Neurologic Conditions

The neurology team at CINN, comprised of Doctors Zak and Wang, treat the full range of neurologic conditions, including multiple sclerosis, headache/migraine, epilepsy, various neuropathies, Alzheimer’s disease, and Parkinson’s Disease, to name a few. The conditions highlighted above, are those that Doctors Wang and Zak have a special interest in and CINN treats frequently.

In addition to their clinical practice, doctors Wang & Zak are responsible for providing extensive intraoperative monitoring services for both CINN and non-CINN surgeons.

Intraoperative monitoring (IOM) of electrophysiological activity during surgery has quickly evolved into a standard of care for many performing spinal, cranial and neurovascular procedures. The purpose of intraoperative monitoring is to notify the surgeon of potential injury to vital neural structures and blood supply during an operative procedure. It provides early warning to the surgeon who can then adapt or modify the operative procedure accordingly. Early detection of a surgically induced neurological deficit increases the success of intervention strategies and may eliminate or reduce the severity of post-operative morbidity.

A variety of electrophysiological procedures are administered during surgeries that require IOM. These procedures include several modalities of evoked potentials (somatosensory, auditory, and motor), Electroencephalography (EEG), and Electromyography (EMG). The type of monitoring modality used is dependent on the type of surgery. Frequently several modalities are used together in the same surgery.

The primary benefits of intraoperative monitoring include:

	Increased safety of the surgical procedure. IOM has been shown to play a significant role in reducing patient morbidity and mortality. IOM guides the degree of surgical intervention and provides a means for assessing the likelihood of post-operative complications. Furthermore, some high-risk patients may be candidates for a surgical procedure only if monitoring is available.
	Increased ability to accommodate more complex cases. IOM helps to identify new neurologic impairment early enough to allow prompt correction of the cause. This “early warning” system provides surgeons with the confidence necessary to perform complex cases.

CINN surgeons utilize IOM extensively in performing complex cranial, spine and vascular cases. CINN’s IOM services are enhanced through the services of Steven Zak, MD, and Charles Wang, MD, board-certified neurologists and subspeciality board-certified clinical neurophysiologists, with significant experience and training in electrophysiological activity monitoring. These physicians provide the medical oversight and professional interpretation of many of the cases performed throughout CINN’s network.