Intraoperative neurophysiological monitoring

Intraoperative neurophysiological monitoring (IONM) consists of the continuous, real-time monitoring of nerve functions during a surgical procedure. The objective is to detect early any suffering of the nervous system (brain, spinal cord, cranial or peripheral nerves) in order to alert the surgeon and allow an immediate modification of the surgical gesture before an irreversible lesion occurs. The techniques used include somatosensory evoked potentials (SEP), motor evoked potentials (MEP) by transcranial magnetic or electrical stimulation, continuous electromyography (free-running EMG), direct nerve stimulation and electrocorticography. The choice of techniques depends on the type of surgery and the nervous structures at risk. Intraoperative monitoring has considerably improved the safety of spinal surgeries (scoliosis, disc herniation, spinal cord tumours), skull base surgeries, thyroid surgeries (protection of the recurrent nerve) and operations on the peripheral nerves. The presence of a neurophysiologist in the operating theatre has become a quality standard in many procedures involving a neurological risk. The Clinique Pasteur in Tunis offers an intraoperative monitoring service provided by experienced neurophysiologists, working in close collaboration with the surgical and anaesthetic teams to optimise patient safety.