Name of the Procedure:

Continuous Intraoperative Neurophysiology Monitoring (IONM) Common name(s): Continuous intraoperative neurophysiological monitoring, IONM
Technical/medical term: One on one neurophysiological monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure).

Summary

Continuous Intraoperative Neurophysiology Monitoring (IONM) is a procedure where a specialist continuously monitors the nervous system's function during surgery. This real-time monitoring aims to prevent potential damage to the brain, spinal cord, and peripheral nerves.

Purpose

IONM is crucial for surgeries that pose a risk to the nervous system. The primary goal is to ensure the protection and proper functioning of neurological structures by immediately detecting and correcting potential issues.

Indications

IONM is indicated for:

• Spinal surgeries (e.g., scoliosis correction, spinal tumor removal)
• Brain surgeries (e.g., tumor resection, aneurysm repair)
• Peripheral nerve surgeries Patient factors include underlying conditions such as spinal deformities, neurological disorders, or tumors near critical nerves or brain areas.

Preparation

• Patients may be instructed to fast for a specific period before surgery.
• Certain medications may need adjustment or discontinuation as directed by the physician.
• Preoperative diagnostic tests, such as MRI or CT scans, may be required to map out the surgical area.

Procedure Description

1. The patient is placed under general anesthesia.
2. Electrodes are strategically placed on the patient's scalp, limbs, or other relevant areas to monitor neural pathways.
3. A trained neurophysiologist continuously observes the data displayed on specialized equipment.
4. The neurophysiologist and surgical team communicate constantly to address any detected abnormalities.
5. Adjustments in surgical technique are made based on real-time feedback to avoid nerve damage.

Tools and Equipment: Electrodes, EEG/EMG machines, monitoring software.
Anesthesia/Sedation: General anesthesia is typically used.

Duration

The duration of the monitoring coincides with the length of the surgery, with continuous monitoring occurring every 15 minutes.

Setting

IONM is performed in a hospital operating room equipped with the necessary neurophysiological monitoring equipment.

Personnel

• Neurosurgeon or specialized surgeon
• Anesthesiologist
• Neurophysiologist (provides real-time monitoring)
• Surgical nurses and support staff

Risks and Complications

• Minor risk of skin irritation at electrode sites.
• Rare possibility of false-positive/negative signals.
• Potential errors in data interpretation that could affect surgical decisions.
• Management includes immediate surgical correction and follow-up evaluations if complications arise.

Benefits

• Increased surgical safety by minimizing nerve damage risk.
• Immediate detection and correction of potential neural injuries.
• Improved long-term neurological outcomes and reduced risk of postoperative deficits.

Recovery

• Standard postoperative care for the primary surgical procedure.
• Monitoring electrode sites for irritation or infection.
• Follow-up appointments to assess neurological function and address any concerns.

Alternatives

Other treatment options may include:

• No monitoring: Higher risk of nerve damage.
• Preoperative mapping only: Limited real-time feedback compared to continuous monitoring. Each alternative has its own set of benefits and drawbacks, typically with higher risks of adverse outcomes compared to IONM.

Patient Experience

• Under general anesthesia, the patient will not feel anything during the monitoring process.
• Postoperative discomfort might be due to the primary surgery rather than the monitoring itself.
• Pain management will be tailored based on the primary surgical procedure and individual needs.

Feel free to add, adjust, or omit any details to better fit your specific needs or preferences.