Neuroanatomy course and lab provides a systemic survey of the structure of the human nervous system, including major pathways, neurotransmitters, and functions.

Introduces students to the neural and behavioral basis of motor control. In-depth study on nervous system structures involved in planning, executing, and learning movements, as well as the principles of motor control that apply to locomotion, reaching and grasping, eye movements, and more complex skills.

A combination of lecture and lab discusses the various electrical parameters used to activate and record from the intact nervous system. Modern neurophysiological signal acquisition and processing such as averaging, filtering, and fast Fourier analysis are covered as pertinent to electroencephalographic, sensory, visual, auditory, and motor stimulation and recording. Lab component provides students with hands-on experience in SSEP, EEG, EMG, BAEP, VEP, and TMS techniques.

Fundamental intraoperative neurophysiology course studying the application of standard techniques applied to a vast array of spinal and ENT procedures. Procedure-specific anatomy and surgical approaches are covered. Alert criteria, clinical statistical analyses (predictive and preventative value), and surgical risk factors are discussed.

Skills course rotating students through a sequence of (neuro) clinical exam testing, procedure-specific OR space management, and neurophysiology software programming. Students will learn and practice proper application and interpretation of a standard neurologic exam, identify and practice proper patient-electrode application techniques in a simulated OR setting, and become proficient in programming surgical neurophysiology acquisition software.

Intraoperative neurophysiology course focused on cerebrovascular and spinal vascular physiology. Correlations between neurophysiologic tests and functional outcome. Correlation between neurophysiologic tests vs cerebral autoregulation and neuroprotective interventions. The role of pharmacologic provocative testing in endovascular interventional procedures.

Seminar course focused on Neuro MRI and angiography. Students will learn proper identification of basis neuroanatomic and spinal structures on brain, cervical, thoracic, and lumbar spine MRIs. Detailed angiographic anatomy of the cerebral and spinal vasculature will be covered. MRI sequences (T1, T2, Flair, contrast) and their advantages will be discussed. Students will identify lesions and associate with involved neural structures. Minor topics of head CT, PET scan, and fluoroscopy will also be addressed.

Advanced intraoperative neurophysiology course focused on mapping techniques typically employed during tumor resection procedures. Electrical and physiologic basis of phase reversal in brain and spinal cord mapping, electrical reflex testing and monitoring techniques, and threshold cortical and subcortical mapping is covered. Additional topics include neurophysiologic testing aids in DBS and spasticity procedures.

Lecture course discussing general anesthesia and specific considerations for neurological surgery. Classification of major inhaled and intravenous drugs used in a general anesthetic. Hemodynamic considerations and effects on intraoperative neurophysiologic tests will be covered in depth. Consciousness, awareness, and specific pediatric considerations are discussed.

IONP 664

Initial clinical rotation in intraoperative neurophysiology. Students will focus on proper position and timing of electrode placement, anticipating appropriate modalities prescribed to various surgical procedures, primarily spine and otolaryngologic surgery. Students will practice proper documentation and communication, as well as correlation of signal changes with surgical, anesthetic, physiologic, and technical factors.

IONP 668

Second clinical rotation in intraoperative neurophysiology. Students will continue the practice of skills and disciplines learned in 664 and begin discussing the IONM procedure with patients pre-operatively. Students will gain further experience in spine and otolaryngologic procedures and begin monitoring cerebrovascular and nerve mapping cases. Students will engage and interact directly with the surgical and anesthesia teams regarding intraoperative signal changes.

During the final clinical rotation and program requirements, students will complete an immersive, semester-long capstone clinical rotation at one of several affiliate clinical sites throughout the country. Students will continue to monitor spine, otolaryngologic, and cerebrovascular procedures while also participating in advanced procedures, the volume and variety of which will be determined by the clinical site.

Areas of expertise at varying clinical affiliate sites include (but not limited to):

• Complex brain mapping including awake speech, language and motor mapping, as well as asleep motor mapping for resection of gliomas or epileptogenic foci
• Anterior and posterior skull base tumor resection including extensive cranial nerve mapping and BAEP testing
• Vascular reconstructive surgery involving dynamic neurophysiologic feedback
• Peripheral nerve repair involving intraoperative mapping
• Neurointerventional vascular procedures involving pharmacologic provocative testing

Students will be assigned clinical capstone sites based on a matching program carried out using input from both individual students and clinical sites.