What is Intra Operative Neurophysiologic Monitoring?

Every patient is afraid of surgery and perhaps there is some justification for it. After all, any surgery no matter how routine or inconsequential carries an inherent risk.

But, so does life!

If you think about it, walking down the road has its own share of risks when compared to sitting in your living room. But, that doesn’t mean you should lock yourself away from the world for the duration of your natural life.

Refraining from surgery which could improve the very quality of your life is akin to this – silly.

This is made even more so given some of the amazing advances in technology which have made complex surgeries simpler and safer than ever.

One of the most pathbreaking advances in medical technology is the use of ‘intraoperative neurophysiologic monitoring’ (IONM) systems for a wide array of surgeries.

As the term implies, it is the monitoring of various nerves and neural pathways during the course of surgery.

Why would this be needed?

Well, to say that the human body is exceedingly complex is an understatement. The human brain alone has up to a 100 billion neurons while the human body has many times that. These form literally miles and miles of nerves connecting every part of the body . There are motor nerves and sensory nerves. Sensory nerves carry information to the brain while motor nerves carry commands from the brain to the muscles thereby controlling them. The nervous system is incredibly sensitive and complex and therefore the slightest damage to it can cause unforeseen complications, both large and small.

Great surgeons take many years to hone their skill to a knife edge (or scalpel rather) but, each surgery is unique in its own way . No two injuries, conditions or tumours are alike, just as no two human beings are identical. Every time a surgeon delves into the human body, he is undertaking a new exploration. Even getting to the specific loc ation which has to be operated upon within the body involves immense skill and concentration. The location of these nerves can vary or change in different people due to a number of reasons – displacement due to a tumour , distortion due to trauma to the area, changes in landmarks and scar tissue from a previous surgery and just simple variation in anatomy. It is therefore of paramount importance to monitor the state of the nervous system during surgery. This is where IONM systems prove invaluable.

How does it work?

Intra operative neurophysiologic monitoring is a broad term which covers various ways to monitor the nervous system using methods of electroencephalography (EEG), electromyography (EMG) and evoked potentials. Different technologies make use of different methods. NIM nerve monitoring systems for example make use of electromyography (EMG). EMG is carried out using an electromyograph, which detects the electrical potential which muscle cells generate when activated electrically or neurologically.

During the surgery, at specified periods or on a continuous basis, a trained neurophysiologist will use one or more of these techniques to monitor the nerves which could be impacted by the surgery for things such as medical abnormalities, activations levels and so on. This ensures that the surgeon gets constant feedback during the procedure, allowing him to ensure the least possible impact on the nervous system and the best possible outcome. In some cases, such as during the excision of a tumour in a sensitive region of the brain, it also allows the surgeon to test the extent of the damage caused by the tumour , to what extent his or her excision has been completed, potential side effects of the procedure and so on.

In short, IONM helps increase the safety of the patient during surgery and improves the level of outcomes by several orders. Once the province of a select few, IONM technology is used by a number of good hospitals (including us here at Sita Bhateja Speciality Hospital) to telling effect.

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