pelvic Neuromonitoring
Transcription
pelvic Neuromonitoring
Intraoperative Neuromonitoring Functional Neurosurgery Pain Treatment Neurological Diagnostics APPLICATION NOTES pelvic Neuromonitoring N PATEN d GY in TE e om LO EA T EUROP >> ISIS IOM SYSTEM CHNO 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 [email protected] www.inomed.com D020118 / Subject to change without prior notice © copyright by inomed 08.2015 rev 1 4