YOUR IOM PARTNER
HOSPITALS
Intraoperative monitoring has been shown to reduce the costs associated with surgically induced neurological deficits. Our services help give your surgeons the feedback they need to ensure the best possible surgical outcomes and patient care possible.
Partnering with hospitals to deliver superior intraoperative monitoring services at the local level, NW Monitoring provides individualized solutions that meet your OR objectives. Built on exceptional customer service, we establish a long-term supply chain partnership with facilities with our technicians providing the consistency and 24-hour dependability necessary to run an efficient OR. Our scheduling team ensures you have the monitoring coverage your surgeons need so nothing falls through the cracks, and our in-house billing department works diligently with insurance companies to reduce and often eliminate patient responsibility.
Unlike larger, impersonal IOM companies, NW Monitoring is privately owned which means you will always be working with a familiar associate to get the intraoperative monitoring services you need.
A Trusted Name in Intraoperative Monitoring
The Gold Seal is Our Gold Standard
Joint Commission Accredited
Monitoring Modalities
| Monitorable Structures | Surgical Applications | |
|---|---|---|
| Brainstem evoked potentials are obtained by stimulating the auditory system with click stimuli. The neural action potentials between the cochlea and the medial geniculate body are evaluated based on the brainstem evoked response. Brainstem evoked responses are sensitive to disturbances of the auditory nerve and to retractor disturbances of the brainstem. | Cranial Nerve VIII
Auditory Brainstem Pathways |
|
| Monitorable Structures | Surgical Applications | |
|---|---|---|
| Language, motor, and sensory areas of the exposed cortex can be identified by direct brain recording or stimulation. The somatosensory response is recorded from the surface of the brain. Language areas are determined by verbal responses during brain stimulation in the awake patient. Motor areas of the cortex and the internal capsule are determined from EMG and evoked by electric brain stimulation. | Motor Cortex and Internal Capsule
Language Areas of the Brain Sensory Cortex |
|
| Monitorable Structures | Surgical Applications | |
|---|---|---|
| On going EEG activity from the scalp is recorded from a multi-electrode array and subjected to a fast Fourier transform (FFT) analysis producing a frequency/power spectrum that can be monitored to assess changes in the metabolic state of cortical structures. | Cortex |
|
| Monitorable Structures | Surgical Applications | |
|---|---|---|
| Blood flow velocity is measured from intracranial arteries using Doppler ultrasound. This technique is used to detect emboli, vasospasm and inadequate blood flow to cortical structures. Microvascular Doppler can also be used to directly assess blood flow within and through an aneurysm. | Middle Cerebral Artery
Aneurysm Feeder Arteries |
|
| Monitorable Structures | Surgical Applications | |
|---|---|---|
| Near-infrared absorption measurements are used to calculate an index of cerebral venus oxygen saturation | Cortical Perfusion |
|
| Monitorable Structures | Surgical Applications | |
|---|---|---|
| Visual evoked potentials are obtained from flash stimulation of the eye, and are measured from the occipital region. They may provide useful information regarding the function of the pre-chiasmal visual pathways, but are labile and require careful anesthetic control. Additionally, retrochiasmal functional changes are difficult to assess using flash visual evoked potentials. | Optic Nerve Fuction Anterior to Chiasm |
|
| Monitorable Structures | Surgical Applications | |
|---|---|---|
| Somatosensory evoked responses are obtained by stimulating a peripheral nerve at the wrist and/or ankles. The propagation of the sensory action potentials is evaluated along their pathways to the cortex. This modality gives information about the integrity of the sensory pathways. It is also highly correlated with preservation of the spinal cord motor pathways. | Spinal Cord
Lumbar and Sacral Nerve Roots Monitoring Metabolic Function of Cortical Structures Brainstem Somatosensory Pathways |
|
| Monitorable Structures | Surgical Applications | |
|---|---|---|
| Motor Evoked Potentials are obtained by transcranial electric stimulation of the cortical motor areas. Monitoring the evoked muscle responses or the descending potentials from the spinal cord (The “D” wave) can assess the integrity of the motor pathways. | Spinal Cord Motor Pathways |
|
| Monitorable Structures | Surgical Applications | |
|---|---|---|
| Spinal Nerve Roots: Spontaneous EMG monitoring warns of potential nerve damage during manipulation. Evoked EMG stimulation of the pedicle screws can indicate a misdirected screw placement.
Cranial Nerves: The evaluation of spontaneous and evoked electromyogenic activity can be extremely useful in monitoring cranial nerve function. Spontaneous activity in the distribution of these nerves can signal mechanical disturbance of the cranial nerve. Peripheral Nerves: The function of peripheral motor nerves can be evaluated during surgery by means of spontaneous and evoked electromyographic activity. |
Spinal Motor Roots
Cranial Nerves III, IV, V, VI, VII, IX, X, XI, and XII All Peripheral Motor Nerves |
|