INTRAOPERATIVE NEUROPHYSIOLOGIC MONITORING

INTRAOPERATIVE NEUROPHYSIOLOGIC MONITORING University Medical Center Groningen

Joint Sponsorship By:

ASNM Regional Symposia Chair Rebecca Clark-BashThis symposium provides comprehensive updates for neurolophysiologic monitoring professionals andadvanced practitioners who collaborate on the neuromonitoring team, as well as surgeons andanesthesiologists who require intraoperative neuromonitoring (IONM) during procedures. Experts fromthe international IONM community will examine common and important updates, including:

n SEP & Transcranial Motor Evoked Potentials and EMG for spine surgeryn Auditory Evoked Potentials and Cranial Nerve monitoring for craniotomy and skull- based

monitoringn EEG and SEP for carotid endarterectomy and aneurysm monitoringn Didactic sessions and interactive panel forums will focus on pre-existing conditions, data

analysis, anesthetic considerations,complications and troubleshooting.

Intraoperative monitoring professionals n Neurophysiologists n Neurosurgeons n Neurologistsn Orthopedists n ENT Surgeons n Anesthesiologists n Nurses n Audiologists n Professionals involvedin interventional intraoperative neuromonitoring of evoked potentials,EMG and EEG during surgicalprocedures.

At the completion of this symposium, participants should be able to:n Discuss the comprehensive principles for conducting and interpreting intraoperative

neurophysiological monitoring across multimodality applications of IONMn Identify neuroanatomy and neurophysiology relevant to IOMn Describe the principles and methods of recording and monitoring n Identify the elements for clinical decision making during IOM.n Identify the basic aspects related to the business of IOM.n This activity is designed to address the following ABMS/IOM competencies:

medical knowledge, patient care, professionalism.

COURSEDESCRIPTION

TARGETAUDIENCE

SYMPOSIUMOBJECTIVES


ASNM GRONINGEN SYMPOSIUM FACULITY

Jeffery E. Arle, MD, PhDDepartment of Neurosurgery Lahey ClinicBurlington, Massachusetts USA

Rebecca Clark-Bash, CLTM, CNIM, F.ASNMPresident, Director of Education & TrainingKnowledge Plus, Inc.Lincolnshire, Illinois USA

Ulrich Beese, MD, PhDDepartment of AnesthesiologyUniversity Medical Center GroningenThe Netherlands.

Ariane M.J. Bour, MD, PhDDepartment of NeurophysiologyMaastricht University Medical CenterMaastricht, The Netherlands.

Bernard Allan Cohen, PhD, D.ABNMNeurological Monitoring Associates, LLCMilwaukee, Wisconsin USA

Cor J. Kalkman MD, PhDDepartment of AnesthesiologyUniversity Medical Center UtrechtUtrecht, The Netherlands

Vedran Deletis, MD, PhDDirector, Intraoperative Neurophysiology Institute forNeurology & NeurosurgerySt. Lukes Roosevelt HospitalNew York, New York USA

David B. MacDonald, MD, FRCP(C), ABCNHead, Section of NeurophysiologyDepartment of NeurosciencesKing Faisal Specialist HospitalRiyadh, Saudi Arabia

Jan Jacob A. Mooij, MD, PhDChief Dept of NeurosurgeryUniversity Medical Center GroningenGroningen, The Netherlands

Aage R. Møller, PhD, D. Med. Sci.Professor of Cognition and NeuroscienceMF Jonsson Endowed ChairSchool of Behavioral & Brain SciencesThe University of Texas at DallasRichardson, Texas USA

Ernst B. MuskensDepartment of Clinical NeurophysiologyUniversity Medical Center GroningenGroningen, The Netherlands

Dachling Pang, MD, FRCS (C), FRCS (Eng),FACSProfessor of Pediatric NeurosurgeryUniversity of California DavisRegional Centre for Pediatric NeurosurgeryKaiser Permanente HospitalsOakland, California USA

Herbert E. PolakDepartment of AnestheticsSint MaartenskliniekNijmegen, The Netherlands

Josep M.Espadaler, MD, PhDDirector Clinical Neurophysiology DepartmentHospital del MarAssoc Professioal, Medical SchoolUniversity Autonoma de BarcelonaBarcelona, Spain

Ilona RáczDepartment of AnestheticsSint Maartenskliniek

Isabel Fernandez-Conejero, MDDepartment of Intraoperative Neurophysiology HospitalUniversitari de BellvitgeL´Hospitalet de LlobregatBarcelona, Spain


ASNM GRONINGEN SYMPOSIUM FACULITY

Chantal van Hal, MDDepartment of OrthepedicsSint MaartenskliniekNijmegen, The Netherlands

Eric A. Hoebink MDDepartment of Orthopedics Amphia HospitalBreda, The Netherlands

Eelco W Hoving, MD, PhDDepartment of NeurosurgeryUniversity Medical Center GroningenGroningen, The Netherlands

H. Louis Journee, MD, PhDDepartments of Neurosurgery* an Orthopedics’*University Medical Center Groningen‘Sint Maartenskliniek Nijmegen,The Netherlands

Karl F. Kothbauer, MDChief, Division of NeurosurgeryDepartment of Surgery General and Pediatric NeurosurgeryLuzerner Kantonsspital,Luzern, Switzerland

Fiete Lange, MD, PhDDepartment of Clinical NeurophysiologyUniversity Medical Center GroningenGroningen, The Netherlands

Danielle Langeloo MD, PhDDepartment of Orthopedic SurgerySint MaartenskliniekNijmegen, The Netherlands

Prof. Roger Lemon, BSc, MA, PhD, FMedSciNational Hospital for Neurology UCL12 Queen Square, London WC1N 3BG UK

Prof. Werner H. Mess, MD, PhDDepartment of NeurophysiologyMaastricht University Medical CenterMaastricht, The Netherlands.

M.Sc. Maja Rogic´Department for Neuroscience Laboratory for HumanExperimental Neurophysiology School of MedicineUniversity of Split, Coratia

Brett Netherton, MS, CNIMTechnical DirectorRocworks, LLCProsperity, South Carolina USA

Francesco Sala, MD, PhDSection of Neurosurgery, Assist Professor of NeurosurgeryHead Intraoperative Neurophysiology Unit Department ofNeurological Sciences and Vistion University of Verona, Italy

Jay L. Shils, PhD, D.ABNM, F.ASNMDirector, Intraoperative Monitoring Lahey ClinicBurlington, Massachusetts USA

Stanley Skinner, MDAbbott Northwestern's Neuroscience InstituteMinneapolis, Minnesota USA

Tod Sloan, MD, MBA, PhDAssociate Chair for DevelopmentUniversity of Colorado at Denver School of MedicineDepartment of AnesthesiologyAurora, Colorado USA

Michiel J. Staal MD, PhDProfessor of Neuromodulation Department of NeurosurgeryUniversity Medical Center GroningenGroningen, The Netherlands

Mark Stecker MD, PhD, D.ABNM, F.ASNMProfesspr of Neuroscience andDirector of Neurophysiology Marshall UniversitySchool of Medicine / Cabell Huntington HospitalHuntington, West Virginia USA

PD Dr. med. Andrea SzelényiDepartment for NeurosurgeryJohann Wolfgang Goethe University HospitalFrankfurt, Germany

Charles Yingling PhD, D.ABNM, F.ASNMAdjunct Faculty-Clinical ProfessorProfessor of Otolaryngology / Head and Neck SurgeryStanford School of MedicinePalo Alto, California USA


INTRAOPERATIVE NEUROPHYSIOLOGIC MONITORINGFIRST JOINT CROSS-ATLANTIC EDUCATIONAL SYMPOSIUM

Program ScheduleUniversity Medical Center Groningen

The NetherlandsThursday, November 4, 20109:00 a.m. Welcome by the ASNM & ISIN

n Bernard Cohen, PhD, DABNM, President Elect ASNMn Karl F. Kothbauer, MD President ISIN

9:10 a.m. Introduction & Host Welcomen H. Louis Journee, MD, PhD

Session I: Comprehensive Principles in Intraoperative Neurophysiology9:15 a.m. Sensory System & Sensory Evoked Potentials

n David B. MacDonald, MD, FRCP(C), ABCN9:45 a.m. Motor System & Motor Evoked Potential

n Vedran Deletis, MD, PhD10:15 a.m. Auditory Evoked Potentials: Neurophysiology and IONM

n Aage R. Møller, PhD, D. Med. Sci.10:45 a.m. Break with Exhibitors11:00 a.m. Anesthetic Principles

n Tod Sloan, MD, MBA, PhD11:30 a.m. Selective Vascular Model Studies on Ischemic Effects on Responses of

Motor Pathways & Musclesn Cor J. Kalkman, MD, PhD

11:50 a.m. Evaluation Live IONMn Moderator: H. Louis Journee, MD, PhD

12:30 p.m. LunchAbove lectures subjected to delay reservation breaking the IOM Session.

Session II: Concurrent Focus Sessions

Neurosurgery I: 1:30 p.m. Vascular & Brain Tumor Surgery SzelényiWorkshop & Hands-On

2:15 p.m. MEP IONM in the Brain Stem Region FernandezNeurosurgery II: 1:30 p.m. DBS: Micro-Electrode Recording Shils & ArleAdvanced Applications

2:15 p.m. Conus-Cauda Surgery Yingling

Spine Surgery 1:30 p.m. Scoliosis Surgery Polak & Rácz

2:15 p.m. Spinal Monitoring SkinnerDocumentation 1:30 p.m Proper Charting & Medical Legal Aspects CohenVascular Surgery 2:15 p.m. Thoraco-Abdominal Aneurysms Repair Bour & Mess

3 :00 p.m. Poster Presentations: Practical Issues in Neurophysiologic Monitoringn Moderator: Brett Netherton

3:30 p.m. Break with Exhibitors


FIRST JOINT CROSS-ATLANTIC EDUCATIONAL SYMPOSIUM THE NETHERLANDS

Thursday, November 4, 2010 (continued)Forum Discussion:Quality Development & Management of Intraoperative Neuromonitoring Service

4:00 p.m. Televoting In Moderator: Mark Stecker, MD, PhD

4 :10 p.m. Establishing A Quality IONM Program: US Experiencen Mark Stecker, MD, PhD

4 :00 p.m. Establishing A Quality IONM Program: Europe Experiencen Andrea Szelényi, MD, PhD

4:40 p.m. Requirements for IONM in a Hospital Organization: Challenges & Integration in Medical CarePrograms, Financing, Education programs and Credentialing

n Rebecca Clark Bash, R.EEG/EP T. CNIM, CLTM, FASNM5:10 p.m. Remote Monitoring: Coping with Understaffing?Features and Limitations of Remote

Monitoring From Opposite Viewsn Charles Yingling, PhD, DABNM, FASNM

5:30 p.m. A European View on Remote Monitoringn Werner Mess, MD, PhD

5:45 p.m. Introperative Monitoring Service Outsourcing: Pros & Consn Bernard Cohen, PhD, DABNM

5:55 p.m. Televoting IIn Moderator: Mark Stecker, MD, PhD

6:05 p.m. Forum Discussion Guided by Televoting Questionaryn Moderator: Mark Stecker, MD, PhD

6:30 p.m. Adjourn

Please Join UsFor An

ASNM & ISIN Cocktail Reception

When: Thursday Evening • Time: 6:30 p.m. – 8:00 p.m.



Friday, November 5, 20107:30 a.m. Breakfast Open Discussion Sessions (Select One)

I. TES-MEP Monitoringn Vedran Deletis, MD, PhD

II. Fossa Posterior Monitoring: Auditory, Motor &Cranial Nerve

n Aage R. Møller, PhD, D. Med. Sci.

III. Spinal Cord Monitoringn Karl F. Kothbauer, MD

V. Monitoring in Aneurysm & Brain Tumor Surgeryn PD Dr. med. Andrea Szelényi

VI. Mapping of Eloquent Areas of the Brainn Isabel Fernandez-Conejero, MD

VII. Anesthetic Considerations in Monitoringn Tod Sloan, MD, MBA, PhD

IV. Micro-Electrode Recordingn Jay L. Shils, PhD, D.ABNM, F.ASNM & Jeffrey Arle, MD, PhD

Scientific Session: Spinal Cord Monitoring8:30 a.m. Warning Criteria Using Epidural Recorded D-waves & Muscular MEP’s in Medulary

Tumor Surgeryn Karl F. Kothbauer, M.D.

8:55 a.m. Warning Amplitude Criteria of TES Evoked MEP’s in Reconstructive Spine Surgeryn Danielle Langeloo MD, PhD

9:10 a.m. Warning Criteria Based on TES Threshold & Morphology of MEP’s.n Charles Yingling PhD, D.ABNM, F.ASNM

9:35 a.m. Continuous EMG Monitoring in Spinal Cord Surgery: An Experimental Study & Featuresin TES-MEP Clinical Monitoring

n Stanley Skinner, MD10:00 a.m. Current Warning MEP Criteria: What Do and Don’t They Share?

n H. Louis Journee, MD, PhD10:15 a.m. Break with Exhibitors

Scientific Session: Optimizing TES10:30 a.m. Physiological Base of MEP & D-waves

n Professor Roger Lemon, BSc, MA, PhD, FMedSci11:00 a.m. Inter-Patient Variability of Inter-Pulse Interval (IPI) in TES

n Chantal van Hal, MD11:15 a.m. Minimizing TES Induced Movements

n Eric Hoebink MD11:30a.m. How & When to Use Conditioning Techniques?

n H. Louis Journee, MD, PhD11:50 a.m. Procedure for Optimizing TES Parameters

n H. Louis Journee, MD, PhD

Scientific Session: Safety of Transelectrical Stimulation (TES)12:00 p.m. Safety of Transcranial Stimation

n David B. MacDonald, MD, FRCP(C), ABCN12:30 p.m. Lunch

Scientific Session: Neurosurgery (Brain)A. Workshop: Neurophysiologic Mapping of Motor Speech Related Cortical Areas

2:00 p.m. Neurophysiology of TMS Inducing Speech Arrest and It’s Mechanismsn M.Sc. Maja Rogic´

2:20 p.m. Preoperative Testing of Patients Requiring Surgery of Motor Cortex Eloquent Areasn Josep M.Espadaler, MD, PhD



Friday, November 5, 2010 (continued)2:30 p.m. New Approach to the Intraoperative Neurophysiologic Mapping of the Eloquent Cortex

n Isabel Fernandez-Conejero, MD2:40 p.m. Live Demonstration Using Magnetically Induced Speech Arrest & Pre-Operative Mapping3 :00 p.m. Open Discussion

Scientific Session: Fossa Posterior3:10 p.m. Neurophysiology in Neurosurgical Treatment of Hemifacial Spasm

n Jan Jacob A. Mooij, MD, PhD3:30p.m. Intraoperative Monitoring of the Corticobulbar Pathways

n Isabel Fernandez-Conejero, MD3:50 p.m. Break with Exhibitors

Scientific Session: Supra Tentorial Region4:10 p.m. MEP Monitoring Aneurysm and Brain Tumor Surgery

n PD Dr. med. Andrea Szelényi4:30 p.m. Cortical & Subcortical Mapping

n Francesco Sala, MD4:50 p.m. Open Discussion

Scientific Session: Functional Neurosurgery5:00 p.m. Neuromodulation: Present & Future Trends

n Michiel J. Staal, MD, PhD4:20 p.m. Modeled Neurophysiological Assessment of SCS Electrodes & Motor Cortex Stimulation

n Jeffrey E. Arle, MD, PhD5:40 p.m. Deep Brain Stimulation: Micro-Electrode Recording

n Jay L. Shils, PhD, D.ABNM, F.ASNM6:00 p.m. Neurophysiological Assessment in Placement of MCS Electrodes

n Jay L. Shils, PhD, D.ABNM, F.ASNM6:15 p.m. Open Discussion

WorkshopsColloquium Rooms (Participation is Limited to 25 Attendees)5:00 p.m.

5:45 p.m. Scientific Poster Presentationsn Eric Hoebink, MD

I. Brain Stem Mappingn Isabel Fernandez-Conejero, MD

II. Monitoring in Scoliosis Surgeryn Fiete Lange MD, PhDn Ernst B. Muskens

III. Charting & Documentionn Rebecca Clark-Bash, R.EEG/EP T., CNIM,

CLTM, F.ASNM

IV. Anesthesia Protocols in Spine Surgeryn Ulrich Beese MD, PhD

Exhibit Hall Cocktail ReceptionWhen: Friday EveningTime: 6:15 p.m. – 7:30 p.m.


Saturday, November 6, 2010Spinal & Conus-Cauda Monitoring8:00 a.m. The Use of Electrophysiology Monitoring During Surgery for Spinal Dysraphism

n Dachling Pang, MD, FRCS (C), FRCS (Eng), FACS9:00 a.m. Conus-Cauda Surgery: Monitoring & Mapping Afferent Pathways & BCR

n Vedran Deletis, MD, PhD9:20 a.m. Value and Pitfalls of Motor Mapping & Monitoring in the Cauda Equina.

n Francesco Sala, MD9:40 a.m. Pediatric Surgery in the Conus-Cauda Region

n Eelco W. Hoving, MD, PhD9:55 a.m. How to Tailor Anesthesia for IOM in Pediatrics

n Tod Sloan, MD, MBA, PhD10:10 a.m. Motor Monitoring in Young Children

n H. Louis Journee, MD, PhD10:30 a.m. Break with Exhibitors

Forum Presentations: Role of IOM Societies & Future Changes in Care Models10:50 a.m. Televoting I

n Moderator: Karl F. Kothbauer, MD11:00 a.m. ASNM Vision on Education & Credentialing in the United States

n Mark Stecker, MD, PhD11:15 a.m. ISIN Vision on Education & Credentialing in Europe

n Francesco Sala, MD11:30 a.m. Contemporary Challenges for ION Societies

n Karl F. Kothbauer, MD11:55 a.m. Televoting II

n Moderator: Karl Kothbauer, MD12:05 a.m. Forum Discussion Guided by the Televoting Questionary

n Moderator: Karl F. Kothbauer, MD12:35 a.m. Announcement of ISIN Education Programs Starting in Barcelona 2011

n Isabel Fernandez-Conejero, MD12:40 p.m. Concluding remarks by the Presidents of the ASNM & ISIN

n Bernard Cohen, PhD, D.ABNM President Elect ASNMn Karl F. Kothbauer, M. D. president ISIN

12:30 p.m. Adjourn


ASNM requires disclosure and resolution of all conflicts of interest to insure balance,independence, objectivity and scientific rigor in all CME programming. Conflicts ofinterest of all individuals who control CME content will be identified and resolved priorto this educational activity. Full disclosure will be made in the syllabus. Presenters willalso disclose discussion of off-label uses.

FACULTYDISCLOSURE


n CME credits are applied at the TUFT’s University Medical School

n Accreditation has been requested at the European Union Medical Specialists /European Accreditation Council for Continuing Medical Education (UEMS/EACCME)

n For Dutch participants accreditation is requested by: de Nederlandse Verenigingenvoor Anesthesiologie (NVA), Heelkunde (NVvH), Neurochirurgie (NVVN),Neurologie (NVN) en de Nederlandse Orthopedie Vereniging (NOV)

n ASET ACE credits shall be applied for.

PhysicianThis activity has been planned and implemented in accordance with the EssentialAreas and policies of the Accreditation Council for Continuing Medical Educationthrough the joint sponsorship of Tufts University School of Medicine (TUSM) and theAmerican Society of Neurophysiological Monitoring. TUSM is accredited by theACCME to provide continuing medical education for physicians.

TUSM designates this educational activity for a maximum of [#] AMA PRA Category1 Credits™. Physicians should only claim credit commensurate with the extent oftheir participation in the activity.

Once we clarify the amount of credits to be offered you can fill in the number for thissection.

Requirements for Successful CompletionTo receive CE credit, participants must sign-in, attend the entire activity and completeand submit the activity evaluation provided in syllabus materials.Certificates/statements of credit will be mailed within 4-6 weeks after the activity.Commercial Support and ExhibitorsA list of commercial supporters and exhibitors will be provided to participants inactivity materials.

Non Endorsement StatementThe content and views presented in this educational activity are those of the facultyand do not necessarily reflect the opinions or recommendations of Tufts UniversitySchool of Medicine or American Society of Neurophysiological Monitoring. Inclusionin this activity does not constitute approval or endorsement of any commercialproducts or services. These materials have been prepared based on the best availableinformation, but are not exhaustive of the subject matter. Participants are advised tocritically appraise the information presented and encouraged to consult the availableliterature for any commercial products mentioned.

ADA/OEO Nondiscrimination PolicyTufts University School of Medicine (TUSM) considers all applicants and activityparticipants without regard to race, color, national origin, age, religious creed, sex orsexual orientation. TUSM is an Equal Opportunity Employer. TUSM does notdiscriminate on the basis of a disability in admissions, access to treatment, oremployment in their programs and activities as identified in the American withDisabilities Act. Please let us know in advance if you require any accommodations.

Policy On Privacy And Confidentiality: To view TUSM OCE privacy policy,please see: http://www.tufts.edu/med/about/offices/oce/privacy.html

For question regarding certification please contact: Tufts University School ofMedicine-Office of Continuing Education at [email protected] or 617-636-6579.

ACCREDITATION& CREDITS


INTRAOPERATIVE NEUROPHYSIOLOGIC MONITORINGFIRST JOINT CROSS-ATLANTIC EDUCATIONAL SYMPOSIUM

University Medical Center GroningenThe Netherlands

Registration InformationThe registration fee includes tuition, electronic version of course syllabus, daily continental breakfast, both receptions& break refreshments.

Cancellation of registration is accepted up to Oct. 1, 2010

Registration is accepted on-line at: http://www.esnm.org Confirmations will be sent for registrations directly from the website.Registrations cannot be processed or confirmed without full payment.

Symposium Rates Before October 1st, 2010 After October 1st 2010Program Registration 300 400Technologists & Students 200 300With Full Price Physician 75 175

Printed Handout* 75Syllabus Options: The registration fee includes an electronic version of the course material (e.g.: USB flash drive or disk). A printed syllabus isavailable for an additional charge and must be ordered in advance.

Extra Ticket for Thursday Evening Cocktail Reception FREEExtra Ticket for Friday Evening Cocktail Reception 37.50

Meeting Location: University Medical Center Groningende Blauwe Zaal (main auditorium)Groningen, The Netherlands

Information for directions one can contact the secretary of Mr H.F.E.M. Gubbels: Please phone: +31 (0)50 3611402Hotel & Hostel Information: Visit http://www.esnm.org

Traveling to Groningen: Groningen is located in The Netherlands with 185,000 inhabitants and is the capital of theprovince of Groningen. Groningen city was founded around 1100 A.D. and has a rich history, which can clearly be seenfrom the old medieval buildings in the down town area.

By Train: Groningen has three train stations, the central station (Station Groningen), Groningen Europapark and GroningenNoord. All trains eventually arrive at the central station; only a few trains stop at the smaller stations. There are direct trainsfrom Schiphol airport (Amsterdam), Utrecht and Rotterdam to Groningen (2-2.5 hours) and Amsterdam Centraal can bereached with one change.

Exhibitor Opportunities - Contact Us:Please contact the Wenckebach Instituut, Postgraduate School of Medicine Mr. H.E.F.M Gubbels, consulentP.O.Box 30.001, NL-9700 RB GroningenThe Netherlands(t) +31 (0)50 361 1396 (f) +31 (0)50 3611819 mail to: [email protected]

Route by car: For visitors to congresses or other events the University Medical Center Groningen (UMCG) has a car parkingat the north end of the terrain. To get there follow from the Groningen Ring the signs ‘UMCG Noord’.

Public transport: The UMCG is easily reached by public transport. Several bus lines departing from the Central RailwayStation drive in about 10 minutes to the UMCG. Some buses stop at the head entrance of the hospital, others at the sideand at the north end. You can also use the ‘park and ride’ city bus. Because the bus schedules vary often, we direct you forup to date information to the sites for public transport (www.92920ov.nl and www.citybus.nl/English). Regretfully, the9292ov.nl site is in Dutch. However, its homepage offers the possibility to make an inquiry that probably is understandable,even if you do not speak Dutch.

All small group workshops & hands on sessions are held in theOnderwijs Centrum. The exact room numbers will be handed outwith the materials.

PRSRT STD

U.S. POSTAGE PAID

GREEN BAY WI

PERMIT NO. 460

ASNM20 N.Michigan Ave., Suite 700Chicago, IL 60602

INTRAOPERATIVE NEUROPHYSIOLOGICMONITORING

FIRST JOINT CROSS-ATLANTIC EDUCATIONAL SYMPOSIUMNovember 4-6, 2010

CONTACT US:If you have further questions:

American Society of Neurophysiological Monitoring20 North Michigan AvenueSuite 700Chicago, IL 60602Phone: (Country Code: 001) 800-479-7979Fax: (Country Code: 001) 800-479-7989

INTRAOPERATIVE NEUROPHYSIOLOGIC MONITORING

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