If the nervous system is irreparably damaged during surgery, the cost of long term care can be astronomical. The cost in human suffering is incalcuable. Compare that with the relatively reasonable cost of monitoring—and there is no comparison.
Yet, simply providing clear, detailed images of the patient's nervous system during surgery is often not enough. Only neuromonitoring can provide the information that is so vital: assessing how well the nervous system is performing at rest, and in response to a stimulus. Drawing on that information, Bromedicon offers a virtually fail safe system for any surgery that could put the nervous system at risk. Including:
Brain surgery
Surgery in or near the spinal cord
Vascular surgery where blood and oxygen may be compromised for several hours.
SSEP—Somatosensory Evoked Potentials: An intraoperative modality that stimulates peripheral nerves in upper and lower extremities to obtain information about the sensory function of the spinal cord.
TCMEP—Transcranial Motors: This intraoperative modality tests the integrity of the motor tracks of the spinal cord via the use of electrical stimulation through the cranium.
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Spinal instrumentation
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Spinal cord at risk by surgical retraction or direct manipulation
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Procedures involving anterior Circle of Willis
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Craniotomies extending deep into the frontal lobes
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Anterior Communicating Artery or Anterior Cerebral Artery Aneurysm
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Abdominal Aortic Aneurysm
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Arteriovenous Malformation (AVM) involving the above noted arteries
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Procedures listed above when patient condition inhibits monitoring of the Tibial nerve
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Procedures involving Carotid Artery including Carotid Endarterectomies
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Procedures involving lateral Circle of Willis
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When Brainstem areas from the Medulla to the Thalamus are at risk
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Posterior Communicating Artery Aneurysm
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Basilar Artery Aneurysm
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Cervical instrumentation
EMG—Electromyography:
During spinal instrumentation where pedicle screws are inserted, their integrity can be tested by direct electrical stimulation and recording compound muscle action potentials if specific nerve roots are irritated. This technique is the triggered EMG Response and is utilized in conjunction with free running EMG.
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Risk of injury to specific nerves (ex. Facial nerve during surgery around the Parotid Gland)
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Tethered cord surgery where sphincter muscles are at risk
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Spinal surgery where nerve roots can be compromised
EEG/CSA—Electroencephalography / Compressed Spectral Array: EEG is sometimes used in certain vascular procedures in conjunction with TCD to monitor brain waves and cerebral blood flow.
Cortical burst suppression monitoring (including hypothermia, drug titration, etc.)
Facial Nerve Monitoring—Includes the recording of 2-4 channels of free-run and triggered EMG responses durig certain procedures where facial nerve may be at risk for injury.
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Posterior fossa tumors
Vestibular neurectomy
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Mastoid and temporal bone procedures
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Parotidectomies
BAEP/VEP—Brainstem Auditory Evoked Potentials & Visual Evoked Potentials: Brainstem Auditory Evoked Potentials & Visual Evoked Potentials are used to test the integrity of the auditory and visual system.
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Posterior fossa craniotomy, especially cerebellar-pontine angle (CPA) tumors
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Basilar Artery Aneurysm
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Temporal craniotomy for evaluation of lateral cerebral cortex
TCD—Transcranial Doppler: Used during certain vascular procedures to monitor cerebral blood flow. TCD works by insonating specific extracranial and intracranial arteries implemented in the various procedures including:
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Carotid Endarterectomies
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Cardiovascular Surgery
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Detection of cerebral Artery emboli
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Detection of vasospasm
Electrocorticography—The intraoperative recording of potentials from the cortical surface.
