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.
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From NREM and REM to the Cost of Sleep Loss
This video explains what happens when you sleep, walking through the 90-minute sleep cycle, the stages of NREM sleep, and the paradox of REM sleep. It also shows how sleep affects emotional regulation, metabolism, cognitive performance, accident risk, and overall health, ending with the key benefits of getting full restorative sleep.
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Deep Sleep, Circadian Rhythms, and the Glymphatic System
This video explores how circadian rhythms and the sleep cycle prepare the brain for deep restorative sleep, when physical repair and brain waste clearance are most active. It highlights the glymphatic system, the restorative role of deep sleep, and the cognitive and health consequences of not getting enough sleep.
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.
2nd International Basic Medical Sciences Conference 2023
This video series is from BMedCon ’23, the Basic Medical Sciences Conference held by Khyber Medical University in Peshawar, Pakistan. The videos capture key discussions, expert insights, and emerging trends in biomedical science and clinical practice. Together, this series highlights the integration of scientific innovation with clinical application, offering valuable knowledge for students, clinicians, and researchers seeking to stay at the forefront of modern healthcare.
Part 1
This opening session introduces the central themes of the conference, focusing on the current state of biomedical science, interdisciplinary collaboration, and the foundational principles driving innovation in healthcare.
Part 2
This segment explores how scientific discoveries are translated into real-world clinical applications, emphasizing evidence-based practice, technological advancements, and improving patient outcomes.
Part 3
This session highlights recent developments in biomedical technologies, including diagnostic tools, monitoring techniques, and innovations that are shaping modern clinical and research environments.
Part 4
The final session focuses on the future of biomedical science, discussing emerging trends such as precision medicine, data-driven healthcare, and the evolving role of innovation in improving global health outcomes.
These videos explore how the brain adapts to changes in sensory input and how this adaptability—known as neuroplasticity—can lead to both beneficial and maladaptive outcomes. Using tinnitus as a key example, the videos highlight how altered neural activity in the auditory system reflects the brain’s attempt to compensate for lost or distorted input, offering important insights into both normal function and clinical disorders.
Neuroplasticity
This video introduces neuroplasticity as the brain’s capacity to reorganize in response to experience, injury, or sensory deprivation. It covers mechanisms such as synaptic plasticity and cortical remapping, and connects these processes to both recovery and maladaptive conditions like tinnitus. The video emphasizes how the same plastic mechanisms that support healing can also contribute to persistent neural dysfunction.
Tinnitus
This video explains how tinnitus originates from changes within the central auditory system rather than the ear alone. It demonstrates how reduced auditory input (such as hearing loss) can increase neural gain and spontaneous firing in auditory pathways, leading to the perception of sound without an external source. Key concepts include central gain, thalamocortical dysrhythmia, and cortical reorganization.
This video demonstrates the proper setup of the international 10–20 EEG system tailored for motor evoked potential (MEP) monitoring in the intraoperative setting. It highlights key electrode landmarks, strategic placement for effective cortical stimulation, and practical considerations to ensure robust, reproducible MEP responses. Emphasis is placed on accuracy, symmetry, and minimizing impedance to optimize signal quality and patient safety during neuromonitoring procedures.
This video demonstrates the key differences between single-pulse and high-frequency (30 Hz) stimulation in neurophysiological monitoring. It highlights how varying stimulation paradigms influence neural recruitment, temporal summation, and waveform characteristics. Viewers will gain a practical understanding of how frequency modulation affects response amplitude, consistency, and clinical interpretation—critical for optimizing intraoperative neuromonitoring strategies.
Are We Measuring Neuromuscular Blockade Correctly?
This video introduces the principles and clinical importance of Train-of-Four (TOF) monitoring in intraoperative neurophysiology and anesthesia. It explores how peripheral nerve stimulation is used to assess neuromuscular blockade, highlights common misconceptions in interpretation, and emphasizes best practices to ensure accurate, reliable data for optimizing patient safety and IONM signal integrity.
Webinar
Techniques, Clinical Applications, and Surgical Impact
This webinar provides an in-depth overview of pelvic floor neuromonitoring, highlighting its role in preserving autonomic and somatic neural function during complex pelvic surgeries. It covers key anatomical pathways, monitoring modalities such as EMG and evoked potentials, and practical intraoperative strategies to reduce postoperative complications like bladder, bowel, and sexual dysfunction. The session also emphasizes real-world surgical integration, interpretation of neurophysiological signals, and the importance of multidisciplinary collaboration in optimizing patient outcomes.
Webinar
Real-Time Neuroprotection in the OR
This expert-led session by Dr. Jason Labuschagne delivers a focused and clinically relevant overview of vagal nerve stimulation within the framework of IONM. The video highlights the physiological foundations of vagal nerve function, practical stimulation techniques, and key monitoring parameters essential for real-time assessment in the operating room. Emphasis is placed on waveform interpretation, troubleshooting strategies, and the critical role of vagal monitoring in preventing neural injury and optimizing surgical outcomes.
Saudi Spine Society Virtual Conference 2020
This video is part of the 2020 Saudi Spine Society Virtual Meeting, an international academic forum focused on advancing spine care through education, research, and clinical innovation. IONM is highlighted as a critical tool for enhancing patient safety during spine surgery. The video demonstrates how real-time monitoring of neural function enables early detection of potential injury, supports informed intraoperative decision-making, and facilitates timely interventions to preserve neurological integrity and improve surgical outcomes.
Eastern Mediterranean Epilepsy / Saudi Epilepsy Society Conference 2022, Riyadh, Saudi Arabia
This subsection features three educational videos related to brain mapping and functional localization, presented in the context of the EMR SES 2022 Conference. EMR-SES 2022 refers to the Eastern Mediterranean Epilepsy Society – Saudi Epilepsy Society meeting, a scientific conference focused on epilepsy, neurophysiology, and related clinical neuroscience topics. These videos highlight how brain mapping is used not only to identify functional cortex during surgery, but also to support the localization of epileptic regions while helping preserve essential motor and sensory function.
Together, the three videos offer complementary perspectives: a training-oriented overview, a formal conference lecture, and an epilepsy-focused discussion of localization and mapping of seizure-related cortex. The lecturers include Dr. Faisal R. Jahangiri and Dr. Tariq Abalakhail, both presenting on the broader theme of mapping of the brain in relation to neurosurgical and epilepsy practice.
Core Concepts and Planning
This video presents a structured teaching session on the fundamentals of brain mapping, with emphasis on training objectives, planning, and the role of mapping in surgery. Dr. Faisal R. Jahangiri introduces the major concepts involved in preparing for mapping procedures and understanding how functional areas of the brain can be identified during operative care. The presentation appears educational and foundational, making it especially useful for trainees or learners seeking an introduction to the topic.
Clinical Applications and Intraoperative Techniques
In this conference lecture from EMR SES 2022, Dr. Tariq Abalakhail discusses the principles and clinical applications of brain mapping. Based on the presentation slides, the lecture addresses topics such as pre-operative functional mapping, what to assess during mapping, and the use of stimulating electrodes in operative settings. This video reflects a more formal conference presentation style and provides a practical perspective on how mapping is approached in clinical neurophysiology and neurosurgery.
Identifying and Managing Epileptogenic Foci
This video expands the discussion by focusing more directly on the epilepsy-related role of brain mapping. Dr. Faisal R. Jahangiri addresses themes such as epilepsy localization, the management of medically refractory epilepsy, and the mapping of epilepsy foci using cortical grids and functional mapping techniques. Compared with the first video, this lecture more clearly connects brain mapping to the epilepsy setting of the conference, showing how localization and cortical mapping contribute to epilepsy surgery and help guide safe resection near eloquent brain regions.
Neuromonitoring Outside the Box
In this virtual conference, Dr. Jahangiri showcases how intraoperative neurophysiological monitoring can be extended beyond traditional spine and intracranial cases into a wider range of surgical applications, including shoulder and hip procedures, ulnar transposition, tibial/fibular osteotomy, bladder/pelvic monitoring, and cranial nerve assessment. Using case examples, waveform data, electrode-placement images, and modality-specific discussion of MEP, triggered EMG, laryngeal adductor reflex, and related techniques, the presentation emphasizes practical strategies for adapting IONM to anatomically diverse and surgically challenging settings.
Ohio Neurodiagnostic Society (ONDS) Conference Series (2024–2025)
These two videos are presentations delivered at the Ohio Neurodiagnostic Society (ONDS) Annual Conferences (2024 and 2025), a regional professional meeting under ASET – The Neurodiagnostic Society that provides continuing education and promotes excellence in neurodiagnostics.
Within this platform, Global Innervation LLC–driven educational content is presented through expert-led lectures by Faisal Jahangiri, showcasing both core and advanced applications of intraoperative neurophysiological monitoring (IONM).
The 2024 session focuses on fundamental and comparative motor monitoring techniques (TcMEP vs. D-wave/DECS), emphasizing clinical decision-making in spine surgery. The 2025 session expands into broader, innovative applications of motor evoked potentials (MEP) beyond traditional spine cases, including orthopedic, peripheral nerve, and multisystem monitoring strategies.
Together, these lectures illustrate how ONDS conferences serve as a regional academic platform, while Global Innervation contributes cutting-edge, globally relevant IONM education, bridging foundational practice with next-generation clinical expansion.
TcMEP vs. D-wave (DECS) Monitoring
(Ohio Neurodiagnostic Society Conference, November 2024)
This focused conference lecture presents a comparative analysis of transcranial motor evoked potentials (TcMEP) and direct epidural cortical/spinal (D-wave/DECS) monitoring. Frame structure and slide patterns indicate emphasis on motor pathway physiology, signal reliability, anesthesia considerations, and intraoperative decision thresholds. The session is clinically oriented, helping practitioners understand when and how to use each modality to optimize spinal cord protection during surgery.
Motor Evoked Potentials Beyond Spine
(Ohio Neurodiagnostic Society Conference, September 2025)
This extended lecture (~86–93 minutes) explores advanced applications of MEP monitoring beyond traditional spine surgery. Frame analysis confirms coverage of orthopedic procedures (shoulder, hip), peripheral nerve surgeries (ulnar, peroneal), pelvic/autonomic monitoring (EUS/bladder), and cranial nerve reflexes (laryngeal adductor reflex). The presentation integrates waveform interpretation, electrode strategies, triggered EMG, and intraoperative case examples, reflecting a high-level, innovation-driven approach to expanding the clinical boundaries of IONM.
Saudi Association of Neurological Surgery Conference 2021
This 15th annual SANS conference presentation from 2021 by Faisal Jahangiri delivers a technique-focused exploration of urethral sphincter motor evoked potentials (US-MEP) as an extension of standard multimodal monitoring in spine surgery. The lecture, supported by pelvic neuroanatomy diagrams, electrode placement schematics, and real waveform examples, demonstrates how traditional limb MEPs fail to adequately assess sacral segments (S2–S4). By integrating US-MEP into the monitoring paradigm, the presentation emphasizes improved intraoperative detection of cauda equina and pelvic motor pathway compromise, with direct implications for preserving postoperative bladder and urogenital function in high-risk spine cases.