pelvic Neuromonitoring

Intraoperative Neuromonitoring
Functional Neurosurgery
Pain Treatment
Neurological Diagnostics
APPLICATION NOTES
pelvic Neuromonitoring
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Procedure
Placement of recording electrodes
Introduction
Placement of recording electrodes
In the internal and the external sphincter muscle one
bipolar needle electrode is placed. The correct placement can be supported and controlled with ultrasound
guidance.
The green needle electrode is placed in the surrounding
tissue. Alternatively a rectal elecrode can be used.
Basic Principle
The term intraoperative neuromonitoring (IONM) refers to
the graphic and acoustic representation and documentation of the neurophysiological activity of one or more
nerves or nervous system structures. Neurophysiological
assessment enables intraoperative monitoring of motor,
sensory or autonomic nervous system tissue at risk during a surgical procedure.
Needle electrode
Electrical stimulation of an autonomic peripheral nerve
results in depolarization and subsequent modulation
of its baseline activity. The resulting increased muscle
activity is recorded from electrodes placed on or inside
the muscle. These electrical potentials are known as electromyography recordings (EMG).
The effect of a muscle contraction, such as changes in
force or pressure, can be used as indirect verification
of intact innervation. In pelvic IONM the activity of the
detrusor muscle can be assessed by measuring bladder
pressure.
Ultrasound control of the needle electrode
in the internal anal sphincter
Detection of the characteristic changes of EMG and
pressure signals is performed automatically by state-ofthe-art signal processing and portrayed acoustically via
a loudspeaker and visually on a monitor. Therefore it is
feasible to identify the autonomic nervous system structure and precisely monitor its function.
1
The purpose of this measurement is to identify and measure the function of the autonomic pelvic nerves to reduce damage leading to possible urogential and anorectic
dysfunction.
2
Placement of the bipolar needle electrode in
internal anal sphincter (1) and
external anal sphincter (2)
Art.-No. 520 300
pIOM Box
bladder pressure measuring
for connection to IONM devices,
for use with disposable pressure
converter with 1.5mm touchproof
female connector
• USB powered
• delievered non-sterile
• non-autoclavable
2
Procedure
Setup of the bladder pressure measurement
Setup of the bladder pressure measurement
The catheter connection set with the pressure transducer
have to be connected as shown to the bladder catheter as
well as to the neuromonitoring device.
Setup catheter connection set for bladder pressure
measurement
CH.
1-4
Art.-No. 520 335
pIOM Set
with SDN electrodes
Art.-No. 520 336
pIOM Set
with rectal electrode
complete set consisting of
Catheter Connection Set
for bladder pressure measuring
• SDN electrodes
• fork probe 400mm
• single-use
• ETO-sterilized
complete set consisting of
Catheter Connection Set
for bladder pressure measuring
• rectal electrode
• fork probe 400mm
• single-use
• ETO-sterilized
3
Procedure
Application of the stimulation probe
Application of the stimulation probe
The bipolar stimulation probe can be used for localization
and function control of nerve branches.
Once the probe is in contact to the tissue the neuromonitor
confirms the applied stimulation with a sound sequence.
During this time the contact between the probe and the
tissue has to be maintained. A successful nerve stimulation and the resulting increase of activity in the innervated
muscle is detected automatically and indicated acoustically
and visually.
A muscle response can be expected especially at the pelvic
splanchnic nerves and at the inferior hypogatricus plexus.
Stimulation in the pelvic plexus
Superior hypogastric
plexus
Hypogastric nerves
Fork probe
Sacral plexus
Pudendus nerve
Inferior hypogastric
plexus
Pelvic splanchnic nerves
Your distributor
For further information, please contact:
Manufacturer
inomed Medizintechnik GmbH
Im Hausgruen 29
79312 Emmendingen (GERMANY)
Tel.: +49 7641 94 14-0
Fax: +49 7641 94 14-94
info@inomed.com
www.inomed.com
D020118 / Subject to change without prior notice © copyright by inomed 08.2015 rev 1
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