Download to read offline
Presentation_IONM_CME. PowerPoint presentation
- 1.
- 2. WHEN WE DO IT? WHY WE DO IT? HOW WEDO IT ? WHAT WE DO? WHAT IS IONM?
- 3. IONM • Use ofelectrophysiological methods to monitor the integrity of neural structures. • Surgoens obtain and interprets signals from the patients continuously or intermittently during the course of the surgery. • Neurophysist monitor and document the signals in real time
- 4. INDICATIONS. • VASCULAR • TUMOURSINVOLVING ELOQUENT AREAS. • CP ANGLE TUMOURS . • BRAINSTEM LESIONS. • SPINAL CORD TUMOURS • SPINAL DEFECTS AND DEGENARATIVE DS. • KYPHOSCOLIOSIS. • PEDIATRIC PTS
- 5. WHY • MINIMISE MORBIDITY •INTRAOPERATIVE MANIPULATIONS. • GOAL IS TO IDENTIFY, MONITOR NEURAL STRUCTURES INTRAOPERATIVELY TO PREVENT IRREVERSIBLE NERAL DAMAGE. • INDIVISUAL ANATOMY VARIES • TUMUOR CAN DISPLACE NEURAL STRUCTURES. • TRAUMA CAN DISTRORT THE ANATOMY.
- 6. WHY DO WEMONITOR? Locate Identify Verify Observe Confidential | Do not distribute
- 7. HARDWARE • LAPTOP • ECLCPROCESSING UNIT • DIGITAL PRE AMPLIFIER • STIMULATION BOX • ELECTRODES • NERVE STIMULATORS.
- 9. WE MONITOR • EEG •SPECTRAL EDGE FREQUENCIES • MEP. • SSEP. • VEP • BAER.
- 11. EMG 1.RAW Electromyography(EMG): electrical activity of the muscles 2.Triggered EMG: 1. Direct nerve stimulation: Electrical activity of the muscle due to direct nerve stimulation 2. Nerve Proximity testing: Electrical activity of the muscle due to spread of stimulation in the proximity of nerve 3. Screw Testing: Electrical activity of the muscle due to stimulation on the screw shaft placed in the pedicle
- 12. RECORDS MUSCLE ACTIVITYRESULTING FROM THE ACTIVATION OF CRANIAL OR SPINAL N. 2 ELECTRODES 3-6 MM APART. CURRENT UP TO 1000 MICRO V. AMPLIFIER GAIN 2000FSI. NO NOTCH FILTER BAND PASS 30-1500HZ.
- 13.
- 16. RAW EMG ⮚Bursts, blurpsshort- • Mechanical (near by dissection, CUSA, drilling) • Nerve retraction • Cautery • Thermal irrigation ⮚Continous synchronous Trains/popcorn/ bomber aircraft/ motor boat • Direct Nerve compression • Traction • Ischemia Neurotonic 30 sec Bursts 100 msec
- 18.
- 19.
- 20.
- 21.
- 25.
- 26.
- 32. Methods for Cranial Nerve Monitoring II Opticsensory: VEP III Oculomotor motor:inferior rectus m IV Trochlear motor: superior oblique m V Trigeminal motor: masseter and/or temporalis m VI Abducens motor: lateral rectus m VII Facial motor: obicularis oculi and/or obicularis oris m VIII Auditory sensory: ABR IX Glossopharyngeal motor: posterior soft palate (stylopharygeus m) X Vagus motor: vocal folds, cricothyroid m XI Spinal Accessory motor: sternocleidomastoid m and/or trapezious m XII Hypoglossal motor: tongue, genioglossus m
- 33.
- 36. Confidential | Donot distribute
- 37. ALARM CRITERIA • All ornone • 50 % decrease in amplitude • Higher threshold for stimulating currents • Muscle MEP- INTERMITTENT • Kindling • Seizures , jerking, tongue bite • No muscle relaxation
- 38. Significance of MEP monitoring • Spinalcord monitoring- 50-80% reduction in morbidity in spine surgery • Tumors around motor cortex • If the MEP signals are present in the level below the operating area, cord is intact.
- 39. Somatosensory evoked potentials (SSEPs) •Electrical activity of the brain recorded from sensory cortex after stimulating the peripheral nerves
- 41. BASIC TERMINOLOGIES Peak Trough Amplitude Latency PEAK Nomenclature-P(positive) or N (negative) followed by latency in milli secs P40, N20 Voltage vs Time
- 48. SSEP • Alarm criteria: 50% DECREASE IN AMPLITUDE and 10 % INCREASE IN LATENCY • Good Ischemia monitor (MORE RESISTANT TO EEG) • Vascular cases- aneurysm ⮚ Temporary clipping – early loss- post op neuro deficits ⮚ Acom-ACA territory- Lower limb SSEP), CEA and MCA- upper limb SSEP • Continuous monitor
- 49. •Orthodromic and antidromicstimulation
- 50. Posterior Tibial N.SSEP stimulus Primary Sensory Cortex Med. Lemniscus Cervico- Medullary Junction Spinal Cord
- 51.
- 52.
- 54. BETTER OUTCOME –MINIMISESRISK FOR THE FUNCTIONAL STATUS OF THE NEURAL STRUCTURES DURING THE SURGERY. ALERT –SURGERICAL TEAM AND HELP THEM IDENTIFY THE CAUSE AND TAKE CORRECTIVE ACTIONS BETTER PT CARE. REDUCES MORBIDITY AND MORTALITY. REDUCES HOSPITAL STAY REDUCES MEDICAL COSTS.
- 55.
- 56.