After anesthesia gets the patient off to sleep, the IOM tech will place both stimulating and recording electrodes on the body to both elicit and receive particular signals relative to which procedure is being done.  The monitored modalities will be specific to what areas the surgeon will work on.  These electrodes are sub-dural (needles) which directly monitor the muscles.  When subdural electrodes are used, the tech will prep the site with alcohol wipes before placing the lead.  Once the leads are in place, the tech will run a baseline recording, to which the rest of the surgery will be compared.  Once the baselines are obtained, the reading neurologist will be contacted to begin supervision.  Even though the IOM tech is the only monitoring staff in the actual room, the reading neurologist sees everything that is on the recording screen in real-time.  The IOM tech and the reading neurologist keep a constant and open communication throughout the surgery, notifying the surgeon of any changes for immediate action if needed.​  After closing, the tech will remove these leads, and clean the sites before the patient wakes up.  In some cases, the OR staff need to get the patient to recovery (or another Post-OP area), and there may still be some blood from the lead placement.  These are usually superficial marks, and can be easily wiped off when convenient.  Recording sites may be sore for a day or two following the surgery.

Vascular Surgery involves management and repair of veins and arteries.  In general, vascular surgeons will request IOM (Intraoperative NeuroMonitoring) if the surgery involves temporarily stopping blood flow to the brain or major peripheral nerves.  

Why does my Vascular Surgery have IOM?

Vascular Surgery

How does the IOM tech monitor my surgery?

Neurosurgeries cover a wide range of procedures.  They can vary from brain surgery (craniotomies) to Carpal Tunnel Release procedures.  In general, neurosurgeons will request IOM (Intraoperative NeuroMonitoring) when they are operating near or on the spinal cord, and at some depth in the brain.  They may also, on occasion, request IOM when they feel there are elevated risks due to location of a tumor or spinal fractures.

How does the IOM tech monitor my surgery?

ENT Surgery (Facial Nerve/Thyroid)

Why does my ENT surgery have IOM?

After anesthesia gets the patient off to sleep, the IOM tech will place both stimulating and recording electrodes on the body to both elicit and receive particular signals relative to which procedure is being done.  The monitored modalities will be specific to what areas the surgeon will work on.  These electrodes are a mix of surface (adhesive) and sub-dural (needles).  In locations where subdural electrodes are used, the tech will prep the site with alcohol wipes before placing the lead.  Once the leads are in place, the tech will run a baseline recording, to which the rest of the surgery will be compared.  Once the baselines are obtained, the reading neurologist will be contacted to begin supervision.  Even though the IOM tech is the only monitoring staff in the actual room, the reading neurologist sees everything that is on the recording screen in real-time.  The IOM tech and the reading neurologist keep a constant and open communication throughout the surgery, notifying the surgeon of any changes for immediate action if needed.​  After closing, the tech will remove these leads, and clean the sites before the patient wakes up.  In some cases, the OR staff need to get the patient to recovery (or another Post-OP area), and there may still be some blood from the lead placement.  These are usually superficial marks, and can be easily wiped off when convenient.  Recording sites may be sore for a day or two following the surgery.

ENT will use IOM when there is a tumor/lesion entangled amongst the cranial nerves that run throughout the head, including facial and laryngeal nerves.  The surgeons want to be 100% sure that what they remove is tumor tissue, and not these nerves.  Using IOM to help identify which tissue is nerve tissue vs tumor can be the crucial difference between facial paralysis or a successful outcome. 

ENT (Facial Nerve/Thyroid) surgeries usually involve the removal of tumors or lesions that are tangled in with nerves or muscle tissue.  In general, ENT surgeon request IOM to help differentiate these abnormalities with savable tissue.

Vascular surgeons may use IOM on cases when they need to cut off blood flow for any amount of time to the brain or major peripheral nerves during arterial/veinous repair.  Though the repair may be away from the brain, the blood traveling through the afflicted area may be a direct supply to cranial functions.  Using the direct observation of waveforms for brain function during the repair, the monitoring team is able to notify the surgeon immediately when neurophysiological changes occur during the procedure.  This may include an actual change related to surgical manipulation, or positioning issues which may become semi-permanent depending on the length of the case.

Why does my Neurosurgery have IOM?

Neuro Surgeries (Brain and Spine)

After anesthesia gets the patient off to sleep, the IOM tech will place both stimulating and recording electrodes on the body to both elicit and receive particular signals relative to which procedure is being done.  The monitored modalities will be specific to what levels/areas the surgeon will work on.  These electrodes are a mix of surface (adhesive) and sub-dural (needles).  In locations where subdural electrodes are used, the tech will prep the site with alcohol wipes before placing the lead.  Once the leads are in place, the tech will run a baseline recording, to which the rest of the surgery will be compared.  Once the baselines are obtained, the reading neurologist will be contacted to begin supervision.  Even though the IOM tech is the only monitoring staff in the actual room, the reading neurologist sees everything that is on the recording screen in real-time.  The IOM tech and the reading neurologist keep a constant and open communication throughout the surgery, notifying the surgeon of any changes for immediate action if needed.​  After closing, the tech will remove these leads, and clean the sites before the patient wakes up.  In some cases, the OR staff need to get the patient to recovery (or another Post-OP area), and there may still be some blood from the lead placement.  These are usually superficial marks, and can be easily wiped off when convenient.  Recording sites may be sore for a day or two following the surgery.

Intraoperative NeuroMonitoring is a tool used by surgeons for a constant, real-time status of their patients during surgery.  It is regularly used in Neuro (Brain & Spine), ENT, and Vascular cases. 

Surgeons regularly use IOM on neuro procedures due to the nature of these surgeries.  IOM ensures that they have the best and most accurate information possible on a constant basis throughout the surgery.  Nerves and the spinal cord are extremely sensitive to any manipulation or disruption.  Since the patient is asleep, the surgeon relies on IOM to let them know if these nerves become irritated, which can be a precursor to further injury.  IOM can also test instrumentation (screws), nerves, or even watch for an arm falling asleep during a long surgery (which can lead to neuropathy).

Intraoperative

​Neuro-

Monitoring

(Surgery)

All Intraoperative cases are monitored with an online reading neurologist in real-time.  You have a whole team working to ensure the surgeon is aware of any changes during your procedure.

How does the IOM tech monitor my surgery?