Intraoperative Neuromonitoring

IntraNerve Neuroscience (INN) is a respected national Telehealth services provider committed to patient safety, supporting surgeons and the various types of healthcare facilities across the United States. Whether you are a healthcare system, university, surgery center, or a small, medium, or large hospital, we customize to your specific needs. Since our inception, INN has grown organically, providing a patient-centric operations support model and staffing our facilities with local, competent teams of surgical neurophysiologists. Established in 2007, our presence quickly expanded across the U.S. We now provide IONM across the country in support of over 100 facilities and 300+ surgeons.

Our neuromonitoring company provides diverse technical staff members who come from all different educational backgrounds, including M.D., AuD, PhD, DC, MS, CNIM, BS, BA, R. EEGT, and R.EP.T.

Contact us today!

What is IOM?

IONM stands for IntraOperative Neurophysiological Monitoring. It is also commonly referred to as intraoperative neuromonitoring, IOM, and “monitoring”. IONM has been clinically proven to reduce the patient’s risk of iatrogenic damage to the nervous system and provide functional guidance to the surgeon and surgical team. IOM neuromonitoring can be used to localize and test the function of neural structures.

IONM consists of both a technical and professional component. The monitoring is performed by a certified or board eligible Surgical Neurophysiologist in the operating room (technical component) and is overseen remotely in real-time by a fellowship-trained physician or doctor of audiology (professional component). Together, a qualified, experienced Surgical Neurophysiologist along with certified, experienced professional interpretation melds the high-level technology and specialized neurological background needed to provide patient safety and positive outcomes.

IntraNerve Neuroscience

How do we work?

Hospital schedules case with IntraNerve.

Hospital schedules case with IntraNerve Neuroscience (INN).

IntraNerve notifies regional team and neurophysiologist is assigned.

INN notifies regional team and neurophysiologist is assigned.

IntraNerve Neuroscience Provides Solutions for Hospitals

Surgical Neurophysiologist arrives at hospital, talks with patient and surgical team, and sets up equipment.

Secure HIPAA compliant screenshare and chat

Surgical Neurophysiologist connects to remote real-time professional interpretation via a secure HIPAA compliant screenshare and chat.

Neurophysiologist notifies surgeon of alerts during surgery.
Surgeon is kept informed of the patient’s status throughout the procedure.
IntraNerve Neuroscience Provides Solutions for Patients

Patient leaves surgery with improved outcome and experience.

What procedures and modalities do we commonly monitor?

  • Cervical, Thoracic & Lumbar levels
  • Instrumentation Cases, Total Disk Replacement, Scoliosis Correction, Growing Rod, Discectomy/Laminectomy, Corpectomy & Decompressions 
  • XLIF/LLIF/OLIF/ALIF
  • Spinal Cord Stimulator
  • Craniotomies: Brain Tumor Removal, Microvascular Decompression, Awake, Acoustic Neuroma & Skull Base 
  • Spinal Cord Tumor, Tethered Cord Release & Rhizotomy 
  • Deep Brain Stimulator
  • Thyroidectomy & Parathyroidectomy 
  • Parotidectomy, Submandibular Gland Removal & Neck Dissection
  • Tympanoplasty/Mastoidectomy
  • Canalplasty
  • Cochlear Implants
  • Atresiaplasty
  • Endolymphatic mastoid shunt
  • Encephalocele Repair
  • Repair CSF leak
  • Micro Vascular decompression
  • Glomus Tympanicum/Glomus Jugulare
  • Semi Circular Canal Dehiscence repair
  • Acoustic Neuroma Removal and other skull base tumors
  • Auditory Brainstem Implants
  • Carotid Endartectomy 
  • Brain Aneurysm & Aortic Aneurysm 
  • EC-IC Bypass
  • Trans Carotid Artery Revascularization (TCAR)
  • Transcatheter Aortic Valve Replacement (TAVR) 
  • Arteriovenous Malformation & Arteriovenous Fistula 
    •  
  • Acetabular Fractures & Arthroplasty Revisions 
  • Open Reduction and Internal Fixation
  • Joint Replacement
  • Limb lengthening and deformity correction
  • Brachial Plexus, Nerve Release, Carpal Tunnel Revision  
    & Peripheral Tumor Removal 
  • Sensory & Motor Re-innervation 
  • Prostate Surgery
  • Somatosensory Evoked Potentials (SSEPs)
    • Assess the functional integrity of the dorsal column sensory pathways from the peripheral nerve to the sensory cortex.
  • Transcranial Motor Evoked Potentials (TcMEPs/MEPs)
    • Assess the functional Integrity of descending motor pathways, from the motor cortex to peripheral muscles.
  • Electromyography (EMG)
    • EMG activity is recorded using needle electrodes placed subdermally (under the skin and near a muscle), or directly in the belly of the muscle(s) of interest.
  • Free-running EMG (sEMG)
    • Provides real-time feedback whenever a motor nerve is activated or irritated by surgical manipulation such as pulling, stretching, and/or compression of nerves.
  • Stimulus-Triggered EMG (tEMG):
    • Response to direct or indirect electrical stimulation of nerves. A hand-held probe is used to deliver electrical current to the site of interest. When a functional nerve is depolarized, a response is recorded in the form of a compound muscle action potential (CMAP).
  • Pedicle Screw Testing
    • The test is designed to evaluate pedicle screw placement, specifically focusing on medial pedicle screw breaches.
  • Electroencephalography:
    • Records electrical activity from the cerebral cortex.
  • Train of Four (TOF)
    • Assess the neuromuscular junction to assess the reliability of modalities that record from peripheral muscles (i.e. EMG, TceMEP).
  • Auditory Brainstem Responses (ABR):
    • Monitors the auditory brainstem function (hearing) in response to auditory (click) stimuli.
  • Language Mapping:
    • Performed by asking the patient various tasks while they are awake to identify eloquent areas.
  • Motor Mapping:
    • Cortical Stimulation: Allows for functional mapping of the primary motor cortex.
  • Subcortical Stimulation:
    • Allows surgeon to functionally assess proximity to descending corticospinal tracts during deep tumor resection.
  • Cranial Nerve Electromyography (CN-EMG):
    • Allows for functional identification and mapping of motor and/or mixed cranial nerves. CN-EMG provides real-time feedback regarding mechanical irritation of motor and/or mixed cranial nerves.
  • Visual Evoked Potentials (VEP):
    • Assess the function of the entire visual pathway in response to light stimuli.
  • Phase Reversal:
    • Identify the location of Central Sulcus by recording SSEP responses from a grid placed on the exposed surface of the brain by the surgeon.
  • D-Waves:
    • Assesses the motor pathway by recording electrical responses (D-Waves) from an epidural electrode placed by the surgeon.
  • Dorsal Column Mapping:
    • Aids in identifying structures in the spinal cord during intramedullary tumor resection. Involves the direct stimulation of the dorsal columns with a handheld probe and recording the corresponding sensory evoked potential from the scalp.
  • Electrocorticography (ECoG):
    • Electrodes placed directly on the exposed surface of the brain to record electrical activity from the cerebral cortex.
  • Pelvic Floor Mapping for Robot-Assisted Radical Prostatectomy (RARP):
    • Identify and preserve critical non-visible somatic nerves.
  • Compound Nerve Action Potentials (Nerve Conduction):
    • Measure conduction velocity and integrity of sections of peripheral nerves during peripheral nerve surgeries, i.e. tumor resection.

Robotics, Prosthetics & IONM

In 2015 INN provided services on a groundbreaking procedure using target sensory reinnervation (TSR) and targeted muscle reinnervation (TMR). When a surgeon asked if INN’s Director of Education could help assist in reestablishing not only the motor but sensory functions to a patient with an amputated arm; INN began researching the feasibility and logistics. After successfully mapping out the sensory nerves in the patients arm and connecting them to a robotic prosthetic, this patient was given back valuable functions of her life. Today this patient has been touted as the “Worlds most advance amputee” by People Magazine and seen on the TV show “The Doctors”. Contact INN to learn more about our High-Performance Difference in Neuroscience.

Grand Rounds in IONM

We place high value on Continued Medical Education (CME) within INN. As a service to our employees and customers, we offer Grand Rounds education quarterly. Below are some topics we have covered in the past and will cover in the future.

Previous Grand Rounds Topics

  • Alert Communication Grand Rounds
  • Monitoring Lateral Lumbar Fusions (XLIF, DLIF, LLIF, OLIF)
  • Monitoring for Scoliosis Procedures
  • Monitoring for Anterior Cervical Discectomy and Fusion Procedures (ACDF)
  • SSEP Best Practices

Upcoming Grand Rounds Topics

  • IONM Billing
  • Recurrent Laryngeal Monitoring (RLN)
  • Monitoring for Spinal Cord Stimulator Placement