Intraoperative neurophysiological monitoring (IONM) can reduce the incidence of complications during complex neurosurgical, orthopedic, spinal, cardiothoracic, vascular, otorhinolaryngology, interventional neurology, and interventional cardiology in adult and pediatric surgeries. Somatosensory evoked potentials (SSEPs), transcranial motor evoked potentials (TcMEPs), electromyography (EMGs), electroencephalography (EEG) are the common modalities used to perform IONM. Specifically, IONM with SSEPs and TcMEPs during idiopathic scoliosis fusion (ISF) has been shown to decrease the incidence of paraplegia during surgery. In addition, IONM with SSEPs and EEG can be used during carotid endartectomies to inform the surgeon about the need for shunting to improve cerebral perfusion and decrease the risk of stroke.
Somatosensory evoked potentials (SSEP’s) have become a mainstay of neurophysiologic monitoring in spine surgery due to their high sensitivity and specificity for identifying spinal cord injury and proven ability to reduce new postoperative neurological deficits. Epidural spinal cord stimulation (SCS) has emerged as a successful treatment for chronic pain disorders such as failed back syndrome, complex regional pain syndrome (CRPS) and peripheral vascular disease. Cervical SCS is less commonly utilized but also has proven effective for pain syndromes such as upper extremity CRPS, intractable facial pain, angina pectoris and post-amputation limb pain. While thoracolumbar epidural electrodes are commonly placed with local anesthesia and conscious sedation so the patient may communicate with the surgical team and confirm that regions of pain are satisfactorily treated, placement of surgical cervical epidural leads requires general anesthesia for reasons of safety, patient comfort, and the need for head immobilization. Although modern multi-contact electrodes have expanded our capability for manipulating the distribution of stimulation current postoperatively, the initial location of the electrode lead is the predominant factor which determines whether stimulation will be effective for treatment of painful regions. Moreover, stimulation of regions not involved in the pain syndrome may cause patient discomfort and therefore limit the therapeutic efficacy of the ultimate treatment by altering the tolerance threshold of stimulation parameters.
Deep Brain Stimulation (DBS) have been used for the treatment of Parkinson’s Disease (PD), Essential Tremor and Dystonia and more recently to treat Obsessive Compulsive Disorders (OCD). The movement disorder program at KIMS now has an experience of treating over one hundred PD patients all of whom have optimally placed DBS electrodes and all of whom have benefited from DBS therapy.
The use of IOM at KIMS reaches across many surgical disciplines and has proven to be an invaluable adjunct not only in adult and pediatric neurosurgical procedures but also in orthopedic, ENT, vascular and cardiothoracic surgical procedures.
Intraoperative multimodality monitoring at KIMS includes expertise in somatosensory evoked potentials (SSEP), brainstem auditory evoked potentials (BAEP), motor evoked potentials (MEP) and electromyography (EMG).
Direct peripheral nerve recordings also are performed as well as single unit micro-electrode recordings performed during placement of DBS electrodes in various subcortical structures. EEG is also used to monitor cerebral function and ischemic risk during cerebral and peripheral vascular procedures including cerebral aneurysm treatment, carotid endarterectomy and a variety of cardiothoracic procedures.
EEG recorded directly from the pial surface of the brain, or Electrocorticography (ECOG) is used to help determine resection margins in epilepsy surgery, and to monitor for seizures during direct electrical stimulation of the brain surface carried out while mapping eloquent cortex in awake patients.
In addition to providing IOM services, we also perform diagnostic evoked potential testing, continuous EEG services as well as transcranial Doppler studies.