Neurosurgery: Neuromonitoring during precise surgical interventions

Prevention of neurological deficits due to intraoperative neuromonitoring

Neurosurgery is concerned with the recognition and surgical treatment of diseases, malformations and injuries of the central and peripheral nervous system.

Intraoperative neuromonitoring (IONM) plays an essential role in these activities. By means of IONM, important functions of the nervous system are continuously monitored during neurosurgical procedures, thereby reducing the risk of postoperative functional impairments to the patient.

IONM allows the surgeon to perform a function-controlled resection of tumours, consequently preserving the function of brain territories, associated nerve tracts, the spinal cord and peripheral nerve structures.

Using continuous IONM provides real-time feedback via neurostimulation >> about the functions at risk in the operative area; therefore if neurological changes occur, the surgeon can be warned, and immediately adapt their operative strategy during the surgical intervention.

Versatile applications

During surgical interventions in the cerebellopontine angle and the posterior cranial fossa, the nuclei and intramedullary fibres of 10 of the altogether 12 cranial nerves are close together. During surgical interventions in this area the function of the nerves and the brainstem is supervised by IONM. The most common tumour in the cerebellopontine angle is the acoustic neuroma (vestibular schwannoma), in which, above all, the VII and VIII cranial nerves (facial nerve and vestibulocochlear nerve) are at risk. The postoperative preservation of these two nerve structures is assured by monitoring of EMGs and BAEPs.

In the surgical resection of brain tumours, among other things, the localisation of functional areas - known as mapping - also play an important role. Mapping allows the surgeon to localise motor and speech eloquent areas and then perform sparing surgical tumour resection by continuously monitoring these regions.

Surgical interventions in the spine in neurosurgery include, for example, spinal tumours and scoliosis treatments which can cause damage to the spinal cord with associated post-operative deficits and paralysis. During surgical interventions on the spine, the ascending and descending spinal cord fibres are predominantly monitored by recording SEPs and MEPs.

Intraoperative neuromonitoring can also be used for the following neurosurgical applications:

  • Epileptic surgery 
  • Cerebral aneurysms
  • Interventions in the brain stem
  • Interventions in supratentorial areas
  • Interventions in the posterior cranial fossa
  • Acoustic neuromas
  • Spinal stabilisation
  • Spinal tumours and malformations
  • Selective dorsal rhizotomy
  • Drezotomy
  • Plexus surgery
  • Peripheral nerve surgery

The system suitable for any surgical application

Experts around the world place their trust in neuromonitoring systems from inomed. With the ISIS IOM System >> in various versions (ISIS Xpert, ISIS Xpertplus, ISIS Xpress) and the flexibly deployable C2 Xplore >> inomed offers an all-inclusive package for multimodal intraoperative neuromonitoring.
These high performance systems are user friendly and provide flexible and versatile applications. inomed consistently offers the most safe and practical system for every surgical application.