Introduction to Intraoperative Neurophysiological Monitoring (IONM): Foundations to Clinical Application
This three-part lecture series introduces the core principles of intraoperative neurophysiological monitoring (IONM), guiding learners from foundational concepts to practical clinical relevance. Together, these lectures establish the knowledge base needed to understand why IONM is used, how it works, and how it supports patient safety during surgery.
Purpose and Core Concepts
Dr. Jahangiri introduces the field of intraoperative neurophysiological monitoring, including its historical development, clinical purpose, and role in modern surgery. Students will learn why IONM is used, the types of surgeries that benefit from monitoring, and the fundamental goals of protecting neural structures and preserving neurological function.
IONM Modalities and Physiologic Principles
Major monitoring modalities and their underlying neurophysiologic principles are explored. Attention is given to signal generation, recording, and interpretation, with discussion of sensory, motor, and electromyographic techniques and their relationship to specific neural pathways.
Clinical Application and the Role of IONM in the Operating Room
Practical integration of IONM within the surgical environment is addressed, including the roles of the neuromonitoring team, communication with surgeons and anesthesia providers, and the use of real-time data to support intraoperative decision-making and patient safety.
These videos provide a concise yet comprehensive overview of Brainstem Auditory Evoked Potentials (BAEPs), covering auditory pathway anatomy, waveform generators, technical setup, and clinical interpretation. They are designed to build foundational understanding while reinforcing practical application for clinical and intraoperative monitoring.
BAEPs
Understanding Auditory Pathway Anatomy, Waveform Generators, and Core BAEP Concepts
This video introduces the fundamentals of BAEPs, including auditory pathway anatomy, waveform generators, and the clinical significance of Waves I–V. It lays the foundation for understanding how BAEPs assess brainstem integrity during monitoring.
BAEPs
Technical Setup, Troubleshooting, and Clinical Interpretation of BAEPs
This video builds on the basics by focusing on technical setup, stimulus parameters, troubleshooting, and interpretation of abnormal BAEP findings in clinical and intraoperative settings.
These lectures by Dr. Faisal R. Jahangiri provide a structured exploration of sleep from foundational physiology to clinical diagnostics and emerging genetic insights. Together, they bridge basic sleep mechanisms with real-world applications in sleep medicine and neurophysiology.
Physiology and Architecture of Sleep
This lecture explains normal sleep architecture, including NREM and REM stages, cycling patterns, and the neurophysiology behind sleep regulation. It builds the essential framework for understanding all sleep-related diagnostics.
The Biology Behind Sleep Variability
This lecture explores how genetics and genomics influence sleep patterns, disorders, and individual variability. It introduces cutting-edge perspectives on personalized sleep medicine and research.
Clinical Evaluation and Monitoring
This lecture focuses on polysomnography, sleep study parameters, and clinical interpretation of sleep data. It highlights how sleep disorders are identified and evaluated in real clinical settings.
This video series presents practical, case-based applications of intraoperative neurophysiological monitoring (IONM) across orthopedic, peripheral nerve, pelvic, and cranial nerve surgeries. Each session highlights the anatomical rationale, monitoring strategies, electrode placement, and troubleshooting approaches needed to optimize neural protection and improve surgical outcomes in diverse operative settings.
Part One
This session reviews neuromonitoring considerations during shoulder procedures, emphasizing brachial plexus risk, positioning-related neuropathies, and the use of SSEPs and EMG to detect traction or compression injuries in real time.
Part Two
Focused on peripheral nerve surgery, this video demonstrates how EMG and nerve stimulation are used to identify, protect, and confirm functional integrity of the ulnar nerve during decompression and transposition procedures.
Part Three
This lecture explores monitoring techniques used in hip operations to safeguard the sciatic and femoral nerves, highlighting modality selection, baseline acquisition challenges, and interpretation of intraoperative signal changes.
Part Four
This session discusses lower-extremity osteotomy procedures, detailing strategies for protecting the peroneal and tibial nerves using multimodal monitoring, with emphasis on early detection of stretch or ischemic injury.
Part Five
This video examines the neurophysiology of bladder innervation and demonstrates how specialized monitoring techniques help preserve sacral pathways during pelvic and spinal procedures that may impact urinary function.
Part Six
Dedicated to extraocular motor nerves, this lecture reviews the anatomy and monitoring of cranial nerves III, IV, and VI, including electrode placement, triggered EMG applications, and interpretation of responses to prevent postoperative diplopia and ocular dysfunction.
This video series introduces the four principal modalities used in intraoperative neurophysiological monitoring—SSEP, EMG, TCeMEP, and EEG. The lectures emphasize physiologic pathways, signal generation, anesthetic considerations, technical parameters, and real-world troubleshooting to help learners translate theory into safe and effective operating-room practice. The section is designed to build modality-specific competence while reinforcing multimodal integration for surgical decision-making.
Foundation Modalities: Part One
This lecture reviews dorsal column–medial lemniscal anatomy, key neural generators, and optimal stimulation/recording parameters. Emphasis is placed on waveform interpretation, electrode placement, and recognizing surgical versus physiologic changes.
Foundation Modalities: Part Two
A practical exploration of free-run and triggered EMG, focusing on detection of nerve root irritation, technical pitfalls, and strategies to avoid under-monitoring. The session highlights how subtle EMG findings influence intraoperative decision-making.
Foundation Modalities: Part Three
This lecture explains corticospinal activation, stimulation paradigms, anesthetic sensitivity, and optimization of train parameters. Troubleshooting algorithms are discussed to maintain reliable motor pathway surveillance during high-risk procedures.
Foundation Modalities: Part Four
An overview of EEG applications in surgical monitoring, including cerebral perfusion assessment, anesthetic depth considerations, and ischemia detection. The talk connects neurophysiology principles with real-time intraoperative interpretation.
The following three instructional videos provide an overview of key anesthesia principles essential for successful IONM. They explore how different anesthetic agents and techniques influence neurophysiologic signals such as SSEPs, MEPs, EMG, and EEG, and discuss strategies for optimizing monitoring conditions during surgery. Together, these videos highlight the importance of close collaboration between the neurophysiology team and anesthesia providers to maintain reliable signals while ensuring patient safety.
Part 1
This video introduces the fundamental relationship between anesthesia and neurophysiological monitoring. It explains how anesthetic agents affect neural transmission and electrophysiological signals, and reviews basic concepts necessary for maintaining reliable monitoring during surgery.
Part 2
This video examines how commonly used anesthetic agents—including inhalational agents, intravenous anesthetics, and neuromuscular blockers—impact neurophysiological recordings such as SSEPs, MEPs, and EMG. It discusses how different drugs influence amplitude, latency, and signal stability.
This video focuses on practical anesthesia management strategies that support high-quality intraoperative monitoring. Topics include total intravenous anesthesia (TIVA), minimizing neuromuscular blockade when monitoring motor pathways, and effective communication between the anesthesia and neuromonitoring teams to ensure optimal surgical outcomes.
This three-part video series introduces the fundamental principles, techniques, and clinical applications of cortical mapping during neurosurgical procedures. Cortical mapping is a critical technique used to identify and preserve eloquent brain regions responsible for motor, sensory, and language functions while maximizing safe tumor or lesion resection. The videos demonstrate how electrical stimulation is applied to the cerebral cortex, how neurophysiological responses are interpreted, and how intraoperative findings guide surgical decision-making. Together, these videos provide a step-by-step overview of cortical mapping workflows used in modern IONM.
Part 1
This video introduces the foundational concepts of cortical mapping, including the rationale for functional localization of the brain during neurosurgery. It explains how electrical stimulation is used to identify motor and sensory cortex regions and discusses the importance of preserving eloquent cortical areas during tumor or epilepsy surgery. The video also provides an overview of the neuroanatomy relevant to cortical mapping and the basic setup of stimulation and recording equipment used in the operating room.
Part 2
This segment focuses on the technical aspects of performing cortical mapping using direct electrical stimulation. It demonstrates electrode placement, stimulation parameters, and the interpretation of motor or sensory responses. The video highlights practical considerations such as stimulation intensity, safety thresholds, and strategies for identifying functional cortical boundaries. Emphasis is placed on how neurophysiological feedback guides the surgical team in real time.
The final video illustrates how cortical mapping findings are integrated into surgical decision-making. It shows how mapping results help surgeons navigate around critical brain regions during lesion or tumor resection. The video also discusses common challenges encountered during mapping, interpretation of responses, and the role of the neurophysiology team in maintaining patient safety and optimizing surgical outcomes.
The following video demonstrations provide a practical overview of cranial nerve monitoring and mapping techniques used during neurosurgical procedures. These videos illustrate the principles of IONM, including electrode placement, stimulation methods, and interpretation of electromyographic responses during cranial nerve identification and preservation. Through real-time surgical examples, viewers can observe how neurophysiological monitoring assists surgeons in identifying critical neural structures, minimizing neurological injury, and improving patient outcomes.
Part 1
This video introduces the basic principles of cranial nerve monitoring during neurosurgical procedures. It demonstrates how electromyography (EMG) is used to detect neural activity from muscles innervated by cranial nerves, allowing the surgical team to assess nerve integrity throughout the operation. The video highlights essential equipment, recording techniques, and the clinical importance of continuous monitoring for protecting neural function.
Part 2
This video focuses on cranial nerve mapping using electrical stimulation to identify nerve structures within the surgical field. The demonstration shows how stimulation probes are applied to suspected neural tissue and how compound muscle action potentials (CMAPs) or EMG responses are recorded to confirm nerve identity. Mapping helps guide the surgeon during tumor resection or lesion removal by accurately locating functional nerve tissue.