The Center for Clinical Neurophysiology (CCN) at UPMC was organized in 1981 to serve as an interdepartmental resource serving then-Presbyterian University Hospital, Montefiore Hospital and Children’s Hospital of Pittsburgh. At that time, the CCN was composed of just a few clinicians providing diagnostic testing and intraoperative neurophysiological monitoring (IONM) services for only very specific surgeries in the neurosurgical and orthopedic disciplines.
The service has now grown to providing more than 8,000 IONM cases per year at all UPMC pavilions, as well as supporting UPP and non-UPP surgeons at non-UPMC hospitals. The use of IONM at UPMC reaches across many surgical disciplines and has proven to be an invaluable adjunct not only in adult and pediatric neurosurgical procedures but also in orthopedic, ENT, vascular, cardiothoracic and interventional neurological procedures.
The CCN and its highly trained and nationally renowned faculty and technical staff’s primary goal is to provide high-quality service in a cost-efficient manner to the UPMC patient population. The center focuses on interdisciplinary research to improve the understanding and the value of IONM to predict and prevent neurological injury. In addition, CCN faculty have established two annual IONM courses and a formal, clinical training program at Carlow University. The first undergraduates in this program graduated in May of 2020.
Parthasarathy Thirumala, MD, is director of the CCN and is joined by Jeffrey Balzer, PhD; Donald Crammond, PhD; Katherine Anetakis, MD; and Varun Shandal, MD.
The CCN is the largest and busiest academic IONM program in the country, offering and providing services at all UPMC hospitals including UPMC Hamot, Horizon, Altoona, Somerset, Susquehanna, Western Maryland and Pinnacle. In addition, the CCN provides professional and technical services at Excela Health System, Indiana Regional Hospital and Trinity Health System. The CCN faculty can achieve this service expansion to community hospitals through the use of telemedicine technology. Patients in community hospitals, more than 100 miles away, can receive the same quality care in real-time without having to travel to Pittsburgh.
Intraoperative multimodality monitoring at UPMC includes expertise in somatosensory evoked potentials (SSEP), brainstem auditory evoked potentials (BAEP), transcranial motor evoked potentials (TcMEP), direct cortical motor evoked potentials (dcsMEP) electroencephalography (EEG) and electromyography (EMG). Direct peripheral nerve recordings (CNAP and CMAP) are also performed, as well as single unit micro-electrode recordings (MER) and macrostimulation performed for subcortical mapping during placement of DBS electrodes in various subcortical structures. EEG is used to monitor cerebral function and ischemic risk during cerebral and peripheral vascular procedures, including cerebral aneurysm treatment, carotid endarterectomy and a variety of cardiothoracic procedures.
EEG recorded directly from the pial surface of the brain, or electrocorticography (ECoG), is used to help determine resection margins in epilepsy surgery, and to monitor for seizures during direct electrical stimulation of the brain surface carried out while mapping eloquent cortex in awake patients. In addition to providing IONM services, the CCN also performs diagnostic evoked potential testing, and transcranial Doppler studies.
The CCN is proud to provide a high-quality, high value service at a significantly low cost to patients, which it can achieve by constantly evaluating and improving clinical services through its various research initiatives and quality improvement programs. The center’s cutting-edge research efforts—represented by multiple, peer-reviewed publications in high quality journals each year—have demonstrated the value of the application of multimodality intraoperative neurophysiological monitoring to improved patient safety during various peripheral and central nervous system operative procedures.