Intraoperative Neuro - Monitoring Training
Evoked Potentials 15 Days Course
1. Somatosensory Evoked Potential (SSEP/MEP) (Upper and Lower Extremity)
2. Brainstem Auditory Evoked Potential (BAEP)
This 15 day course is designed to improve knowledge and skills necessary to adequately perform Evoked
Potentials (EP) in the workplace. This course is also a good foundation for learning or sharpening
Intraoperative Monitoring (IOM) skills.
A detailed explanation of the EP instrument is featured on day one ~ five. An introduction to EP modalities
is followed by lectures on near-field vs far-field recording methods, stimulus types and characteristics,
calibration, polarity, amplification (recording gain, display gain, sensitivity), and filters. The averaging
process will be explained in detail. You will learn how the analysis time, number of points, dwell time and
sampling rate determine horizontal resolution and how to calculate each. Vertical resolution and the
number of voltage levels expressed as bit capacity will be explained. You will gain an understanding of the
signal-to-noise ratio and its effect on the resolution of the signal. You will gain a working knowledge of EP
terminology.
SSEP( Sensory Evoked Potential ) will be the focus of day 6~8. We will begin with an introduction of the
SSEP followed by anatomy and physiology of the Sensory System, electrode placement, instrument
parameters, visual angle, montage construction, and peak identification. This series of lectures is followed
by an extensive hands-on workshop where each participant will have the opportunity to function as a
technologist and a patient. The workshop is followed by lectures discussing waveform measurements,
criteria for abnormality, and troubleshooting techniques.
MEP ( Motor Evoked Potential ) will be the focus of day 9~11. We will begin with an introduction of the
Upper/Lower Extremity MEP followed by anatomy and physiology of the Extremity Motor System, electrode
placement, instrument parameters, montage construction, and peak identification. This series of lectures
is followed by an extensive hands-on workshop where each participant will have the opportunity to function
as a technologist and a patient. The workshop is followed by lectures discussing waveform measurements,
criteria for abnormality, and troubleshooting techniques.
BAEP ( Brainstem Auditory Evoked Potential ) will be covered on day 12~15. We begin with an
introduction of Brainstem Auditory EP followed by anatomy and physiology of the Brainstem Auditory
System, electrode placement, instrument parameters, montage construction, and peak identification. This
series of lectures is followed by an extensive hands-on workshop where each participant will have the
opportunity to function as a technologist and a patient. The workshop is followed by lectures discussing
waveform measurements, criteria for abnormality, and troubleshooting techniques.
IOM Information
The purpose of intraoperative monitoring (IOM) is to reduce the incidence of surgically induced
neurological deficits. By reducing this incidence, surgical outcome is improved which decreases short and
long-term medical costs, morbidity and mortality.
Surgical procedures that most often require IOM include, but are not limited to the following: Carotid
Endarterectomy, Anterior Cervical Diskectomy, Instrumentation for Spinal Instability including pedicle
screws, Scoliosis Correction, Spinal Cord Untethering, Cranial Base Tumors, Posterior Fossa Tumors,
Microvascular Decompression, Intracranial Aneurysms and Arteriovenous Malformation.
A variety of electrophysiological and vascular procedures are administered during surgeries that require
IOM. These procedures include all modalities of evoked potentials (somatosensory, auditory, visual and
motor), Electroencephalography (EEG), Electromyography (EMG), ultrasound imaging and TransCranial
Doppler (TCD).
Epstein et al. (1993) assessed the clinical usefulness of IOM during cervical spine decompression by
comparing 218 patients that were not monitored with 100 patients that were. There was a 3.7% incidence
of quadriplegia and a 0.5% incidence of death in the unmonitored patients. There was no incidence of
quadriplegia or death in the monitored group (Epstein et al., 1993, SPINE 18(6): 737-74). Since this article
there are numerous other studies that support the direct relationship between monitoring and the
associated reduction in patient morbidity, mortality and costs. Intraoperative monitoring is now considered
a standard of care for many surgical procedures despite its relatively low appliance.
For details, please contact us
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