Intraoperative neuromonitoring (IONM) offers a reliable layer of safety against neural injury for complex brain surgeries. Because IONM sensors can detect neurological signals in real time, surgeons can make adjustments to prevent the impairment of function before it happens, circumventing liability issues and sparing the patient of potential long-term complications.
When it comes to surgeries dealing with highly sensitive areas of the brain, IONM provides responsive data to preserve motor, sensory, and visual pathways throughout the operation, informing the surgical team’s decisions and improving outcomes. Salvaging overall functioning is a critical part of the success of these complex surgeries.
IONM Case Study: Resection of a High-Grade Cerebral AVM
In a recent case study, SpecialtyCare surgical neurophysiology specialists supported a surgical team in a procedure to remove a high-grade cerebral AVM in an eloquent area of the brain. IONM brain-mapping techniques enabled the surgical team to minimize neurological deficit during the complex operation and realize a successful outcome for the patient.
The patient presented with an AVM in the left cerebral cortex, involving the motor cortex, sensory cortex, corticospinal tracts, visual pathways, and posterior thalamus. The surgical team employed multimodal neuromonitoring to ensure neurological functions could be assessed throughout the procedure, implementing motor evoked potentials, sensory evoked potentials, visual evoked potentials using visual stimulation goggles, and cortical and subcortical mapping.
After cutting off the main blood supply to the AVM, the surgical team removed the abnormality piece by piece while receiving real-time data from electrical stimulation to determine proximity to critical neural tissue. Sometimes they were just millimeters away; the signals allowed them to adjust and avoid potentially interfering with the nerves during the resection. Our clinicians played an integral role in implementing and interpreting the signals to support these vital modifications.
The surgery was completed over two days using a staged approach that relied heavily on subcortical mapping. Ultimately, the AVM was completely removed with minimal neurological impact. Additional procedures were performed post-operatively to manage fluid build-up in the patient’s brain.
Two years later, the patient was re-assessed, and her results were very positive. The lasting effects of the surgery were only mild numbness and a small area of vision loss. She had been able to resume her life activities as normal without any other remarkable deficits in neurological functioning.
IONM Collaboration Improves Safety and Success
In this case and many others involving the brain and spine, dynamic feedback outperforms static imaging alone in reducing the possibility of neural injury. Both surgeons and patients can feel more secure in face of high-risk procedures because of the reliability of IONM modalities.
IONM involves continuous communication between the neurophysiologist and the surgeon, from preoperative assessment to lead placement, in-the-moment relays of data during the procedure, and postoperative analysis. The neurophysiologist assists in areas such as cortisectomy placement, dissection planes, and when to stop or stage a procedure, empowering the surgical team with accurate information and greater confidence in decision-making.
How SpecialtyCare Makes Surgery Safer with IONM
At SpecialtyCare, our highly-trained neurophysiologists partner with surgical teams at hospitals around the country to reduce the neurological risks of complex operations. As the largest provider of IONM in the US, we serve over 115,000 patients every year, improving outcomes and supporting success in the surgical suite. We have over 500 neurophysiologists employed across 42 states, and all of them have met 100% of their CNIM requirements. Additionally, our full-time physicians are board certified neurologists with over 10,000 procedures worth of collective experience. To learn more about how we can help you make complex surgeries safer with IONM, contact us today!
