Intraoperative Neuromonitoring

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Intraoperative neuromonitoring – application for reducing risks of neurological damage

Intraoperative neuromonitoring (IONM) is a key technology during surgical procedures. The use of IONM provides additional information and helps to maintain nerve integrity, neural pathways and brain function. inomed IONM products and  industry-leading innovation is making a major contribution to clinical risk management and the reduction of neurological impairment during surgical procedures.

Intraoperative neuromonitoring is primarily used in specialist areas. These include neurosurgery, cardiothoracic surgery, ENT surgery, orthopedics, emergency surgery, vascular surgery, visceral surgery and general surgery. The use of IONM helps to reduce risks of impairment to neurophysiologically-relevant nerve structures during a surgical intervention or possible impairment of nerve function as a result of  improper positioning of the patient. Using targeted neurostimulation, nerve structures can be identified and potential impairment prevented by adapting or adopting changes to surgical approach. This enables surgeons to focus on optimizing the intervention whilst maintaining function.

Developments in intraoperative neuromonitoring

Prior to the development of IONM equipment and techniques, a simple visual check was used to determine whether the muscle in question contracted after neurostimulation. These methods no longer meets the demands of neuromonitoring in today's operating room. Clinicians use EMG and EP modalities to make the technology used in intraoperative neuromonitoring systems more sensitive, effective and easier to use. This allows clinicians to detect muscle responses that are not otherwise visible to the human eye, or are inaccessible due to the patient's position. The resulting waveform and table displays are presented on a monitor. The main goal of neuromonitoring is to obtain a response signal waveform in the form of amplitude and latency.

Intraoperative neuromonitoring today

Generally, there are two methods of neuromonitoring.

Continuous monitoring:  The clinician monitors patient waveform/tabular data in real-time to observe changes to the morphology of the data. Deviation beyond expected range of data forms the basis of a warning to the surgeon of possible nerve impairment. This enables the surgeon to take timely corrective action. Continuous monitoring includes the following modalities EMG, SEP, AEP, MEP, EEG and VEP >>.

Neuromonitoring for localization. The use of targeted stimulation enables the surgeon  to identify critical nerve structures in the surgical area. This method helps surgeons have a better spatial orientation and use targeted neurostimulation >>, to periodically check the function of the affected nerves during OR procedures.

The state-of-the-art neuromonitoring technologies and systems from inomed provide clinical specialists and surgeons with easy-to-use equipment that helps with signal interpretation and delivers notification of critical signal changes using visual and acoustic alarms.