Im Hausgrün 29, 79312 Emmendingen
Germany
Telephone +49 7641 941410
Fax +49 7641 941494
info@inomed.com
http://www.inomed.com
Product Categories
Product categories
01 Electromedical Equipment / Medical Technology
01.01 Diagnostics
01.01.06 Neurological diagnosis, apparatus and instruments
Neurological diagnosis, apparatus and instruments
01 Electromedical Equipment / Medical Technology
01.03 Surgery devices, endoscopy devices
01.03.08 Neurosurgical instruments and equipment
Neurosurgical instruments and equipment
01 Electromedical Equipment / Medical Technology
01.03 Surgery devices, endoscopy devices
01.03.12 Other surgical instruments and products
Other surgical instruments and products
01 Electromedical Equipment / Medical Technology
01.04 Therapy and physical medicine
01.04.04 Cryotherapy, cryosurgery equipment
Cryotherapy, cryosurgery equipment
Our products
Product category: Neurological diagnosis, apparatus and instruments, Neurosurgical instruments and equipment, Other surgical instruments and products
ISIS Xpert® – Maximum flexibility for demanding neuromonitoring
The ISIS Xpert, ISIS Xpert plus and ISIS Xpress offer a complete package for multimodal intraoperative neurophysiological monitoring.
Thereby the new ISIS IOM family impresses with its outstanding performance, ease of use, flexibility and versatility. The low noise amplifier modules with 16 channels each and the ISIS neurostimulator with the possibility to significantly reduce the stimulation artifacts have been especially designed to meet the highest demands of intraoperative neuromonitoring.
The new ISIS IOM systems are equipped with the innovative NeuroExplorer 2019 software.
This new software generation offers optimal usability and extends the areas of application in the field of intraoperative neuromonitoring:
Clarity of Measurement windows:
Hide unneeded information with one click
Pelvic neuromonitoring – pIOM®:
Autonomic function of the lesser pelvis can be monitored using the pIOM® module
Spinal neuromonitoring:
Automatic stimulation and evaluation functions in intuitive setup and measurement windows to support the placement of pedicle screws and lateral accesses to the lumbar spine
Train-of-four (TOF) measurement:
Automatic control of muscle relaxation during the operation using TOF monitoring
Neuromontoring in Thyroid Surgery – Channel Select Function:
Reliable detection of muscle responses for even the smallest signals: Automatically selects and shows a magnified display of the optimal trace from the 4 channels of the Laryngeal Electrode select or ALM Tube
Multi-channel Video:
Enables to display up to four simultaneous video sources
HL7-Ready:
For synchronisation of patient data with the hospital network
Product category: Neurological diagnosis, apparatus and instruments, Neurosurgical instruments and equipment, Other surgical instruments and products
C2 NerveMonitor
C2 NerveMonitor – Specialist for versatile use in the OR
The C2 NerveMonitor from inomed was developed for daily use and is considered as a specialist for a versatile application in the OR.
The intelligent technology offers reliable signal stability in the monitoring of motor and sensory nerves and with an additional simple and intuitive user interface. The C2 combines all the functions of the current purely acoustic nerve monitors, and combines their simplicity with precise visual display and comprehensive documentation. All components of the device are optimized for precise and reliable neuromonitoring in order to achieve the highest signal quality and reliability. With its versatile applications, the C2 NerveMonitor is therefore a true all-rounder which impresses with its uncomplicated handling.
Specially developed software modules extend applications
The C2 NerveMonitor specially developed for thyroid surgery was expanded with new C2 software modules. This substantially extends its range of applications and the C2 is now also available as a reliable partner for efficient neuromonitoring to surgeons in spinal, vascular, facial nerve, rectal and neurosurgery. The perfectly matched accessories allow intermittent and continuous neuromonitoring.
Features
Intuitive user interface
Barcode scanner for patient ID input
High quality loudspeakers
Integration into hospital network possible (HL7 Ready)
Integrated patient database
USB interface for easy data export
The main application areas of the C2 NerveMonitor are:
Thyroid surgery
Ear, nose and throat surgery / facial surgery
Vascular surgery
Rectal surgery
Spine surgery
Neurosurgery (C2 Xtend)
Product category: Cryotherapy, cryosurgery equipment
C3 CryoSystem for cryotherapy
Freeze pain with the C3 CryoSystem
Using cryotherapy (cryolesion) techniques, the inomed C3 CryoSystem allows the pain therapist to “put the pain on ice”. Effective treatment of pain has been the goal for clinicians and pain treatment experts throughout human history. Both acute and chronic pains represent a huge challenge for patients, as well as their clinicians, and diminishes the patient’s quality of life. The pain-relieving effect of cold has been known since ancient times. By building on the past and using the latest advances in cryotechnology and pain relief, patients and clinicians are now choosing the state-of-the-art inomed C3 CryoSystem for cryotherapy and pain treatment.
Treatment-resistant, chronic pain in the spinal column region is one of the main indications of cryotherapy and thus the main area of application for the inomed C3 CryoSystem. When medicated pain or injection treatments for chronic back pain do not bring relief, neurodestructive procedures such as cryotherapy and thermolesion can be the solution. Using the inomed C3 CryoSystem and disrupting the conduction pathways of pain with cryotherapy, effective pain relief can be delivered to the patient. The precision cryoprobes from inomed allow for a targeted application of the cooling effect on the affected peripheral nerve.
Cryotherapy method
The basic principle of cryotherapy requires that the affected nerve is located and identified using imaging and visual techniques, followed by precise targeting using the built-in electrical stimulator in the inomed C3 CryoSystem. Once the nerve has been located and targeted, the CryoSystem probe starts the process and freezes the nerve. During the freezing process, an ice ball of about 3-5 mm in diameter is formed on the nerve. This process takes around 2 minutes and reduces the temperature of the nerve to approximately -60 °C. The inomed C3 CryoSystem provides the user with a choice of gases to enable the freezing process. These include carbon dioxid (CO2) and nitrous oxide (N2O) gas supplies and adaptors are available to allow connection to the respective gas cylinders. Freezing causes axonotmesis of nerves (disruption of the axon), but the connective tissue remains intact and allows the nerve to regenerate. In view of the precise targeting of the sensory nerve, there is no direct risk from cryotherapy to the nerves responsible for motor activity and sensitivity.
Features of the C3 CryoSystem for cryotherapy:
Intuitive and easy to use
User-friendly menu navigation
The entire cryotherapy treatment and documentation process can be carried out with the footswitch (optional)
Integrated electrical stimulator (motor and sensory stimulation)
Excellent low-temperature (cryo) results
Automatic control and regulation of all relevant parameters, such as gas flow and pressure
Automatic purging procedure
Patient management system
Treatment report with comments
Documentation of all functions used, including stimulation and cryo processes
Barcode reader for patient identification
Device communication via USB
Data import and export
Connection to a printer
Applications for cryotherapy
The main indication for cryotherapy is treatment-resistant, chronic pain in the spinal column region, most commonly lumbar facet syndrome. Additionally, they include:
Facet syndrome
Pseudoradicular postnucleotomy syndrome (radiating pain after disc surgery)
Discogenic pain without disc herniation (nucleus pulposus prolapse)
Coccygodynia (pain in the coccyx)
Post-thoracotomy pain
Primary and secondary intercostal neuralgia
Neuroma-related pain syndromes
This technique offers significant pain relief lasting several months, while additional treatment procedures, such as physiotherapy, can ensure further and continued pain relief. The cryotherapy procedure can be repeated at any time.
Product category: Neurological diagnosis, apparatus and instruments
ISIS Switchmatrix
ISIS Switchmatrix switches between iEEG and electrical stimulation – an intuitive and scalable solution
Stimulation and recording of iEEG has never been so easy
The intracranial EEG, or iEEG, is a method of evaluating epileptic activity in the brain. In case of intractable epilepsy, surgical intervention is an option. To narrow down the focus of the epileptic activity, an iEEG is measured and the pathological sites in the brain are identified. Applications of iEEG are found in neuroscientific research, e.g. in cortical mapping and functional studies.
Flexibility, speed and simplicity
The ISIS Switchmatrix has a range of areas of application. These include applications with iEEG in the diagnosis of epilepsy or with chronic or acute electrophysiological studies of the cortical surface. The complete study is often supported with a VEEG. The ISIS Switchmatrix works with all stimulators and digital amplifiers for iEEG recording. Whenever flexibility, speed and simplicity are required, the inomed Switchmatrix provides a powerful and simple stimulation switching tool for use with invasive multi-channel recording or an intracranial EEG. The ISIS Switchmatrix benefits from a history of developing electrical stimulation systems for IOM and diagnostic applications. The design of the Switchmatrix benefits from extensive cooperation with neurologists, neurosurgeons and other specialists to ensure optimal usability and performance.
Individually controllable electrodes
The ISIS Switchmatrix is like the ISIS standard recording modules powered by a USB port and connects one or two of the 64 channels from iEEG to electrical stimulation. The ISIS Neurostimulator is the perfect partner for the ISIS Switchmatrix with iEEG. In combination with a digital amplifier, the ISIS Switchmatrix can connect individual electrodes of the iEEG lead with the ISIS Neurostimulator or other nerve stimulators. At the same time, the other non-switched channels continue to record the iEEG. However, the ISIS Switchmatrix also offers the ideal starting point for complex applications. Up to three expansion modules – ISIS Switchmatrix extensions – can be connected to the ISIS Switchmatrix. Each of these expansion modules also contain 64 channels and the option to connect up to two additional stimulators. inomed offers a complex solution to meeting complex neurological testing challenges. A maximum of eight stimulators can be connected to individual electrodes for up to 256 channels for the iEEG.
Features
Simple and intuitive operation
Expansion option with up to 3 ISIS Switchmatrix extensions
64 to 256 channels
Connections for up to 8 external neurostimulators
Applications
Presurgical evaluation of epilepsy
Electrocortical stimulation mapping
Fast switching within an electrode array
Product category: Neurosurgical instruments and equipment, Other surgical instruments and products
C2 NerveMonitor Thyroid surgery
Precise neuromonitoring for thyroid surgery and many other applications
The C2 NerveMonitor – optimised for daily use in the OR
The C2 NerveMonitor offers effective intraoperative neuromonitoring for thyroid surgery. It allows direct neurostimulation with hand guided probes, making it a useful aid, for the localisation of the vocal cord nerve, the recurrent laryngeal nerve, and for its functioning testing. Specifically developed for surgical removal of the thyroid, the two independently working stimulators of the C2 NerveMonitor also provide continuous neuromonitoring with the delta electrode.
ALM® – Cutting-edge technology for highest reliability
The innovative ALM® technology for Advanced Laryngeal Monitoring in thyroid surgery offers an intelligent complete solution for precise and reliable recurrent laryngeal nerve monitoring.
The collaborative effects of the ALM® Tube, the C2 NerveMonitor and the C2 Channel Select Software perform ideally together to create a perfected and seamless monitoring method. Through the intuitive user navigation of the C2 NerveMonitor and the easy placement of the ALM® Tube, the surgeon benefits from efficient monitoring during the surgical procedure. Subsequently, the C2 Channel Select Software, a specially developed C2 software module for thyroid surgery, automatically selects the strongest signal.
Neuromonitoring as the standard of care
Neuromonitoring is explicitly recommended for redo-operation in thyroid surgery by the German Society for General and Visceral Surgery – German Association of Endocrine Surgeons. Therefore, documenting the monitoring process and implementing it as rapidly and intuitively as possible are of critical importance in thyroid surgery. The C2 NerveMonitor offers a barcode scanner to quickly read patient data, effortless integration of data into the patient management system, and many other possibilities for straightforward and fast reporting.
Features
Ease of use for Operating Room staff
Clear presentation of the muscle response in the form of EMG waveforms
In combination with the ALM® Tube: Channel Select software for optimal signal quality in thyroid surgery
High quality loudspeakers
Continuous vagus nerve monitoring during thyroid surgery
Integrated patient database
Barcode scanner for patient ID input
Applications
The C2 NerveMonitor was developed to protect nerve tracts in thyroid surgery and many other surgical applications:
Thyroid Surgery
ENT Surgery
Vascular Surgery
Rectal Surgery
Spinal Surgery
Neurosurgery (motor cranial nerves)
Product category: Other surgical instruments and products
C2 NerveMonitor ENT surgery
Intuitive neuromonitoring in ENT surgery
C2 ENT software module for facial nerve neuromonitoring
Intraoperative neuromonitoring makes an important contribution to the localisation and functional monitoring of nerves and to the intraoperative preservation of nerve function. In ENT surgeries, for example involving the parotid gland, neuromonitoring is of great value. By sparing the nerves, the risks associated with the interventions can be considerably minimised.
Intraoperative neuromonitoring in delicate ENT surgery
ENT surgery in particular, demands a fine and cautious approach by the surgeon to produce the best functional and cosmetic results. To avoid damaging the nerve branches inside the parotid gland and its surrounding structures, the C2 NerveMonitor in ENT surgery offers intuitive channel identification through individual acoustic signals. The spontaneous activities of the nerves and the muscle contractions of the nerve branches are represented acoustically and visually by specific localisation.
Reduction of the risk of nerve injuries in ENT surgery
Neuromonitoring by inomed supports the surgeon among other things in tympanoplasty, the placement of a cochlear implant, and in mastoidectomy when operating near to bony structures; inomed neuromonitoring minimises the risk of nerve injury.
Monitoring of nerve branches during operations
Also, in the field of ENT surgery, manually guided stimulation probes locate the nerve branches for monitoring functionality during the intervention. Bipolar probes offer high selectivity, optimal for identifying nerve branches, while monopolar probes have a broader scope of action and thereby offer the localisation of nerve structures. The electrophysiological signals are recorded by placing electrodes in the relevant indicator muscle. Nerve irritations can cause spontaneous activity in the target muscles, which is indicated visually and acoustically. These activities are stored automatically for documentation and can be commented upon during the course of the operation. The HL7-Ready interface offers automatic synchronisation of the patient data with the hospital network.
Intuitive channel identification thanks to individual acoustic output
The C2 NerveMonitor allows clear acoustic identification of the different channels based on the acoustic signal. The sound of a specific channel is audible for the currently highest EMG amplitude that is identified. This ‘channel ident’ function is available for triggered EMG signals in ENT surgery.
Features
Specially developed C2 Software for operations in ENT surgery
Ease of use for Operating Room staff
Clear presentation of EMG
Channel ident’ function for acoustic differentiation of facial nerve branches
Applications
Parotid surgery
Tympanoplasty
Mastoidectomy
CI Implantation
Product category: Neurological diagnosis, apparatus and instruments, Neurosurgical instruments and equipment
C2 NerveMonitor Vascular surgery
Efficient Neuromonitoring during vascular surgery (carotid artery)
Specially developed software for SEP testing for the C2 NerveMonitor
In carotid surgery, the measurement of somatosensory evoked potentials (SEPs) is recommended for monitoring the afferent pathways. This serves to identify inadequate blood supply of the cerebral hemispheres. Changes in SEP amplitudes and latencies indicate deficient blood perfusion. If the amplitudes decrease by 50% or the latencies increase by 10% compared to their baseline situation, it is regarded as a sign of beginning ischemia.
(Source: Domenick et. Al. 2018, „Somatosensory Evoked Potentials and Electroencephalography During Carotid Endarterectomy Predict Late Stroke But Not Death”, Ann Vasc Surg. 2017 January; 38: 105-112.)
Early recognition of changes in cerebral function
Interventions in the carotid artery involve a risk of ischemic events. With the C2 NerveMonitor critical changes in the cerebral function can be recognized in time. Beside numerous other applications, the C2 NerveMonitor thus offers efficient neuromonitoring in vascular surgery.
Specially developed SEP software enables avoidance of irreversible vascular damage
The C2 SEP software was developed for precise neuromonitoring in vascular surgery. It is used to continuously monitor the sensory function. The stimulation electrodes are placed at the median nerve. Stimulation is then applied contralaterally to the surgical site. Recording is performed at the surgical site above the sensory cortex. A comparative measurement at the level of cervical vertebra C7 may also be useful.
Throughout the entire vascular surgical operation, the latency and amplitude of the recorded SEP signals are displayed as a trend. If the measured values reach an adjustable threshold level, the surgeon’s attention is drawn to this fact optically and acoustically. This allows a response to be made, for example by placing a shunt. Irreversible damage from deficient blood perfusion can thereby be avoided.
Simplification of surgery report documentation within vascular surgery
The intuitively applicable comment function of the SEP software offers the possibility of providing relevant time points (clamping, declamping etc.) during vascular surgery with comments. This facilitates the generation of a surgery report. Monitoring the individual stimulation responses is possible at all times.
Features
Specially developed C2 SEP Software for operations in Vascular surgery
Clear view of SEP signals
Floating averaging process
Intuitive display of averages
Continuous and automated impedance control of the measuring electrodes
Applications
Interventions on the Carotid artery
Product category: Other surgical instruments and products
C2 NerveMonitor Rectal surgery
pIOM® technology with particular relevance for rectal surgery
Specially developed C2 pIOM® software for pelvic nerve protection
With the upgrade to the C2 pIOM® software, the C2 NerveMonitor has added a further discipline to its range of uses for surgeons. Pelvic neuromonitoring can be efficiently performed with the patented pIOM® technology from inomed and is of high significance for neuroprotection in surgical interventions of the pelvis minor and in rectal surgery.
Well-proven software concept – extended application
The C2 NerveMonitor and its well-proven C2 software concept stand for user friendliness and high signal quality. In the development of pIOM® software and the other software modules for example SEP, these criteria were optimised and combined with specific functions for the corresponding use. With the new pIOM® software for the C2 NerveMonitor and the pIOM® accessories matched to the software, inomed offers a complete solution for efficient pelvic neuromonitoring.
Step by step through the Operation thanks to Wizard structure
The greatest advantage for the user is the software navigation which thanks to the Wizard structure allows easy use of the pIOM®. The surgeon is guided by the software, starting with the input of the patient data, through the pressure sensor placement, the electrode placement (needle and rectal electrode) and the measurement up to the report. The Wizard structure guarantees error-free application, making pelvic neuromonitoring an efficient method of neuromonitoring in rectal surgery.
Continuous monitoring of anorectal function
The anorectal function is continuously monitored in the measurement mode. For this purpose, electrodes are placed in the internal and external anal sphincter muscle. Alternatively, a non-invasive rectal electrode can be used for ease of application.
Monitoring of the urinary function is performed with the aid of a pressure sensor, which is placed as a complete connection set between the bladder catheter and the urine bag. The stimulation of the pelvic nerves is performed by using a manual probe specially developed for this purpose. It is used by the surgeon for localisation of the individual nerve branches and their functional monitoring.
If such activity occurs, the surgeon will be notified immediately optically and acoustically.
The optical signal is given in the form of independent specific colour bars, depending on the event. At the same time, a continuous acoustic signal indicates the stimulation.
All muscle responses and comments are stored automatically by the C2 pIOM® software and listed in the later report. This documentation allows the surgeon to review every stimulation response of the intervention in rectal surgery at any time and retrospectively.
Features
Specially developed C2 pIOM® software for the rectal surgery
Ease of use for Operating Room staff
Clear presentation of the muscle response in the form of EMG waveforms
Comprehensive pIOM® accessories
Applications
Rectal surgery
Product category: Neurosurgical instruments and equipment, Other surgical instruments and products
C2 NerveMonitor Spinal column surgery
Neuromonitoring for Spinal Column Surgery
C2 Spine Software – simple, fast and intuitive
For efficient neuromonitoring in spine surgery, inomed offers the C2 Spine Software with colour-coded accessories for intuitive handling. The C2 Spine Software is used with the C2 NerveMonitor, which is applied across the world for a wide range of surgical monitoring where user-friendly operation and quality signal acquisition is of paramount importance e.g. in thyroid surgery.
Intuitive controls – especially in positioning needle electrodes and connecting cables
For the monitoring during spinal column surgery the C2 Spine Software guides the user step by step, starting from the correct positioning of the needle electrodes to connecting the cables to the system. The program provides simple options for setup ensuring the user is ready to perform the test very quickly. The specifically designed accessories have been adapted to the Spine Software. This makes neuromonitoring during spinal surgery an easy standard to adopt as part of the surgical procedure. The C2 Spine Software combines efficient neuromonitoring during spinal column surgery with simple and intuitive handling that has been tried and tested for other applications of the C2 NerveMonitor.
Automatic monitoring of the pharmacological relaxation status of patients
The C2 Spine Software includes an integrated twitch-test (relaxation monitoring). The test is used to check the pharmacological relaxation status of the patient’s muscles automatically. This is crucial for effective recording of signals during spinal column surgery.
The muscles are continuously monitored when the software is in measuring mode. If a relevant activity occurs – for example, by direct nerve manipulation – the surgeon is informed of this visually and acoustically. Pedicle screw testing and stimulation capabilities of the C2 make automatic identification of the respective stimulation threshold value possible and thus the position of the screw within the pedicle can be inferred. Essential information is provided quickly and easily and is displayed for users during spinal column surgery.
The C2 Spine Software automatically saves all muscle responses and stimulation limits in one document for the subsequent report. As a result, it is possible to review every stimulation response for the procedure at a later date.
Features
Specially developed C2 Spine Software for operations on the spinal column
Ease of use by OR staff
Clear representation of the EMG signal
Twitch-test for automatic relaxation monitoring
Colour-coded accessories
Applications
Posterior cervical interbody fusions
Posterior lumbar interbody fusions and latera
Product category: Neurosurgical instruments and equipment
C2 Xtend
C2 Xtend – Specialised for cortical applications
Advanced Brain Mapping for safe tumour resection in neurosurgery
Precision and safety are the highest priority in the resection of brain tumours. Interventions in neurosurgery are among the most complex surgical procedures since important neuronal structures are located close to the operating field.
The so-called ‘Mapping’ – the localisation of functional areas – is of central importance in the field of neurosurgery for the focused and sparing removal of gliomas and other cerebral tumours. This technique allows localising language-relevant and motor regions, while subsequent continuous monitoring enables gentle resection of tumours.
Proven C2 concept with extended functions
Based on the reputable concept of the C2 NerveMonitor, the C2 Xtend was perfected for cortical use. Particularly notable is the specially developed software for neurosurgery, which provides a simple and intuitive user interface with dedicated parameters specifically adapted for cortical stimulation.
C2 Software modules for other surgical disciplines
With the upgrade to all other C2 NerveMonitor applications the C2 Xtend offers versatile application options and opens up access to a wide range of surgical disciplines and needs, not only in neurosurgery.
In addition to its diverse features on the surgical level, the C2 Xtend offers user-oriented add-ons such as a barcode scanner, allowing fast input of patient data, an integrated database to store data, and an automated impedance control, ensuring a trouble-free operation.
Features
Specially developed C2 SEP software for cortical mapping in neurosurgery
Easy handling
Clear display of the EMG signals
Stimulation parameters for all cortical stimulations – biphasic pulse form and train stimulation
Barcode scanner for storage of patient data
Integrated database
Applications
Direct cortical stimulation
Speech mapping
Motor mapping
Mapping of cranial nerves
Product category: Neurosurgical instruments and equipment
ISIS Neurostimulator
A general-purpose neurostimulation system
The ISIS Neurostimulator is a USB powered module that can be used with stand-alone Windows based PC software to deliver electrical stimulation. The ISIS Neurostimulator can also be configured to form a part of the ISIS IOM system using the NeuroExplorer software. The device provides a multifunctional constant current stimulator, which is specially designed for Neurostimulation and intraoperative neurostimulation.
Easy to use – safe and reliable connection
The stimulation adapters used with the ISIS Neurostimulator are color-coded and clearly labeled enabling easy connection to probes and electrodes at the patient’s bedside.
The ISIS Neurostimulator can also be configured to be used with neurodiagnostic systems to deliver neurostimulation for EMG and iEEG procedures.
The ISIS Neurostimulator – powerful and flexible
The ISIS Neurostimulator includes 12 channels for high-power stimulation (max. 250 mA) and a single channel for direct nerve stimulation (max 25 mA). The range of outputs allow for the simultaneous use of a range of neurophysiological measurement techniques in surgery, including neurosurgery, epilepsy surgery, general and visceral surgery and ENT. In addition to the 12 channel stimulation capability, the ISIS Neurostimulator also includes technology that continuously monitors the impedances of the stimulation electrodes. This technique ensures that the current delivered to the patient is constant and kept within safe limits. Stimulation parameters can be modified and saved in the control software.
Features
Constant current stimulator with 12+1 outputs for direct neural, cortical, muscular, transcutaneous and transcranial electrical neurostimulation
Stimulation current of 0.01 mA to 250 mA can be set at individually definable levels for each channel
Impedance measurement and current flow control indicator
Each stimulation channel can be used flexibly for all measurement types and freely selected
Simple programming of an unlimited number of application-specific stimulation programs
Patient documentation database
All adaptor/connection boxes required are included
Applications
Transcranial electrical neurostimulation of motor evoked potentials
Direct cortical and subcortical neurostimulation of the speech and motor cortex
Direct intracerebral neurostimulation for localization of functional disorders in pre-surgical diagnostics for certain pharmaco-resistant epilepsies.
Direct neurostimulation for monitoring cranial and peripheral nerves
Neurostimulation of peripheral nerves, neural lesions to measure nerve action potentials
Neural and muscular stimulation for surgery in the small pelvic region and anal atresia
Product category: Neurosurgical instruments and equipment
iPS – inomed Planning System
Target point planning, biopsy and DBS
inomed planning software – iPS
Accurate and precise planning is essential for all forms of neurosurgery that require targeting structures in the brain. For example, targeting the STN for DBS procedures requires that the target is identified and a precise and accurate trajectory is defined for use with stereotactic devices. In order to achieve this, it is essential that a high-precision and easy-to-use planning tool is employed. The inomed iPS software is such a tool, enabling the clinician to easily assemble all of the necessary imaging modalities and create an optimum set of planning coordinates to target the area of interest.
State-of-the-art imaging techniques in combination with developments in the field of IT have led to breakthroughs in stereotactic and functional neurosurgery. These technologies have enabled accurate and tissue-sparing interventions in the human brain. All the planning tasks are carried out by the inomed iPS planning system.
Safe intervention during DBS requires precise planning
Before any surgical intervention, surgeons use the iPS from inomed to plan their access and target point coordinates for specific surgical interventions in the brain. The target defined may be verified prior to surgery using the inomed target point simulator.
What sets the IPS planning software apart is the high quality of its image manipulation tools and the methods and algorithms used to merge images together. If required, anatomical atlases can be projected onto the patient’s own data. In turn, this allows verification based on anatomical principles and provides for safe intervention.
Seamless connection to IT systems
Interfacing with hospital imaging tools is a prerequisite for successful and effective operation in planning and stereotactic interventions. The inomed iPS software connects seamlessly to hospital-specific imaging equipment and IT structures. In addition, the iPS software supports a variety of different image formats, allowing for a wide range of applications. Once planning is complete, the resulting data is transferred to the stereotactic system, paving the way for an accurate and safe surgical intervention.
There is currently no other stereotactic planning software besides iPS that supports the wide range of different stereotactic systems on the market. Whether carried as a laptop or in stationary mode with a network connection, iPS provides reliable coordinates and helps ensure successful interventions.
Supporting all planning approaches
iPS supports all planning approaches, whether free-hand, functional, atlas-based or metabolically-oriented. In each case, various options are available that can complement each other to provide greater safety in interventions, such as DBS.
A powerful multi-level fusion algorithm allows the merging of digital and digitized image information, always preserving the exact patient geometry in the foreground, with simultaneous optimization of anatomical visibility and image quality. This forms the basis for a secure, high-risk intervention, such as DBS.
Additionally, post-operative imaging can, after an intervention such as DBS, be combined with pre-operative information so that complications can be excluded and the accuracy of the procedure verified.
Features
PACS connectivity
DICOM import and export
Automatic image fusion
3D simulation
Visualization of electrodes
Anatomical atlases
Supports all imaging systems
Post-operative checks
Applications
Stereotactic target planning
Biopsy planning
Deep Brain Stimulation (DBS)
SEEG planning
Product category: Neurosurgical instruments and equipment
Stereotactic systems
Stereotactic systems from inomed
inomed continues the tradition of uncompromising precision in stereotactic tools
Modern functional neurosurgery procedures are now so minimally invasive that they have to be planned and performed with the highest degree of precision. The inomed stereotactic systems are defined by their reliability, precision and stability in their overall function. The fact that the work of the surgeon and the OR team is so simplified – because inomed’s systems are so easy to operate – is one of the qualities of inomed’s stereotactic systems that our customers appreciate most.
To date, there are no other systems on the market that are more convenient or have higher precision than the stereotactic systems created by inomed. The following reasons will help to explain why.
High stability for stereotactic interventions
The ring-based stereotactic system used by inomed provides the highest level of stability. The basic physical properties of a ring are superior to all other basic geometric shapes in terms of strength and tolerance. This basic design element of the system and structure avoids common sources of error.
inomed stereotactic systems are the only systems worldwide with an advanced target point simulator. With the inomed target point simulator, theoretical planning from the planning software tools can be measured and verified according to the real-world geometric environment. There is no better way to ensure maximum patient safety combined with optimum precision. In addition, the use of inomed target point simulator results is a second and clear practical advantage. This means that when using the planning software, stereotactic frame and MicroDrive system, it is easy to check that the instruments used are functioning properly and within tolerances prior to surgical intervention. No other system on the market is more capable of providing this level of safety and design. inomed stereotactic systems set the absolute benchmark in terms of accuracy.
Choose the right system for optimal patient treatment
inomed offers a choice of stereotactic systems to suit customer-specific requirements our customers are able to choose between the Riechert-Mundinger system (RM) and the Zamorano-Duchovny (ZD) system. Both systems were developed by fellow neurosurgeons. Both systems are also an indelible part of the history of stereotactic neurosurgery. This is a further reason why inomed enjoys an international reputation for providing the highest precision and is respected for continuing the tradition of the application-driven and patient-oriented development of stereotactic devices.
Verification of the stereotactic planning coordinates is performed by the inomed target point simulator, also known as a phantom. All the systems combine methods of traditional stereotactics with the modern requirements of stereotactically-guided microsurgery, deep brain stimulation, thalamotomy/pallidotomy, and stereotactic biopsies.
Using inomed products for stereotaxic surgery means you will be benefiting from the reliability of a system where the functioning of all individual components is perfectly coordinated into one complete system.
RM-System
ZD-System
Target point simulator
Product category: Neurosurgical instruments and equipment
RM Stereotactic system
RM – the most accurate stereotactic system in the world
High-precision from Germany: The inomed RM system
The Riechert Mundinger (RM) system is the only stereotactic system on the market with three fixation points. This gives the device a very high level of stability and precision. The RM is regarded to be the most precise stereotactic system in the world and, with its unique design, provides uncompromised accuracy in stereotactic surgery.
The RM system from inomed is based on the polar coordinate principle. This concept was developed by the two well-known stereotactic experts, Prof. Traugott Riechert and Prof. Fritz Mundinger. The RM aiming arm with its probe mount delivers a high level of mechanical precision. A wide range of accessories ensure that the RM system delivers universal application for the modern stereotaxy service.
Stereotactic system offering the highest precision
The high precision of the inomed RM system was specifically developed for stereotactic interventions in functional neurosurgery. The configuration can be easily adapted for stereotactic brachytherapy. The precision and stability of the RM stereotactic system means that it is the frame of choice, particularly for interventions in functional neurosurgery.
The RM stereotactic system consists of an RM stereotactic base ring and an RM aiming arm unit. The application of the stereotactic base ring and the use of localizers for imaging are described in separate manuals (patient immobilization, localization systems). The RM target device allows the attending neurosurgeon to reach every point in the brain precisely. In order to achieve optimum results, it is a requirement that the patient’s head, the position of the target and the trepanation point are taken into consideration when mounting the ring. Different mounting options can be applied both positively and negatively. The standard mount method is used for all acquisitions in the frontal and occipital region of the skull. With negative mounting of the RM, the posterior fossa and pituitary gland can be reached.
Vernier scale for accurate setting
To ensure the settings are as accurate as possible, Vernier scales are attached to the corresponding scales on the RM system. The Vernier scale allows surgeons to define small measurement units that can no longer be read on the main scale. A Vernier scale line corresponds to 1/10 of a degree. In the Vernier scale, 9° are divided into 10 equal sections. Using the Vernier scale in this way, the RM coordinate values can be adjusted precisely to decimal points (1 -, 1 -, 3, etc.). The digits after the decimal point are read from the scale line on the Vernier.
Components of the inomed stereotactic product can be adapted as part of a modular system directly on the aiming arm carriage of the RM system. Other components can also be used separately, and provide further helpful tools for the attending neurosurgeon.
Features
Polar coordinate system, with 5 setting parameters allowing for extremely high precision
Three fixation points for unmatched stability
Trepanation in the target direction
MicroDrive with depth sensor for micro-electrode recording (MER)
Target point verification using target point simulator
Artifact-free, optimized for medical imaging
Compatible with inomed iPS planning software
Applications
Deep Brain Stimulation
Pallidotomy
Thalamotomy
Brachytherapy
Stereotactic biopsy
SEEG depth electrodes
Product category: Neurosurgical instruments and equipment
ZD Stereotactic system
The ZD stereotactic system – for neurosurgery and neuromodulation
Aiming arm system for frame-based stereotactic neurosurgery
The inomed ZD frame derives its name from partners who developed it, Prof. L. Zamorano and Prof. M. Dujovny. This ZD localization system is most often used for neurosurgery and neuromodulation surgery applications.
The ZD system is an unparalleled combination of classical stereotaxy methods with the modern requirements of stereotactically-guided microsurgery. The procedures include stereotactic endoscopy, laser therapy and other cutting-edge applications, including neuromodulation and stereotactic biopsy.
The design of the ZD frame combines precision engineering and manufacturing with easy and intuitive operation. The ZD system therefore provides an important tool for the modern neurosurgeon. The minimally invasive neurosurgery techniques undertaken using the ZD frame offer patient-friendly and life-sustaining treatment options for disorders of the brain.
Almost unlimited access to all intracranial regions
The ZD system is based on the center-of-arc principle, which allows almost unlimited access to all intracranial regions, with a free choice of trepanation point. The surgeon is able to select the access point, offering the greatest safety to the patient and ensuring that all the settings for neuromodulation are configured on the ZD system with the highest level of mechanical precision.
The ZD system is compatible with all imaging procedures used with advanced therapy requirements, including DBS. The ZD head ring unit is made of titanium and guarantees artefact-free CT and MR images. The head ring is also transparent for X-rays. By design, the modular nature of the ZD system makes it possible to quickly and easily pick up whilst accurately and safely performing a number of diagnostic and therapeutic stereotactic procedures and neurosurgery. This is true for DBS procedures in the field of neuromodulation and also for stereotactic biopsy performed on the brain.
Variety of accessories for neuromodulation
When using the ZD system in neurosurgery and neuromodulation procedures, the surgeon is advised to take into consideration all indications and contraindications that generally apply to frame-based stereotaxis.
The ZD system can be used together with all inomed stereotactic rings. There are a variety of accessories and tools available for use with the ZD system. Using the inomed planning system (iPS), surgery can be planned and mapped on to the ZD frame. This includes all steps leading to a neuromodulation (DBS) implantation.
Features
Center-of-arc principle, target point remains the same from different trepanation points
6 possible mounting positions for best possible access
Single-point fixing for easy and flexible mounting
MicroDrive with depth sensor for micro-electrode recording
Target point verification using target point simulator
Compatible with inomed IPS planning software
Applications
Deep Brain Stimulation
Pallidotomy
Thalamotomy
Stereotactic biopsy
SEEG depth electrodes
Product category: Neurosurgical instruments and equipment
inomed Target point simulator
The inomed target point simulator – Stereotaxic phantom
Recommended by leading neurosurgeons – inomed target point simulator (Phantom)
The stereotactic target point simulator from inomed, also referred to as a phantom, is a unique product and only available from inomed. Professors Riechert and Mundinger, globally recognized pioneers in neurosurgery, have developed the phantom alongside the development of the RM stereotactic system. The target point simulator has become internationally established and is regarded by leading neurosurgeons to be an essential and recommended tool for planning and conducting complex operations on the brain. The use of the phantom becomes especially significant for the highly complex neuromodulation (DBS) techniques.
The target point simulator (phantom) is used primarily to translate the coordinates from the planning software and mechanically setting the target point in real-space prior to surgery. A steel target point rod is moved with three movable thumb screws in the X-, Y-, and Z-axis (coordinates from the planning software). The tip of the rod forms the target point, in accordance with the planning software. A base ring is attached to the target point simulator and the aiming arm unit can be placed on this ring. The phantom consequently simulates the respective target point for the patient.
There are two options for setting the target direction on a phantom:
a) Mechanical adjustment on the phantom:
The desired stereotactic coordinates are set on the phantom. The trepanation marker is brought and fixed to the patient’s head in the position of the desired trepanation gap. This is transferred to the base ring on the target point simulator by loosening the retaining screw and attaching in the same place (number of degrees on the ring).
After attaching the aiming arm to the base ring on the phantom, a puncture probe is directed through the opening of the trepanation marker directly to the target point. In order to do this, all screws on the aiming arm and carriage are loosened. This enables the assembly to be moved in all directions. By looking through the depth gauge, with the instrument holder and the trepanation marker, it is relatively easy to slide the assembly in all directions and move until the tip of the aiming point marking rod is visible. Once the best possible setting is reached on a phantom, all fixing screws are locked and secured and the entire aiming arm is attached to the base ring.
b) Mathematical adjustment on the phantom:
Using X-ray, CT and MRI scans with the inomed planning software (iPS), the target and trepanation point coordinates are calculated and converted to stereotactic angles. The coordinates calculated by the iPS can be set directly on the aiming arm carriage of the RM or ZD stereotactic system. The aiming arm is then mounted on the phantom for verification.
Despite this rather simple target setting, an additional check on the phantom is always recommended. Any errors in adjusting the angle on the aiming arm or curved/bent instruments are detected immediately with the phantom. The phantom is therefore the final authority for preventing stereotactic errors. Only the use of a phantom can ensure the highest level of safety for patients during neurosurgery and neuromodulation.
Features
Patient-customized checking of target points
The setting of the stereotactic system in relation to the patient’s target point is guaranteed to be accurate and correct for the given coordinates
Faulty instruments are detected before being used
Perfect for training beginners
X, Y and Z axes can be set for the patient-specific target point
Autoclavable
Applications
Target point verification for the stereotactic system and instruments
Product category: Neurological diagnosis, apparatus and instruments, Neurosurgical instruments and equipment
ISIS MER System
The inomed ISIS Micro Electrode Recording (MER) system
inomed ISIS MER – The most compact and intuitive MER system available
Deep brain recording and stimulation or extracellular recording in other regions of the brain is potentially a high-risk intervention requiring a precise and systematic approach. The ISIS MER system is a self-contained, micro-electrode recording system that provides all of the hardware and software elements necessary for targeted measurement in MER and neuromodulation techniques. The ISIS MER system can be configured for a wide range of applications and is designed to be easy and intuitive to use.
ISIS MER System: Modularity in neurosurgery
The portable ISIS MER system comprises all the equipment the neurosurgeon will need in one box: ISIS MER USB Headbox module for micro-electrode recording and ISIS EMG USB Headbox module for electromyography. The system includes a high specification Notebook computer and medical grade power supply. The MER system carry case includes space for the high-precision inomed MicroDrive and sterilization box. The ISIS MER system also includes a small yet powerful and portable workstation for the OR.
Within the cart configuration, the system also includes a wide-screen monitor with an easy-to-clean surface and optional touchscreen operation. A high-performance speaker system and laser printer complete the cart configuration. The cart also benefits from additional space for accessories.
The intuitive interface of the ISIS MER Headbox ensures that both the surgeon and the operator of the MER system can see the electrode depth at all times throughout the procedure. This is critical to target localization during deep brain stimulation or when measuring local field potentials. Easy access to this information is also vital to ensuring accurate and safe procedures.
Hightech Systems combine to deliver the ultimate MER
The ISIS MER system has an intuitive and easy-to-use user interface. This means that the surgeon and the MER operator can focus on the procedure and patient during the critical recording and stimulation phases of the procedure.
System integration with the inomed MicroDrive and the micro-macro electrodes delivers seamless performance. The design is stunningly simple. This means that only one plug-in connection is required per electrode. Switching between recoding and stimulation for a given electrode/channel is very simple – internal computer-controlled switching means there is no need to swap cables from recording to stimulation. All raw signal information is recorded for each channel used and signal filtering is an online function of the software. This results in the complete signal spectrum being recorded and available for post-operative investigation and intra-operative display.
Features
5 MER channels for recording and stimulation
Up to 16 EMG channels
Intuitive and easy to use
Upgradeable with additional functions and additional ISIS USB headboxes
High-quality loudspeakers
Online analysis functions
Depth sensor for electrode position display
Applications
Target localization for extracellular recording and deep brain stimulation
Recording and localization of the core area in case of lesions
Product category: Neurological diagnosis, apparatus and instruments, Neurosurgical instruments and equipment
MSV – MicroDrive for deep brain recording and stimulation
A mechanical masterpiece
This is the fourth generation of the sophisticated high-precision instrument used by surgeons and medical professionals around the world to position electrodes during stereotactic interventions and in deep brain stimulation.
The inomed MicroDrive was developed in cooperation with leading international practitioners and experts. The resulting standards and specifications set by the experts were extremely high. inomed has delivered on the specifications required and achieved mechanical precision delivering unique performance. The inomed MicroDrive is known to most specialists in the field and the device is favored for deep brain recording and stimulation applications.
Professionals and subject matter experts use the MicroDrive routinely. Using the inomed MicroDrive delivers the best possible neurophysiologically targeted diagnostics (deep brain recording and stimulation).
Modern imaging technology can identify physical structures of the brain, however, imaging modalities alone are not able to clearly and finitely identify target areas. In addition to this, target location can be affected by brain shift or indeed the functional target point may differ from the imaging results. For all of these reasons, microelectrode recording is used to further improve target point localization and precision. Precise localization, recording and stimulation are particularly important for DBS and neurmodulation procedures. For this entire spectrum of uses, the inomed MicroDrive is an indispensable tool. Correct application of the MircoDrive enables users to determine the optimum target point, for optimal treatment outcome in deep brain stimulation (DBS).
The universal nature of the MicroDrive design means that the inomed MicroDrive can be used with other Stereotactic systems and a wider range of users are able to benefit from the technology. With the addition of a suitable adaptor available from inomed, the MicroDrive can be used on all currently available stereotactic systems.
Functional neurosurgery requires more than just manual dexterity
Surgeon’s tools become an extension of his hands. The tools and technology used in the OR must work in perfect synchronization with the surgeon and be entirely reliable too. This is especially the case when positioning electrodes during a stereotactic procedure, such as deep brain stimulation (DBS).
The depth stops on the inomed MicroDrive ensure that fitting the electrodes and guide tubes incorrectly is not possible. The tactile feedback (‘click’) allows the neurosurgeon to ‘feel’ when a full turn of the MicroDrive spindle has been completed.
The inomed MicroDrive is able to position and deliver up to five electrodes for recording and stimulation for deep brain stimulation (DBS) procedures. The inomed MicroDrive has a resolution of 50 µm per division and allows the surgeon to position the electrodes accurately, with tactile feedback after each full turn.
With the addition of the optional depth sensor to the MicroDrive, the stereotactic position of the electrodes is automatically transferred to the ISIS MER system and is indicated on the screen and recorded as part of the patient recording process.
Features
Implanting of DBS electrodes from Medtronic® , St. Jude® and Boston Scientific®
Positioning resolution of 50 µm
Tactile feedback after one complete turn (0.5mm)
Optional depth sensor available
Autoclavable
Applications
Deep Brain Stimulation
Recording and localization of the core area in the case of lesions
Micropositioning of other probes and electrodes
Product category: Neurological diagnosis, apparatus and instruments, Neurosurgical instruments and equipment
inomed Biopsy instruments
Stereotactic biopsy for the brain
inomed delivers the best instrument for every biopsy requirements
When the diagnosis of a brain tumor is uncertain, a stereotactic biopsy can provide clarity and confidence. To ensure that such clarity and confidence is delivered during a biopsy, inomed offers a sophisticated set of biopsy instruments for intra-operative stereotactic surgery.
From an evidence-based perspective, histopathological diagnosis of a brain tumor is the method with the highest accuracy rate for classifying a tumor. In this sense, stereotactic biopsy is the best method of treatment, especially for smaller and more deeply-seated lesions. This is considered to be the best way to classify a lesion accurately, and only this way can each and every patient receive the optimal treatment for their specific disease.
Working lengths for every application
Depending on the application and the requirements of its intended use, inomed biopsy sets offer a range of working lengths. Biopsy sets are selected to suit the stereotactic system that is being used. This means all systems with internationally established stereotactic working lengths, i.e. both 190 mm and 280 mm, can use inomed stereotactic instruments.
Planning a stereotactic biopsy can be performed with the inomed planning software (iPS): inomed’s software supports current methods for target point definition, visually, functionally and metabolically. Due to the high quality of inomed’s biopsy instruments, users are able to work precisely at the point from where tissue is to be removed. The inomed target point simulator helps to validate the design and verify the exact calibration of the instruments used.
Safety and precision during the biopsy
inomed provides a safe process within the framework of planning and implementing a stereotactic biopsy for the brain. Using the unique inomed target point simulator, inomed is uniquely positioned to offer the highest levels of precision in the field of stereotactic biopsy. inomed continues to set standards for accuracy and precision.
The inomed portfolio comprises all current types of biopsy instruments, including forceps and probes (Sedan-type and Backlund).
Depending on personal preference or clinical requirements, disposable products and reusable products are also available. The sets include guide tubes and, if necessary, Mandarin and sterilization boxes.
Zamorano-Duchovny (ZD)
Riechert-Mundinger (RM)
Leksell
Micromar
CRW Radionics
Features
Available as single-use or reusable instruments
Available as forceps, probe or needle
Working length 190 mm or 280 mm
Applications
Controlled removal of tissue in the brain (biopsy)
Product category: Neurological diagnosis, apparatus and instruments, Neurosurgical instruments and equipment, Other surgical instruments and products
IOM Accessories
A complete connection concept from needle electrodes to adapter box
inomed stimulation and recording accessories have been specifically developed to meet intraoperative applications.
Thyroid surgery
Pelvic neuromonitoring (pIOM)
Our accessories portfolio includes stimulation probes and electrodes (e.g. subdermal needle electrodes) for stimulation and recording. These are complimented by color-coded adapter boxes and connecting cables in a wide range of lengths.
Electrodes for stimulation and recording
In addition to their use in relation to signal recording, electrodes, including needle electrodes, can also be used for stimulating nerve and muscle tissue. Application-specific electrodes with a range of different geometries have been optimized for use with a range of multimodality applications (surface and needle electrodes). All electrodes, including needle electrodes, can be used for all measurement modalities (AEP, EEG, EMG, MEP, SEP, VEP) in a multimodal neuromonitoring application. All electrodes also feature a 1.5 mm safety connector and are compatible with a variety of connection schemes on other manufacturer systems.
Subdermal needle electrodes (SDN electrodes)
The subdermal needle electrodes available from inomed provide an easy and reliable patient connection to enable the high-quality recording of electrophysiological signals. These electrodes can also be used for the electrical stimulation of nerve and muscle tissue. Subdermal needle electrodes are also available in the form of corkscrew electrodes, hookwire electrodes, hook electrodes and short needle electrodes for pediatric applications. In addition, the range offers various bipolar needle electrodes, including electrodes for vocalis and oculomotor nerve recording.
D-wave electrode
The inomed D-wave electrode is a bipolar flexible drainage and stimulation electrode. It can be used for recording both D- and I-waves. The D-wave electrode can also be used to stimulate the spinal cord and enables electrical intraoperative functional testing during the procedure. In addition, this flexible electrode is also used in the postoperative prognosis of spinal cord function in neurosurgery, spinal surgery and vascular surgery.
Strip and grid electrodes (including needle electrodes)
inomed strip and grid electrodes are typically used for reverse-phase SEPs, direct cortical stimulation – bipolar or monopolar against a counter electrode (e.g. needle electrodes). In addition, these electrodes can also be used for epilepsy surgery. The electrodes are available in a range of designs with 4, 6 or 8 contacts per strip. The strips are combined in a range of configurations to deliver grinds of differing numbers of electrodes.
Stimulation probes (including needle electrodes)
Hand-held stimulation probes are used for electrical stimulation of nerves and neural structures. When used in conjunction with needle electrodes, probes and electrodes can be used to record electrophysiological signals. A wide variety of bayonet-shaped probes are available from our product range. These products help ensure that working under the microscope remains unobstructed and easier for the surgeon. The probes are sterilized with ETO and have a cable with length of 3 m, leading to a standard safety plug for connection to a full range of stimulation outputs and headboxes. All monopolar probe packages include a needle electrode used as a ground electrode. Reusable probes are connected to the systems via a 4-meter probe cable.
Bipolar stimulation probes
Bipolar probes are available in the following form factors; bipolar concentric probes, fork sensors and hook probes. In order to accommodate the various application requirements from direct cortical stimulation to stimulation and recording of direct nerve action potentials (NAPs), bipolar probes can be delivered in a variety of geometries.
Monopolar stimulation probes
Monopolar stimulation probes are primarily used for motor mapping and muscle stimulation in spinal surgery and pedicle screw stimulation. The probes have an active electrode (the probe) and a return electrode (ground), which is placed outside the stimulation region. The electrode used for ground can be in the form of a needle electrode or stick-on pad electrodes.
VEP goggles
inomed offers a range of a VEP stimulators that can be used for intraoperative stimulation of the visual pathways. With two independent LED pads, disturbing immobilizing elements are not necessary. The recording of electro-physiological signals takes place on the primary visual cortex and can be carried out using surface electrodes, as well as subdermal needle electrodes.
Product category: Neurological diagnosis, apparatus and instruments, Neurosurgical instruments and equipment
Accessories for stereotaxy and functional neurosurgery
inomed offers a wide range of accessories and instruments for stereotactic and functional neurosurgery
inomed micro-macro electrodes (MiMa):
Ideal for neurosurgery requiring electrophysiological identification of anatomic target points for stereotactic-functional interventions, including deep brain stimulation (DBS). The patented bipolar architecture allows for both recording and test stimulation to be carried out. The low capacitance of the electrodes enables the maximum spike amplitude to be measured. This results in an excellent signal-to-noise ratio for this type of brain surgery.
inomed MicroMove electrodes (IMM):
A combined electrode for the precise electrophysiological localization of anatomical target points in the human brain. The impedance of the MicroMove electrode is 1 MOhm, which means the electrode can be used with most commercially available recording systems.
inomed macro electrodes:
This electrode can be used to identify an anatomical target point by selective test stimulation during brain surgery. The electrode has a monopolar architecture and therefore it does not allow signal recording.
Biopsy Instruments
To enable precise removal of tissue during a stereotactic biopsy, inomed is the single source for all the latest biopsy instruments for brain surgery – these include forceps and probes (Sedan-type and Backlund). Single-use products and reusable versions are available.
Disposable biopsy probes (Sedan-type)
Reusable biopsy forceps (also pediatric)
Reusable spiral probes (Backlund-type)
We support the following stereotactic systems for brain surgery (the choice of system determines the working length of the biopsy instruments):
Zamorano Duchovny (ZD)
Riechert-Mundinger (RM)
Leksell
Micromar
Radionics
Open stereotactic system (OSS) by inomed
The open stereotactic system (OSS) is a system for frame-based stereotaxy in brain surgery. The open ceramic ring is fixed rigidly to the patient’s head and remains in place throughout the entire procedure. The stereotactic coordinates from the tomographic images can be transferred to the ceramic ring-mounted stereotactic systems and allow for a targeted intervention.
For neurosurgical and radiosurgical procedures and treatments, the goal is to achieve – as closely as possible – a preoperatively planned target point for brain surgery. Imaging procedures, such as computer tomography or magnetic resonance imaging, can provide images of the patient during brain surgery. With the help of modern computer software, such as inomed iPS planning software, it is possible to view this tomogram either individually or as a three-dimensional image and to analyze the target for brain surgery.
The inomed open ceramic ring ensures minimum interference and maximum artefact reduction when imaging is used, and this is particularly the case with MRI. The semi-open architecture means a part of the patient’s face is not covered. This increases patient comfort, especially during brain surgery while awake.
Indications: Suitable for all types of neuro- or radiosurgical brain surgery that requires a stereotactic procedure.
The open ceramic ring has been specially designed for use with imaging in modern MRI scanners. Often used in compact head coils for brain surgery (e.g. Siemens Vision), it limits the size to an outer diameter of 260 mm. The concept of the open ring still allows access to the ENT region of the patient. In order to achieve the best possible MR imaging and correct for artefacts during brain surgery, a ceramic material is used. This is a high-performance ceramic material. It is characterized by its high resistance to mechanical loads during normal hospital operation and is largely resistant to the effects of daily steam sterilization.
Product category: Other surgical instruments and products
ALM® – Advanced Laryngeal Monitoring
High-tech technology for advanced signal recording in thyroid surgery
C2 Channel Select Software for ultimate reliability
The innovative and user-friendly Channel Select Software, especially developed for the C2 NerveMonitor and application in thyroid surgery, automatically selects the optimal trace from the 4 channels of the ALM® Tube and displays the strongest signal. This allows a seamless and reliable detection of muscle responses even under poor signal conditions.
8 contacts – 4 channels – 1 best signal
The ALM® Tube (IOM accessories for thyroid surgery) is a multifunctional combination of a clear PVC ET tube and a surface electrode, together providing the best possible EMG signal recording from the vocal cords. Thanks to the easy placement of the recording electrode at the vocal cords and the extended length of the 8 sensor pads, the ALM® Tube offers optimal signal recording of the M. vocalis during intraoperative neuromonitoring in thyroid surgery. The 360° surface sensor coverage with 8 long electrode contacts ensures ultimate signal stability, even if the tube is rotated or vertically shifted.
All signals are displayed acoustically and visually via the C2 NerveMonitor (IOM system for thyroid surgery). The C2 NerveMonitor is known as a smart specialist for various surgical applications, and is the result of inomed‘s several years of experience and intensive research in the field of intraoperative neuromonitoring.
Synergistic effects combined to one high-tech technology
Using the ALM® technology, the users benefit from the synergistic effects of individual key technologies. The ALM® Tube, C2 NerveMonitor, and the C2 Channel Select Software build an intelligent end-to-end solution, ensuring efficient application in thyroid surgery, especially during RLN monitoring.
Together with more than 25 years of expertise, ALM® represents the most innovative cutting-edge technology for advanced signal recording and ultimate reliability in thyroid surgery to date.
Features
Efficient end-to-end solution for ultimate reliability in IOM for thyroid surgery
ALM® Tube – tube for EMG signal recording with 360° surface sensor coverage and 8 long recording electrodes
C2 Channel Select – software module for C2 Nerve Monitor for automatic selection of the optimal signal
C2 Nerve Monitor – available as four or eight channel EMG monitor
Application
Thyroid surgery
Product category: Neurological diagnosis, apparatus and instruments, Neurosurgical instruments and equipment, Other surgical instruments and products
inomed Double Needle
inomed Double Needle – reliable recording of electrophysiological signals
The subdermal double needles enable easy and reliable recording of electrophysiological signals and are especially developed for intraoperative monitoring of the motoric cranial nerves.
Reliable signal detection of motoric cranial nerves e.g. the facial nerve
Quick and precise application due to the placement of two recording needles at the same time thanks to one common handpiece
Reduction of application errors thanks to the pre-defined needle distance and parallel needle guidance during needle placement
Twisted cables for optimal signal quality
Available in convenient sets
Product category: Neurological diagnosis, apparatus and instruments, Neurosurgical instruments and equipment
Mapping Suction Probe by Raabe
An all-in-one disposable surgical suction tube and stimulation probe
Subcortical mapping with synchronous suction
Simplified maximal tumor resection
No change of instruments during the procedure
The combination of a surgical suction tube and a stimulation probe allows suction during tumor resection and also enables the simultaneous continuous dynamic mapping of the corticospinal tract.
The Mapping Suction Probe by Raabe was developed by inomed in cooperation with Prof. Raabe M.D. (Inselspital Bern/Switzerland).
Complicated instrument change from suction to stimulation is not necessary. Use of the suction stimulation probe makes it possible to achieve maximal tumor removal minimizing the possibility of damage to the corticospinal tract.
The suction stimulation probe can be connected to commonly used suction devices. There is no difference in settings but all the advantages of combined suction and stimulation from a single device.
In 2016 the Mapping Suction Probe by Raabe has been awarded as winner of the German Industry Award „Industriepreis 2016“ in the Medical Technology category.
Product category: Neurological diagnosis, apparatus and instruments, Neurosurgical instruments and equipment
Brachytherapy planning in brain tumor application
Unique software module for brachytherapy planning in brain tumor application
inomed Planning System 6.0 with innovative features
The inomed Planning System iPS Version 6.0 is the only CE certificated planning software on the market to implement stereotactic brachytherapy planning for brain tumor application.
The powerful software allows the user to carry out safe and precisely calculated brachytherapy planning and includes a wide range of features for the evaluation of the plan quality. Thanks to the clear and userfriendly software design, the user is intuitively guided through all the necessary steps of stereotactic brachytherapy planning.
Advanced tools for precise and target-oriented brachytherapy planning
Due to the highly advanced Optimization Tool the dose distribution at the target volume can automatically be improved by modifying seeds strength and/or seeds position within the catheters.
The precise isoline drawings allow assurance of the irradiation effect on the target volume. The dose can be displayed at any point.
The included Statistic Function offers an automatic calculation of statistical parameters and the dose-volume histogram (DVH). Especially for quality assurance and documentation purposes in brachytherapy planning, this is a helpful and beneficial tool.
To evaluate possible target deviation in the catheter placement, post- or intraoperatively, as well as its influence on the resulting dose distribution, stereotactical X-Ray imaging of the patient can be fused. Postoperative evaluation is possible and if necessary, the dwell time can be adjusted according to the brachytherapy plan so the resulting prescribed dose optimally fits to the planned dose for the target volume.
Further properties of the brachytherapy planning software:
Brachytherapy plans and trajectories adjustable in different views
Automatic calculation of statistical parameters and dose-volume histogram (DVH)
Optimization tool allows the improvement of the dose distribution at the target volume
Precise isoline drawings and calculation of the gray dose at any defined point
Calculations are based on the recommendations of the Working Group TG43
Print protocol of all trajectories and possible device settings
Supports most common ring based stereotactic devices
Supports most common seed types
The brachytherapy planning has been developed and clinically evaluated in cooperation with the Department for Stereotaxy and Functional Neurosurgery at the University Clinic of Cologne.
Parameter selection of the brachytherapy plan:
Seed type (overall 5 different seed types)
Number of seeds and seed distance used per trajectory
Seed strength at the implantation date
Dwell time and prescribed dose
Seed types supported by the Planning Software:
Bebig IsoSeed 125.S17 plus
Bebig IsoSeed 125.S17
Amersham 6702
Amersham 6711
Theragenics I Seed AgX100
Product category: Other surgical instruments and products
LG2 Lesion generator
RF Thermolesion with the LG2 Lesion generator
Modern device for pain treatment and brain lesion
The LG2 is the new, portable radiofrequency (RF) lesion generator from inomed with attractive design, graphical touchscreen user interface, remote control, and a lot more.
The two-channel RF lesion generator supports a large variety of instruments for pain and brain applications. Suitable TC-Electrodes and cannulas complement the product range of inomed for pain treatment. TC Brain-Electrodes round off the product range for the application in functional neurosurgery.
Lesion generator with comprehensive features for precise thermolesion
The LG2 lesion generator is a modern and portable lesion generator for all common lesion techniques (continuous RF and pulsed RF with different control modes) in pain treatment and functional neurosurgery. All critical application parameters are permanently monitored by the device, thereby providing maximum safety and comfort for both the user and patient during thermolesioning.
All inomed mono- and bipolar TC electrodes can be used with the LG2 lesion generator. The LG2 includes two independent RF channels, which can be used at the same time. The combination of two monopolar electrodes for a bipolar application is possible.
The temperature control of the LG2 lesion generator allows to perform controlled thermal lesions. The volume of the thermolesion will be determined by the cannula diameter, the size of the active tip, and the target temperature and therefore becomes reproducible. An integrated temperature sensor in the tip of the TC electrode is used to monitor the temperature in the tissue. The LG2 lesion generator features continuous RF application with temperature control and temperature step profile or pulsed RF application with control of temperature, pulse duration or voltage.
Integrated electrical stimulation and impedance
In addition to RF application, localisation and differentiation of sensory and motor nerves with electrical stimulation, for even more precise electrode positioning is possible. With the LG2 lesion generator, thermolesion, electric stimulation, and impedances can be performed quickly, precisely and safely.
RF Thermolesion for reduction of chronic pain
Interventional pain therapy uses minimally invasive procedures such as thermolesion or cryotherapy with the aim of achieving a prolonged reduction of chronic pain through selective disruption or modification of the pain pathways of the affected nerves. This is carried out either by targeted drug injections or the interruption of pain transmission by minimally invasive neurodestructive procedures (e.g. thermolesion).
As an example, chronic pain within facet joint syndrome can be treated accurately, effectively, and safely with the proper indications using radio frequency thermolesioning.
Features of LG2 Lesion generator
Continuous RF in two different modes: Temperature or Preset Temperature-Profile
Pulsed RF in three different modes: Temperature, Pulse Duration, or Voltage
Direct Nerve Stimulation for the localisation of motor and sensory nerves
Continuous Temperature and Impedance Monitoring
Neutral Electrode Contact Quality Monitoring (CQM)
Saving of up to 25 pre-set programs
Touchscreen monitor to manage the intuitive workflow
Digital display of all relevant application parameters
Remote control to operate the device from sterile field
Compact and light-weight system design
Compatible with all inomed TC electrodes for pain and brain application
Applicationfields of RF Thermolesion
Facet denervation of lumbar, thoracic and cervical spine
Sacroiliac joint
Trigeminal neuralgia (Thermolesion of Ganglion Gasseri)
Product category: Neurological diagnosis, apparatus and instruments
Non-invasive brain stimulation (NIBS)
New treatment methods for psychiatry
Non-invasive brain stimulation techniques have been developed to address the large number of patients who may be non-responsive to traditional pharmacological and psychotherapeutic treatment.
Therapeutic brain stimulation is particularly relevant for depressive disorders. This is because the treatment can be delivered as necessary to address the frequency and severity of the disorder. According to some estimates, up to 20% of the world-wide population is affected by depressive disorders. This includes chronic and recurring progression of the disorders resulting in a relatively high mortality rate.
Supplementing the spectrum of treatments in a meaningful way through brain stimulation
The intracranial and non-invasive procedures in addition to transcranial brain stimulation procedures that are currently available offer meaningful options to supplement the spectrum of treatments used in psychiatry.
In therapeutic brain stimulation, a distinction is made between convulsive procedures, such as electroconvulsive therapy (EKT) or magnet seizure therapy (MST) and non-invasive procedures, to include repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current therapy (tDCS). Invasive techniques, such as deep brain stimulation (DBS) and vagus nerve stimulation (VNS), are a third option for therapeutic brain stimulation.
Electroconvulsive therapy has been used for many decades and has been highly effective for treating severe depressive disorders.
rTMS as a treatment option based on substantial evidence
Since the beginning of the 1990s and the development of well-engineered magnetic stimulation, the further development of the techniques to include repetitive transcranial magnet stimulation (rTMS), as a non-invasive method for brain stimulation, has become the focus of research. As a result and based on substantial evidence, especially for depressive disorders, rTMS is now considered as a treatment option for non-invasive brain stimulation.
A number of controlled studies on the use of the non-invasive method of transcranial direct current therapy (tDCS) have delivered promising results.
Regional cortical activities can be modulated with non-invasive brain stimulation using rTMS or tDCS methods. The therapeutic effects of using non-invasive transcranial brain stimulation include the potential for normalisation of dysregulations, which occur with depression, especially in the area of the prefrontal cortex.
High acceptance of non-invasive, transcranial brain stimulation by patients
The advantage of rTMS and tDCS as non-invasive brain stimulation methods, is that they are pain-free, well-tolerated and highly accepted by patients and these techniques are comparatively highly effective.
The German Society for Brain Stimulation in Psychiatry (DGHP) indicates in the statement issued by its management board on 15.08.2014 “that the German Institute for Medical Documentation and Information (DIMDI) […] defined a OPS Code for the rTMS (8-632) under the non-invasive therapeutic measures (https://www.dimdi.de/).”
The DGHP sees this as a meaningful step in the development of non-invasive brain stimulation rTMS as a treatment method in psychiatry and expressly welcomes it.
Literature: See the DGHP’s recommendations such as
Plewnia C, Padberg F. Transcranial and invasive brain stimulation for depression. Der Nervenarzt 2012;83:1006-1012
Lefaucheur JP, Andre-Obadia N, Antal A, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol 2014
Product category: Neurological diagnosis, apparatus and instruments
EB Neuro Transcranial Magnetic Stimulation
Transcranial Magnetic Stimulation with the EB Neuro STM9000 and NetBrain9000 rTMS- and Neuronavigation Systems
STM9000 Magnetic Stimulator:
The STM9000 is a powerful next generation magnetic stimulator for repetitive transcranial magnetic stimulation (rTMS).
With a wide variety of programmable stimulation types, it is suitable for use in diagnostics, therapy and research, especially in clinical neurophysiology, psychiatry and rehabilitation.
Available in a range of system configurations – with the option of adding paired-pulse stimulation – it is able to meet a wide range of different requirements.
Its modular structure means that it can be upgraded at any time.
Basic Version (up to 10 Hz)
Perfect for clinical diagnostics, with a choice of monophasic /biphasic magnetic stimulation
Integrated stimulation coil
Standard Version (up to 30 Hz) and Fast Version (up to 50 Hz)
With a choice of monophasic /biphasic magnetic stimulation
Optional Paired-Pulse stimulation
Burst & Theta burst
Integrated 2 ch MEP module
Ultra Fast Version (up to 100 Hz)
For demanding therapeutic stimulation applications and research.
With a choice of monophasic, biphasic and sinusoidal magnetic stimulation
Optional Paired-Pulse stimulation
Burst & Theta Burst
Integrated 2 ch MEP module
Galileo Patient Management System optionally via PC/laptop
The STM9000 magnetic stimulator can be connected directly to a Windows PC (or laptop) via a special program from the Galileo NT Suite. Patient and program management is performed on the PC and can be transferred to the stimulator.
The “All-in-One” solution for navigated TMS:
NetBrain 9000 Neuronavigator with STM9000 Magnetic Stimulator:
Magnetic stimulation, neuronavigation and comprehensive control and patient management functions in a single system
With the full integration between NetBrain Neuronavigator and STM9000 Magnetic Stimulator, all management of the rTMS device is completed over the navigator system and all results of stimulations are directly and automatically transferred back to the navigator software.
Standard MRI or individual 3D MRI images – for perfect localisation of brain structures.
Rapid, user-friendly head and coil calibration makes treating patients simple, safe and accurate.
Value Version of the NetBrain 9000 Neuronavigation System offers maximum flexibility and interoperability
“Stand-Alone” System – the perfect addition to your Magnetic Stimulator
With the Value Version of the NetBrain 9000 Neuronavigation system you get a solution with maximum flexibility and maximum quality:
The precise, configurable system can be combined with magnetic stimulators and coils from a range of well-known manufacturers.
The integrated patient management system can be used both to operate the navigation system and to document and record TMS parameters.
The navigation system is equipped with a 24″ all-in-one, medical grade touchscreen panel PC.
Product category: Neurological diagnosis, apparatus and instruments
Newronika HDCKit for transcranial direct current stimulation (tDCS)
The inomed product offering now includes a compact and powerful HDC Kit for the non-invasive transcranial direct current stimulation (tDCS). The modular system was developed for use in hospitals and research institutions and essentially consists of a programming unit (HDC prog), the stimulator (HDC stim), and the electrode set (HDC Cel), which is also optionally available as a cap (mind cap).
tDCS as a method of treatment for neurological and psychiatric disorders
With the tDCS, an electrical field is generated transcranially by applying a weak electric direct current to a patient’s head. This technique modulates, suppresses or amplifies the activities of neurones:
Anodal (excitatory) tDCS: the cortical activity and the resting membrane potential are shifted to a lowered depolarisation threshold.
Cathodale (inhibitory) tDCS: cortical excitability is reduced, the resting membrane potential is increased and the depolarisation threshold is shifted in the direction of hyperpolarisation.
The neuronal depolarisation threshold is not exceeded with this form of brain stimulation and thus does not trigger any action potential.
The tDCS technique is increasingly being considered as a potential method of treatment for a number of indications, such as depression, schizophrenia, rehabilitation after a stroke, pain therapy and other illnesses. The tDCS technique can be used together with fMRT, transcranial magnetic stimulation (TMS), or also with centrally acting pharmaceuticals.
HDC Kit offers reliable and reproducible tDCS
Users can define a stimulation protocol using the programming unit in the HDC Kit. This means that, if required, the stimulation unit and electrode set can be used by the patient at home.
The physician is always responsible for monitoring the use of stimulation. After a pre-defined series of treatments the need for further treatment and the treatment results can be examined by the stimulator’s readout.
The following protocol can be considered as a recommended form of therapeutic treatment using tDCS for a depressive disorder.
Stimulation can, for example, be done using the following parameters: current intensity of 2mA, 20 min per day, with a total of 10 to 15 stimulations within approximately three weeks. Electrode position F3, anodal. Maintenance treatments can be subsequently carried out in one to two week intervals.
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