Introduction and Goals
The Intraoperative Neuromonitoring (IOM) elective provides an introduction to intraoperative neuromonitoring indications and techniques. The senior resident on this elective will review neurophysiology principles and develop an understanding of the common modalities in use, normal responses, anesthesia effects, and alarm criteria. The rotation offers exposure to the following neurophysiologic monitoring modalities:
- Continuous EEG
- Transcranial electrical motor evoked potentials
- EMG (free run and triggered)
- Brainstem auditory evoked potentials
- Somatosensory evoked potentials
The learner will directly observe set-up and signal acquisition in the OR to gain a perspective on the neurophysiologic and technical principles of IOM monitoring, and then interpret the findings in real time with the IOM reader. The extent and variety of cases changes by the day; typical surgical cases utilizing these modalities include:
- Spine surgery (e.g., corrections and fusions)
- Microvascular decompression of cranial nerve V
- Carotid endarterectomy
- Brain tumor resections
Objectives and Evaluation Matrix
As with all of the neurology rotations, the specific objectives are reflected in the entrustable professional activities and individual milestones listed below. These form the basis for the end-of-rotation evaluation. (Please see the section End-of-Rotation Evaluations above for the list of milestone abbreviations).
| General Service Rotation Objectives | ||
| Upon completion of the curriculum, residents will . . . | ||
| # | Description | Milestones |
| 1 | Describe the types of monitoring modalities and indications for each | MK2 |
| 2 | Differentiate physiological from artifactual changes in IOM (BAER, EEG, SSEPs, MEP) | PC9 |
| 3 | Describe alarm criteria for each IOM modality | MK2 |
| 4 | Describe the electrode placement for commonly used IOM modalities | MK2 |
| Additional Milestones | ||
| Please grade the resident on any of the following milestones you were able to evaluate during this rotation: | ||
| PL1, PR1, PR2, IC3, IC4 | ||
Schedule
At the start of rotation, please coordinate with the attending and IOM staff for the day on which cases to follow and when to go to the OR for direct observation. If OR cases are not available, intracarotid sodium amytal (Wada), diagnostic EP studies, or EMG may be considered.
A short, relevant reading in the textbooks each day of the rotation can be coordinated with the attending of the day. Check with Bryan Wheeler in IOM re: ability to access IOM studies.
Work Hours
The estimated number of work hours is 40 per week.
Suggested References
A Practical Approach to Neurophysiologic Intraoperative Monitoring, Second Edition, edited by Aatif Husain (2015) and Intraoperative Neurophysiology: A Comprehensive Guide to Monitoring and Mapping, edited by Mirela Simon (2018). Please check Ebling Library or EEG reading room for copies to borrow.
Latest revision: 05-14-2021
