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Monday, November 9, 2009

An International Survey on Neuromonitoring?

Neuromonitoring is quite extensively utilized in US, ask both neurosurgeons and Orthopedic surgeons you work, they will tell you how useful this modern tool to them to complete their surgery safely and comfortably, that is what the surgeons I involve with tell me and they are pretty top notch in their field, so imagine what the surgeons nationwide would think about IONM?.

Internationally, IOM is not that widely practiced, there is no data available to ascertain either on the internet or offline on books that can provide information of IOM outside US. There could be various reasons why it is not that common as in US, may be the cost of using IOM, availability of the technology, trained professionals or experts readily available to employ them and numerous other factors may play a role. I have a list of IOM companies in US as well as a stat (from society websites) on trained professionals in US documented in my Neuromonitoringcompanies Blog. This report published in the latest neurosurgery focus journal is perhaps the first of this kind I have noticed recently, a German group did a survey among neurosurgeons in several countries regarding their usage of IOM services. Though the number of instituitions, number of surgeons and patients surveyed is smaller, the number of countries participated also is very small for this kind of survey, I would not make a conclusion based on this study but this certainly a good idea to conduct a survey and it has to be more comprehensive.
Neurosurg Focus. 2009 Oct;27(4):E2.

Neurophysiological intraoperative monitoring in neurosurgery: aid or handicap? An international survey.

Department of Neurosurgery, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany. mario.cabraja@charite.de
OBJECT: Neurophysiological intraoperative monitoring (IOM) is regarded as a useful tool to provide information about physiological changes during surgery in eloquent areas of the nervous system, to increase safety and reduce morbidity. Nevertheless, numerous older studies report that very few patients benefit from IOM, and that there are high rates of false-positive and false-negative changes of neurophysiological parameters during surgery. There is an ongoing discussion about the effectiveness of neurophysiological IOM. This questionnaire study was performed to evaluate the attitude of neurosurgeons toward neurophysiological IOM and the availability of this tool. METHODS: One hundred fifty neurosurgeons from 60 institutions in 16 countries were asked to answer anonymously a questionnaire with 11 questions. The questionnaire covered aspects of personal experience, the neurosurgical institution, and availability of neurophysiological IOM as well as asking the surgeon's opinion of the procedure. RESULTS: One hundred nine questionnaires were returned (73%). Seven questionnaires were excluded because of failure to complete the form correctly or completely, leaving 102 respondents from 44 institutions in 16 countries in the study; 79.5% of the included institutions provided neurophysiological IOM. Young neurosurgeons did not put more trust in IOM than experienced neurosurgeons. With growing IOM experience, surgeons seem to allow less influence of the findings on the course of their operation. At large institutions in which > 1500 operations per year are done, IOM is performed by the neurosurgeons themselves in most cases. In institutions with fewer operations, the IOM team consists mostly of nonneurosurgeons. Regardless of the availability of neurophysiological IOM, all surgeons stated that IOM is gaining increasing importance. CONCLUSIONS: Neurophysiological IOM represents an established tool in neurosurgery. Although the importance of IOM is emphasized by the majority of neurosurgeons, the relevance of this tool to the course of the operation changes with increasing neurophysiological IOM experience.