YOUR IOM PARTNER
SURGEONS
Results from research published in peer-reviewed journals indicates that our monitoring services will significantly reduce the costs associated with surgically induced neurological deficits. By improving surgical outcomes and reducing short-term and long-term costs, we can help you provide your patients with the most effective and efficient services available.
At NW Monitoring clinical excellence is one of our top priorities. All of our surgical neurophysiologists are board certified or preparing for The Certificate in Neurophysiologic Intraoperative Monitoring (CNIM®), the industry standard in intraoperative monitoring services. All your cases will be monitored onsite by our technician and remotely by one of our supervising neurologists using sophisticated and secure telemedicine services.
At NW Monitoring we believe that trust and reliability are essential for the efficient operation of a surgical team which is why we employ local technicians who are available on a 24-hour basis. Our consistent, high quality services and the relationships we build with surgeons and hospitals lead to improved communication and patient safety.
Our privately held ownership allows us to cut through the corporate red tape and focus on offering unparalleled customer service and clinical excellence from local skilled technicians, not the bottom line.
Procedure Types We Monitor
Scoliosis Correction
Corpectomy
Discectomy
Laminectomy
Spinal Osteotomy
Acetabular Fractures and Revision
Brain Tumors
Spinal Cord Tumors
Microvascular Decompression
Malformations
Cerebral Aneurysm Clipping/Coiling
Arteriovenous Malformations
Abdominal Aortic Aneurysm
Parotidectomy
Mastoid Process Procedures
Thyroidectomy
Cochlear Implant
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 | |
|---|---|---|
| Near-infrared absorption measurements are used to calculate an index of cerebral venus oxygen saturation | Cortical Perfusion |
|
| 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 | |
|---|---|---|
| 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 |
|
| 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 | |
|---|---|---|
| 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 | |
|---|---|---|
| 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 | |
|---|---|---|
| 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 |
|