Electrophysiology Services

At Biotronic, we offer several electrophysiology services and are familiar with every monitoring modality that has been invented by man. We can perform neurophysiological monitoring services in any hospital that you want us in.

Our experienced neural monitoring technologists monitor the procedure from the operating room, while our technical staff provide real-time monitoring simultaneously through remote supervision. With remote supervision, the neural monitoring data is transmitted through a secure virtual private network (VPN) to our central location. This allows us to offer your patients the best possible protection against neural damage.

Electrophysiology Services: What Our Neural Monitoring Technologists Do

Using electrophysiology services during surgery, our neural monitoring technologists will stimulate a nerve pathway. Motor pathways are stimulated by activating the brain while sensory pathways are stimulated by activating a peripheral sensory nerve. If the speed and/or intensity of the signals change, it may indicate that the patient is not getting enough oxygen, a nerve is stretched, or there has been a mechanical disturbance. If the data indicates that the patient is suffering from neural damage, our neural monitoring technologist will notify the surgeon, as immediate action must be taken so that the patient does not suffer permanent damage following surgery. To ensure that the technical data is being collected to the highest standards, we offer remote neural monitoring, wherein our senior technical staff can watch the technologists through remote supervision.

Remote Supervision and Professional Interpretation

Biotronic is a recognized leader in intraoperative neurophysiological monitoring and was the first in the field to develop the infrastructure needed for real-time off-site supervision, also called remote neural monitoring. Therefore, while our neural monitoring technologists are gathering data in the operating room, our senior technical staff or physician can interpret the data from a remote location and give instant and accurate feedback on the status of your patient's neural pathways at any time during surgery.

When neurological data change during surgery, critical judgments must be made. These judgments are best made by a physician or other professional certified in interpreting neural monitoring data. However, it is rare that such intervention will be necessary and, therefore, it is not economically feasible to place such an individual in the operating room. Through remote neural monitoring however, certified professionals are able to oversee each and every surgery, interpret the data, and make critical judgments when necessary.

In order for remote neural monitoring to work, our neural monitoring technologists must be able to access the internet, or a local intranet, from the operating room. Data is then acquired from the patient and transmitted via a Local Area Network (LAN), or the internet, through a 100 percent secure virtual private network (VPN) to the remote station where the data will be viewed.

Biotronic will provide, implement, and install all the remote neural monitoring and neurophysiological monitoring equipment. The hospital is responsible only for releasing an IP address and providing access to a high-speed internet connection.

Remote neural monitoring is HIPAA compliant and is a source of:

Advanced care for patient
Quality assurance
Continuing education for our neural monitoring technologist
Peace of mind for surgeon

The unique monitoring protocols and vast experience Biotronic has in the operating room, along with our advanced neurophysiological monitoring equipment and remote neural monitoring, assure that you and your patients will receive the best intraoperative monitoring available.

Which Monitoring Modalities to Use During Surgery

The intraoperative monitoring electrophysiology services we offer are displayed on the chart below. Refer to the chart to determine which structures are monitored with each modality, or to find the modalities used in a particular surgery.

Modality	Monitorable Structures	Surgical Applications
Somatosensory Evoked Potentials	Sciatic nerve Lumbar and sacral nerve roots Spinal cord Brainstem somatosensory pathways Monitoring metabolic function of cortical structures	Acetabular fractures Posterior lateral interbody fusion Lumbar fusion with instrumentation Cauda equine surgeries Spinal deformity surgery Spinal cord tumor surgeries Instrumented cervical surgery Skull base surgery requiring retraction of the brainstem Carotid endarterectomy Aneurysm surgeries
Spinal Cord Evoked Potentials	Spinal Cord	All surgeries that place the spinal cored at risk
Transcranial Motor Evoked Potentials	Spinal cord motor pathways	All spinal surgeries that place the motor pathways at risk
Cortical Mapping	Motor cortex and internal capsule, Language areas of the brain, Sensory cortex	Brain tumor surgeries
Deep-Brain Single Unit Recordings	Globus pallidus Thalamus Subthalamic nucleus Optic pathways	Deep-brain stimulator electrode placement Pallidotomy Thalamotomy
Auditory Evoked Potentials	Cranial nerve VIII Auditory brainstem pathways	Acoustic neuroma surgeries Vestibular nerve sections Microvascular decompression of VIIth or Vth cranial nerves Skull base surgeries when the brainstem risks retraction Posterior fossa surgeries
Visual Evoked Potentials	Optic nerve function anterior to the chiasm	Transphenoidal pituitary tumor surgery
EEG and Computer Enhanced EEG	Cortex	Carotid endarterectomy Cardiopulmonary bypass Evaluation of anesthetic effects
Transcranial Doppler	Middle cerebral artery Aneurysm feeder arteries	Carotid endarterectomy Aneurysm surgeries
Cerebral Venous Oxygen Saturation	Cortical perfusion	Carotid endarterectomy Cardiopulmonary bypass
Electromyography	Cranial nerves: Cranial nerves III, IV, V, VI, VII, IX, X, XI, and XII Peripheral nerves: All peripheral motor nerves *Spinal nerve roots*	Cranial nerves: Skull base surgeries whenever these cranial nerves are at risk Microvascular decompression of VIIth or Vth cranial nerves Acoustic neuroma surgeries Parotid surgeries Revision middle ear surgery Vestibular nerve sections Peripheral nerves: Peripheral neuroma surgeries Monitoring of femoral nerve function during anterior acetabular surgery Spinal nerve roots: Pedicle screw instrumentation surgeries Cauda equina surgeries
Evoked Sensory and Motor Action Potentials	Peripheral mixed nerves	Evaluating remaining nerve function in muscle flap grafts Peripheral neuroma surgery

To learn more about our electrophysiology services or how we may be able to help with your neurophysiologic intraoperative monitoring needs, contact Biotronic today.

812 Avis Drive
Ann Arbor, Michigan 48108
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Toll Free:
(866) 856-4404
Fax:
(734) 677-2423

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Biotronic offers several electrophysiology services to enhance safety during brain and spinal cord surgeries. Contact our qualified professionals before you enter the operating room.