Nerve Monitoring During Tarlov or Meningeal Cyst Surgery

In order to assist in identifying and protecting your nervous system during the surgery special nerve monitoring will be done. This monitoring procedure is referred to as Intraoperative Neurophysiologic Monitoring (IOM).

The technologist may meet you in the pre-operative holding area to discuss the monitoring procedure, perform a brief neurologic exam, discuss your symptoms, and apply non-invasive electrodes to your arms and legs. Some of the electrodes come in the form of small needles attached to a wire. The needle electrodes will only be placed after you are asleep in the operating room and removed before you wake up, so you will not feel any discomfort from the monitoring.

Once the electrodes are placed, they are connected to specialized monitoring equipment which is used to run tests on your nervous system, which includes your brain, spinal cord, and the nerves that run from your spinal cord to your arms and legs. Our technologist will run a set of baseline responses prior to the incision, and then continuously run tests throughout your procedure – "monitoring" the results of the tests and comparing them to the baseline responses. If there are any changes in the way your nerves behave during your surgery, the technologist will inform your surgeon.

The services of a neurologist will also be utilized. The neurologist observes the monitoring response in real-time via remote monitoring technology. The neurologist will interpret the tests being performed by the technologist and ensure that the tests are adequately monitoring your nervous system. The neurologist is also available for consultation during the procedure should the technologist or surgeon need clarification about the status of your nervous system's responses to the testing. All of the members of the monitoring team, including the surgeon, Dr. Frank Feigenbaum, the technologist, and the neurologist, work together to make sure that your nervous system is fully protected.

All of the electrodes will be removed from your body prior to waking up from anesthesia. You may notice some small spots of blood on your arms, legs, or scalp from where the electrodes were placed. The technologist will do everything possible to prevent bleeding from where the electrodes were removed and ensure that the bleeding has been controlled prior to you leaving the Operating Room suite.

Expect the nerve monitoring company, which includes the technologist and neurologist, to bill the hospital and insurance provider on your behalf. You may receive a bill. In the interim, you may receive a notice from your insurer about the monitoring performed on you during your procedure. Procedure terms such as "Evoked Potential Testing", "EMG/Electromyography", "Nerve Conduction Testing", "EEG/Electroencephalography", and "Intraoperative Monitoring" may be used in reference to our services. In addition, you may see the name of the neurologist who performed the interpretation of the monitoring signals during your procedure.