiologic Monitoring?

Intraoperative neurophysiologic monitoring (IONM), also known as intraoperative neuromonitoring, enables your doctor to monitor the central nervous system including the brain, spinal cord, and nerves in real-time during surgery. Immediate feedback provided by IONM allows the surgeon to perform the surgery while protecting vital neurological structures.

Indications for Intraoperative Neurophysiologic Monitoring

Intraoperative neurophysiologic monitoring may be indicated during surgeries such as:

  • Cerebral aneurysm repair
  • Cardiac surgery
  • Carotid endarterectomy
  • Spinal fusion
  • Cranial vascular surgery
  • Scoliosis correction
  • Discectomy
  • Spinal tumor resection

Types of Intraoperative Neurophysiologic Monitoring

The most common types of intraoperative neurophysiologic monitoring include:

  • Electromyography: This method involves the use of small electrodes inserted into the muscles to record electrical activity.
  • Electroencephalogram (EEG): This test helps to assess the function and electrical activity of the brain.
  • Electrocorticography: In this method, small electrodes are placed inside the cortex region to detect the epileptic activity of the brain.
  • Brainstem Auditory Evoked Potentials (BAEP): In this method, the electrodes are placed on the scalp to record the brain’s stimulus.
  • Somatosensory Evoked Potentials (SSEPs): Also known as dermatome evoked potentials (DEPS), this procedure helps to analyze the conduction of impulses through the spine.
  • Motor Evoked Potentials (MEPs): This helps to monitor the signals transmitted from the brain to specific muscle groups.

Preparation for Intraoperative Neurophysiologic Monitoring

There are no special preparations needed for the monitoring. Your doctor will recommend you to follow the common preparation techniques required for the specific surgery.

Procedure of Intraoperative Neurophysiologic Monitoring

Your doctor will examine your medical history and perform a neurological examination. Depending on the type of surgery being performed, your neuromonitorist will place the electrodes on the arms, legs, head, or any other area of the body that may be affected by the surgery. The electrical potentials emitted from the nerves are recorded which helps to analyze motor strength, reflexes, and neuron function. This helps to monitor neurological function and also offers an additional safety layer that guides the surgeon to avoid injuring critical structures.

Benefits of Intraoperative Neurophysiologic Monitoring

Benefits of intraoperative neurophysiologic monitoring include:

  • Improves patient safety
  • Prevents paralysis
  • Reduces the risk of permanent nerve damage
  • Reduces the injury to vital structures
  • Improves surgical outcomes