Utility of intraoperative neurophysiological monitering (ionm) in various surgeries at a tertery care hospital in karachi, pakistan.

Utility of real time multimodal intraoperative neurophysiological monitoring in different intracranial, spinal and peripheral nerve at a tertiary care hospital in Karachi Pakistan.Study design: A retrospective observational study Place and duration of study: Patients admitted in neurology and neurosurgery services as well as out-patients presenting to the clinical neurophysiology lab at the Aga Khan University Hospital Karachi between January 2012 to December 2013.Methodology: The study consisted of 14 patients undergoing different intracranial, spinal and peripheral nerve surgeries including correction of spinal scoliosis, spinal cord lesion ,acoustic neuroma resection and plexus and peripheral nerve repaired. Among the electrophysiological methods patients were monitored using including SSEP, BAEP and EMG (free-running and triggered). EMG was done on Nihon Kohden Viking Quest from Nicolet Co. For SSEPs GillioNT from EB Neuro Co, and for NIOM carefusion from Nicolet Co was used.Results: Mean age of patients was 39 years (4-70 years). SSEP, BAEP and EMG (free-running and triggered) were recorded, during various surgeries. Of total 14 patients, no patient expressed a significant alert to prompt reversal of ongoing intervention. No patients awoke with a new neurological deficit and none had significant intraoperative SSEP /EMG alerts. Conclusion: Neurophysiologic intraoperative monitoring appears to be the modern standard of care for monitoring functional integrity and minimizing the risk of iatrogenic damage to the central and peripheral nervous system