Intraoperative Monitoring Unit
Dr. María del Mar Santiago Sanz
Neurophysiologist.
Intraoperative Neurophysiological Monitoring Unit
WHAT MONITORING ISÓN NEUROPHYSIOLOGYÓGIC INTRAOPERATIVE MONITORING?
It is a set of techniques used in a standardized way, during surgical procedures in which the different nerve structures are at risk of injury. MNIO is performed in an individualized manner, depending on the particularities of the patient as well as the surgical procedure, and in a complete manner, for which different neurophysiological techniques are used, which is known as multimodal MNIO. Multimodality integrates monitoring as a technique of control and continuous functional evaluation of the nerve structures and mapping as a technique of identification and localization of nerve and non-nerve anatomical structures.
¿CUÁHAT ARE OUR OBJECTIVES?
The main objective of the MNIO is to preserver anatomical integrityómica y functional of the nervous system and its components. Injuries that occur can be caused by surgical maneuvers, such asúTheí as physiological eventsóThe use of the product in the productionóThe nerve structures.
In some cases, the distortion of theón anatóThe surgeon is faced with an unforeseeable challenge, and the interpretation of the surgical technique is fundamental.óThe real-time monitoring of the monitored variables to modify the operating strategy.úand, in its absence, to supportíto more efficient maneuvering.áThe most aggressive treatments with the certainty of avoiding subsequent sequelae. Therefore, the identification of the ón anatomicalíThe anatomy and function of a nerve structure and its integrity is a desirable goal of MNIO.
The surgeon must know, to the best of his knowledge, how toóThe surgeon must know, as closely as possible, the prognosis of the patient.óThe surgeon must know, as closely as possible, the short and long term prognosis that is estimated when alterations occur during surgery.ía. In this way, postoperative management is adapted to each patient in the most appropriate way.ámore effectively.
Recognize and avoid injuryóThe nervous system. Enabling the surgeon to change his strategy and anticipate the lesion. Irreversible damage.
Confirm that the strategy willúThe surgical technique is appropriate. Encouraging the surgeon to perform a interventionón más or, on the contrary, to limit it.
Document the exact moment at which an injury occurs.ópossiblepossible irreversiblewith 2 advantages:
● The retrospective understanding of the mechanisms of the injuryón
● The adjustment of the quir strategyúThe adjustment of the surgical strategy in the future
“Predict“ the pronóstico neurologicalógic prognosis, improving the clinical managementípostoperative clinical management of the patient.
One objective of the MNIO that we must not forget is the source of information for theóIt is a source of information for new studies.s research studies.óand advances in the áand advances in the medical field.émedical surgeryúrgical.
The quality of care of this service must be be at the highest leveláThe quality of care in this service must be at the highest national and international competitive level, and the MNIO, with its high performance, must be able to provide the highest quality of care. óThe MNIO with optimal performance guarantees this purpose.ósito.
MNIO is indicated in surgeries in which there is a risk of involvement of the central nervous system and the peripheral nervous system both directly as in spinal tumors, and indirectly in arteriovenous malformations, for example.
We have extensive experience in both pediatric and adult care, so care is comprehensive and not limited in this regard.
The following is a list of the most frequent pathologies and procedures for which MNIO is indicated and which could be treated by our team:
CirugíBrain surgery
- Brain tumors
- Tumor surgery in eloquent areas with awake patient
- Pituitary surgery with transsphenoidal abortion
- Vascular lesions (cerebral aneurysms, arteriovenous malformations, cavernoma)
Brain stem tumors of the brain steméposterior fossa and base of the skull.áneo
PathologyíSpinal Cord Pathology
- Cervical myelopathy
- Extradural and intradural tumors
- Intramedullary and extramedullary tumors
- Epidural electrode implantation for pain management
- Intramedullary vascular malformations
Pathology of conus medullaris and cauda equina
Anchored medulla
Tumors
PathologyíSpine pathology
- Vertebral fractures
- Minimally invasive surgery (XLIF)
- Deformities (scoliosis, etc.)
- Bone tumors
Pathologyíperipheral nerve pathologyérico
- Trauma
- Tumors
- Brachial plexus and lumbosacral plexus injury
- Pudendal nerve decompression
Cirugíhip surgery
Neurinoma of the acú(smaller than 2cm)
PathologyíNeck pathology
- Parotid and thyroid
Cirugívascular surgery
- Carotid endarterectomy
- Arteriovenous malformation
- Cardiac surgery
- Aortic aneurysms
WHAT NEUROPHYSIOLOGICAL TECHNIQUES DO WE USE?
General MNIO techniques allow quantitative and qualitative assessment of the functional and anatomical integrity of the central and peripheral nervous system. In addition, nerve areas and structures are assessed and identified in real time, allowing a correct knowledge of the surgical field.
The protocol varies on a case-by-case basis and may include the following neurophysiological modalities:
General MNIO techniques allow quantitative and qualitative assessment of the functional and anatomical integrity of the central and peripheral nervous system. In addition, nerve areas and structures are assessed and identified in real time, allowing a correct knowledge of the surgical field.
The protocol varies on a case-by-case basis and may include the following neurophysiological modalities:
MAPPING
- Direct cortical and subcortical electrical stimulation
- Direct electrical stimulation of nerve structure (nerve, nucleus of cranial nerves, nerve root, etc.).
- Pedicular stimulation
- Phase reversal
MONITORINGÓN
- Free-scanning EMG (EMG)
- Somatosensory evoked potentials (SSEPs)
- Motor evoked potentials (MEP) by transcranial and transcortical electrical stimulation.
- Brainstem auditory evoked potentials (BAEP)
- Visual evoked potentials (VEPs)
- Onda D Register
- Corticobulbar evoked potentials (CoMEP)
- Electroencephalography (EEG)
- Reflexes (H, RBC, etc.)
The needs and expectations of the surgical teamúThe needs and expectations of the surgical team guide the planning of theóThe needs and expectations of the surgical team guide the planning of the MNIOás preservation of the environment.áThe aim is to minimize the morbidity underlying the procedure by reversing maneuvers detected in real time.
The team of neurophysiology teamólogos is highly The proper planning, methodology used and correct interpretation of the results of the study are the key to the success of the study.n de ldata is a is a guarantee of good results, safety and adequate dynamics of the procedure.of good results, safety and adequate dynamics of the procedure.
A review of the patient’s medical history is performed, taking into account medical and surgical history, imaging tests, neurological examination and treatments received by the patient, with relevant involvement in monitoring.
A baseline scan of the different intraoperative modalities is recorded for each procedure.
The monitoring of brain tumors of eloquent areas such as language, in which the surgical procedure is performed awake, a complete preoperative interview is carried out, including a detailed clinical history, a language exploration (nomination, association tasks, naming, etc.) essential for the correct choice of tasks, and the preparation of the patient.
Our mission is to guarantee the success of surgery and proper monitoring allows us to reduce hospitalization time, reduce the number of reoperations due to complications and consequently increase the number and supply of safe interventions, which is fundamental for a perception of good care and quality by our patients.
We put our experience and knowledge at the disposal of the different surgical teams and thus, we place the Ruber International Hospital at the national and international forefront in this sector in constant growth and development.
Main surgical services
Our
Specialties
Intraoperative Neurophysiological Monitoring Unit
Dr. María del Mar Santiago Sanz
Neurophysiologist. Head of Intraoperative Neurophysiological Monitoring Unit.
