The most rapid and effective way to incorporate new techniques into an existing monitoring practice is through intensive in-house training, rather than attendance at lecture-format conferences. Thus, my consulting services combine didactic lectures, hand-on demonstrations, and monitoring actual surgical cases at your hospital, with your personnel and equipment, and interfacing with your surgeons, anesthesiologists, and other OR personnel.

For example, for groups wishing to add tcMEP to their existing practice, I provide in-house consultation and training in the use of multipulse electrical stimulators for transcranial motor evoked potential monitoring during surgery. This training is intended for groups who are already experienced in intraoperative monitoring using SEP, EMG, EEG, or other techniques and who wish to add tcMEP to their monitoring capability. I have extensive experience in tcMEP; I was one of the first people in the US to use the Digitimer D185 under a research protocol in the late 90's prior to its obtaining FDA approval, and have used it, and subsequently the CV-2 and TCS-1 from Cadwell, in hundreds of cases.

Generally, I visit for 2 or 3 days. During the first day, I help interface the high voltage multipulse stimulator with your existing monitoring equipment, create appropriate protocols, and test the entire system to ensure that the stimulator is correctly connected and integrated with your equipment. I also train your IOM staff in the use of the transcranial stimulation, anatomy and physiology of tcMEP, indications for tcMEP monitoring, risks and patient safety issues, troubleshooting, identification of normal and abnormal tcMEP responses, anesthesia considerations, applications to specific surgical procedures, etc. It is also useful to meet with and/or give formal presentations to the anesthesiologists and surgeons who will be involved and make sure they understand the utility of tcMEP and their role in its successful use in the OR.

On the second and/or third days, we go into your OR and I assist in setting up and monitoring tcMEP during appropriate surgical case(s). I will help your staff in electrode placement, equipment setup, obtaining baseline recordings, and interpreting tcMEP data obtained during the case(s). The goal is to bring your staff to the point where they will be ready to begin using tcMEP independently.

I can also offer similar training in many other types of intraoperative monitoring; for example, cranial nerve monitoring for acoustic neuroma or other skull base tumors, selective dorsal rhizotomy for spasticity secondary to cerebral palsy, cortical and subcortical mapping during resection of tumors near the sensorimotor region, peripheral nerve explorations, as well as monitoring during cardiovascular and interventional radiology procedures. I can also advise on staffing or equipment needs, supervision requirements, and virtually any aspect of intraoperative monitoring. Please contact me for information concerning any of your training needs.