Simulation system for intraoperative neuromonitoring

This paper presents a simulation system (“patient model”) for intraoperative neuromonitoring (IONM) applied to mastoidectomy. IONM is an electrophysiological method for monitoring the integrity and localization of nerve tracts, which helps the surgeon to avoid injuries and damage to neural risk structures (e.g. facial nerve) during surgery. To use the IONM successfully, the surgeon needs appropriate training and experience. The presented simulation system provides training possibilities in a realistic, cost-efficient and reproducible way. In the simulation system, the position of the probe during training is determined by a magnetic tracking method. Depending on the distance to the virtual nerve, a synthetic electromyogram (EMG) signal is sent to a real neuromonitor. The trainee learns to interpret the output of the neuromonitor. The trainer can choose different training scenarios, such as localization of the nerve, milling or coagulating, using a web application.