Dr. Langer IOM

AVALANCHE® SI 2

AVALANCHE® neuromonitors have garnered a reputation for their user-friendly design and dependable performance. What sets them apart is their inherently adaptable framework, featuring up to 8 measuring channels that seamlessly cater to various surgical specialties. This intuitive design accommodates additional functionalities that can be incorporated at a later stage.

Introducing the AVALANCHE® SI 2 neuromonitors, equipped with the capability to pinpoint and evaluate the operational status of motor nerves, sensory nerves, and cerebral structures during surgical procedures. All-encompassing in their functionality, these monitors come equipped with the essential stimulators needed for a wide range of clinical scenarios.

Our comprehensive accessories catalogue outlines a variety of electrodes necessary for both stimulation and signal acquisition, ensuring that all requisites are readily available for a streamlined experience.

Overview

Avalanche SI 2 Nerve stimulator/monitor.

  • Modular
  • Ease of use
  • Functional
  • Reliable
  • Clear Touch screen
  • Latest technology
  • Intergrated database
  • Upgradeable
  • Enhanced connectivity
  • 3 presses and you are running
  • Drag & Drop documentation
  • Vagus electrode “Saxophone”
  • Intuitive software
  • Convenient and quit operation

Modalities: EMG, SEP, AEP and MEP.

Applications:
Thyroid (RLN), perhaps using continous IOM with saxophone electrode,
Parotid for monitoring braches of the facial nerve, up to 8 channels EMG.
Carotid for monitoring Median nerve with SEP.
Acousticus using AEP
Cochlear implants

Specification

Modalities EMG, SEP, AEP, MEP
Max. number of channels 8
Amplifier connection Cable
Dedicated softwares Thyroid, Carotid, ENT (EMG 4Ch),
EP (4 Ch), EMG & EP (8Ch)
Modular / Upgradeable Anytime
Interdisziplinary Usage General surgery, ENT, Vascular surgery, Neurosurgery, Spine surgery
Operation Touch screen, Mouse and keyboard can be attached
Display 15“
Sterile operation possible Yes
Hygiene-optimised glass front Yes
Enhanced data security based on Windows 10 IoT Yes
Database Yes
Wireless LAN / WiFi Optional, integrated
LAN / Ethernet Yes
USB Yes
HL7 Yes, with additional software from Storz,
bi-directional Interface
sFTP Yes
Remote Support Yes
PDF Report (Export) Yes (USB, sFTP, HL7)
Printer Yes
Audiofeedback EMG Real muscle activity
Sensation Audiofeedback Convenient, quiet
Automatic storage of all response signals Yes
Documentation
via „Drag & Drop“		 Yes
EMG signal with highest amplitude is detected and displayed after stimulation period automatically Yes
Documentation
of the signals		 Unhasty at the end / after stimulation period
Free-running EMG is displayed permanently Yes
Trend analysis for cIONM Yes
Individual report Header Yes
Data Analysis Tool for reserch purposes Yes
Full-Disclosure View for cIONM in database Yes
Stimulators Direct-Nerve-Stimulator,
SEP Stimulator,
AEP StimulatorOptional trigger: MEP Stimulation with Digitimer D185
Number of channels
of stimulators		 DNS: 2
SEP: 4
AEP: 2
MEP: 1
Stimulation mode Constant current
(Digitimer: Constant voltage)
Stimulation parameter DNS: 0,05 – 10 mA, 3 / 4 / 30 Hz
SEP: 1-100 mA, 1-20 Hz
AEP: 0 – 100 dB HL, 0,1 – 100 Hz
MEP: 0 – 1000 V, single pulse or train

Material

Thyroid:

  • Ahnen, Thomas von; Wirth, Ulrich; Ahnen, Martin von; Kroenke, Julia; Busch, Peter; Schardey, Hans-Mar-tin; Schopf, Stefan (2021): Endoscopic cephalic access thyroid surgery (EndoCATS) using the retroauricular approach – a single center retrospective data analysis. In: Surgical endoscopy. DOI: 10.1007/s00464-020-08244-6.

https://link.springer.com/article/10.1007/s00464-020-08244-6

  • Alçi, Erman; Özdemir, Murat; Mi Ftari, Almir; Vatansever, Safa; Sergi N, Demet; Nuri Deni Z, Mustafa et al. (2021): Influence of rocuronium on achieving optimal vagal stimulation during intraoperative nerve monitoring in thyroid surgery. In: Asian journal of surgery 44 (3), S. 527–530.DOI: 10.1016/j.asjsur.2020.11.009.

https://www.sciencedirect.com/science/article/pii/S1015958420303651?via%3Dihub  

  • Karaisli, Serkan; Gucek Haciyanli, Selda; Haciyanli, Mehmet (2021): Comparison of stimulating dissector and intermittent stimulating probe for the identification of recurrent laryngeal nerve in reoperative setting. In: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngo-logy – Head and Neck Surgery. DOI: 10.1007/s00405-021-06801-w.

https://link.springer.com/article/10.1007/s00405-021-06801-w

  • Mazzone, Sara; Esposito, Adelaide; Giacomarra, Vittorio (2021): Continuous Intraoperative Nerve Monitoring in Thyroid Surgery: Can Amplitude Be a Standardized Parameter? In: Frontiers in endocrinology 12, S. 714699. DOI: 10.3389/fendo.2021.714699.

https://www.frontiersin.org/articles/10.3389/fendo.2021.714699/full

  • Türk, Yiğit; Kıvratma, Göktuğ; Özdemir, Murat; ğçöz, Gökhan; Makay, Özer (2021): The use of thyroid cartilage needle electrodes in intraoperative neuromonitoring during thyroidectomy: Case-control study In: Head & neck 43 (11), S. 3287–3293. DOI: 10.1002/hed.26810.

https://onlinelibrary.wiley.com/doi/10.1002/hed.26810

  • Turk, Yigit; Makay, Ozer; Kamani, Dipti; Okose, Okenwa; Behr, Ian J.; Ozdemir, Murat et al. (2021): Com-parison of Monopolar and Bipolar Stimulator Probes for Intraoperative Nerve Mapping During Thyroidectomy: A Prospective Study. In: The Laryngoscope 131 (10), E2718-E2726. DOI: 10.1002/lary.29804.

https://onlinelibrary.wiley.com/doi/10.1002/lary.29804

  • van Slycke, Sam; van den Heede, Klaas; Brusselaers, Nele; Vermeersch, Hubert (2021): Feasibility of Autofluorescence for Parathyroid Glands During Thyroid Surgery and the Risk of Hypocalcemia: First Results in Belgium and Review of the Literature. In: Surgical innovation 28 (4), S. 409–418. DOI: 10.1177/1553350620980263.

https://journals.sagepub.com/doi/10.1177/1553350620980263

  • van Slycke, S.; van den Heede, K.; Magamadov, K.; Gillardin, J-P; Vermeersch, H.; Brusselaers, N. (2021): Intraoperative vagal neuromonitoring predicts non-recurrent laryngeal nerves: technical notes and review of the recent literature. In: Acta chirurgica Belgica 121 (4), S. 248–253. DOI: 10.1080/00015458.2020.1722931.

https://www.tandfonline.com/doi/full/10.1080/00015458.2020.1722931

  • Gschwandtner, Elisabeth; Netz, Judith; Passler, Christian; Bobak-Wieser, Ruth; Göbl, Susanne; Tatzgern, Elisabeth et al. (2019): The laryngeal twitch response – Can it avoid unnecessary two-stage thyroidectomy? – A retrospective cohort study. In: International journal of surgery (London, England) 72, S. 130–134. DOI: 10.1016/j.ijsu.2019.11.001.

https://www.sciencedirect.com/science/article/pii/S174391911930305X?via%3Dihub

  • Schneider, Max; Dahm, Valerie; Passler, Christian; Sterrer, Elisabeth; Mancusi, Gudrun; Repasi, Robert et al. (2019): Complete and incomplete recurrent laryngeal nerve injury after thyroid and parathyroid surgery: Characterizing paralysis and paresis. In: Surgery 166 (3), S. 369–374. DOI: 10.1016/j.surg.2019.05.019.

https://www.surgjournal.com/article/S0039-6060%2819%2930281-8/fulltext

  • van Slycke, Sam; van den Heede, K.; Magamadov, K.; Brusselaers, N.; Vermeersch, H. (2019): New placement of recording electrodes on the thyroid cartilage in intraoperative neuromonitoring during thy-roid surgery. In: Langenbeck‘s archives of surgery 404 (6), S. 703–709. DOI: 10.1007/s00423-019-01825-7.

https://link.springer.com/article/10.1007/s00423-019-01825-7

  • Brauckhoff, Katrin; Aas, Turid; Biermann, Martin; Husby, Paul (2017): EMG changes during continuous intraoperative neuromonitoring with sustained recurrent laryngeal nerve traction in a porcine model.In: Langenbeck‘s archives of surgery 402 (4), S. 675–681. DOI: 10.1007/s00423-016-1419-y.

https://link.springer.com/article/10.1007/s00423-016-1419-y

  • Christoforides, Christos; Papandrikos, Ioannis; Polyzois, Georgios; Roukounakis, Nikolaos; Dionigi, Gianlorenzo; Vamvakidis, Kyriakos (2017): Two-stage thyroidectomy in the era of intraoperative neuromonitoring. In: Gland surgery 6 (5), S. 453–463. DOI: 10.21037/gs.2017.07.15.

https://gs.amegroups.org/article/view/16181/17414

  • Motos-Micó, José Jacob; Felices-Montes, Manuel; Abad-Aguilar, Teresa (2017): Intraoperative neuromonitoring in thyroid surgery. In: Cirugía y Cirujanos (English Edition) 85 (4), S. 312–319.DOI: 10.1016/j.circen.2017.08.004.

https://www.sciencedirect.com/science/article/pii/S2444050717300566?via%3Dihub

  • Özdemir, Murat; Makay, Özer (2017): Can postoperative laryngeal examination be neglected in thyroid and parathyroid patients with no loss of signal after intraoperative neuromonitoring? In: Sisli Etfal,S. 32–36. DOI: 10.5350/SEMB.20170123082144.

https://jag.journalagent.com/sislietfaltip/pdfs/SETB_51_1_32_36.pdf

  • Konschake, Marko; Zwierzina, Marit E.; Pechriggl, Elisabeth J.; Moriggl, Bernhard; Brenner, Erich; Hörmann, Romed; Prommegger, Rupert (2016): The nonrecurrent laryngeal nerve: A clinical anatomic mapping with regard to intraoperative neuromonitoring. In: Surgery 160 (1), S. 161–168. DOI: 10.1016/j.surg.2015.12.021.

https://www.surgjournal.com/article/S0039-6060%2815%2901059-4/fulltext

  • Ozemir, Ibrahim Ali; Ozyalvac, Ferman; Yildiz, Gorkem; Eren, Tunc; Aydin-Ozemir, Zeynep; Alimoglu, Orhan (2016): Importance of latency and amplitude values of recurrent laryngeal nerve during thyroidectomy in diabetic patients. In: International journal of surgery (London, England) 35, S. 172–178.DOI: 10.1016/j.ijsu.2016.10.001.

https://www.sciencedirect.com/science/article/pii/S1743919116309499?via%3Dihub

  • Lamadé, Wolfram; Béchu, Maren; Lauzana, Ester; Köhler, Peter; Klein, Sabine; Tuncer, Tuncay et al. (2016): The weepy nerve-different sensitivity of left and right recurrent laryngeal nerves under tensile stress in a porcine model. In: Langenbeck‘s archives of surgery 401 (7), S. 983–990.DOI: 10.1007/s00423-016-1439-7.

https://link.springer.com/article/10.1007/s00423-016-1439-7

  • Ahnen, Thomas von; Ahnen, Martin von; Wirth, Ulrich; Barisic, Anna; Schardey, Hans Martin; Schopf, Stefan (2015): Comparison of an Intraoperative Application of a Haemostatic Agent (PerClot®) with Conventional Haemostatic Procedure after Thyroid Resection. In: SS 06 (06), S. 239–246. DOI: 10.4236/ss.2015.66037.

https://www.scirp.org/journal/paperinformation.aspx?paperid=57142

  • Falco, Massimo de; Santangelo, Giuseppe; Del Giudice, Santolo; Gallucci, Federica; Parmeggiani, Umberto (2014): Double probe intraoperative neuromonitoring with a standardized method in thyroid surgery. In: International journal of surgery (London, England) 12 Suppl 1, S140-4. DOI: 10.1016/j.ijsu.2014.05.026.

https://www.sciencedirect.com/science/article/pii/S1743919114001253?via%3Dihub

  • Billmann, Franck; Bokor-Billmann, Therezia; Lapshyn, Hryhoriy; Burnett, Claude; Hopt, Ulrich T.; Kiffner, Er-hard (2014): Minimal-access video-assisted thyroidectomy for benign disease: a retrospective analysis of risk factors for postoperative complications. In: International journal of surgery (London, England) 12 (12), S. 1306–1309. DOI: 10.1016/j.ijsu.2014.11.002.

https://www.sciencedirect.com/science/article/pii/S1743919114009625?via%3Dihub

  • van Slycke, S.; Stockman, A.; Dionigi, G.; Carette, R.; Gillardin, J. P.; Brusselaers, N.; Vermeersch, H. (2014): Harlequin syndrome after thyroidectomy for compressive retrosternal goiter. Case report and review of the literature. In: Acta chirurgica Belgica 114 (3), S. 212–214. DOI: 10.1080/00015458.2014.11681012.

https://www.tandfonline.com/doi/abs/10.1080/00015458.2014.11681012

  • Périé, S.; Aït-Mansour, A.; Devos, M.; Sonji, G.; Baujat, B.; St Guily, J. L. (2013): Value of recurrent laryngeal nerve monitoring in the operative strategy during total thyroidectomy and parathyroidectomy. In: European annals of otorhinolaryngology, head and neck diseases 130 (3), S. 131–136.DOI: 10.1016/j.anorl.2012.09.007.

https://www.sciencedirect.com/science/article/pii/S1879729613000069?via%3Dihub

  • Cavicchi, Ottavio; Caliceti, Umberto; Fernandez, Ignacio Javier; Ceroni, Alberto Rinaldi; Marcantoni, Alessandra; Sciascia, Silvia et al. (2012): Laryngeal neuromonitoring and neurostimulation versus neurostimulation alone in thyroid surgery: a randomized clinical trial. In: Head & neck 34 (2), S. 141–145.DOI: 10.1002/hed.21681.

https://onlinelibrary.wiley.com/doi/10.1002/hed.21681

  • Schardey, Hans Martin; Barone, Mirko; Pörtl, Stefan; Ahnen, Martin von; Ahnen, Thomas von; Schopf, Stefan (2010): Invisible scar endoscopic dorsal approach thyroidectomy: a clinical feasibility study. In: World journal of surgery 34 (12), S. 2997–3006. DOI:10.1007/s00268-010-0769-9.

https://link.springer.com/article/10.1007/s00268-010-0769-9

  • Moskalenko, Vasiliy; Hüller, Markus; Gasser, Martin; Demidchik, Yuriy; Thiede, Arnulf; Timm, Stephan et al. (2009): Investigation of the regeneration potential of the recurrent laryngeal nerve (RLN) after com-pression injury, using neuromonitoring. In: Langenbeck‘s archives of surgery 394 (3), S. 469–474.DOI: 10.1007/s00423-008-0407-2.

https://link.springer.com/article/10.1007/s00423-008-0407-2

ENT:

  • Palacios-García, José M.; Vizcarra-Melgar, Julissa; Sánchez-Gómez, Serafín (2021): Intraoperative spinal accessory nerve monitoring in neck dissections. In: European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery 278 (9), S. 3579–3581.DOI: 10.1007/s00405-021-06909-z.

https://link.springer.com/article/10.1007/s00405-021-06909-z

  • Virós Porcuna, David; Pardo Muñoz, Laura; Viña Soria, Constanza; Nicastro, Viviana; Palau Viarnès, Mar; Pollán Guisasola, Carlos (2021): A retrospective analysis of surgery in prestyloid parapharyngeal tumors: Lateral approaches vs transoral robotic surgery. In: Laryngoscope Investigative Otolaryngology 6 (5), S. 1062–1067. DOI: 10.1002/lio2.662.

https://onlinelibrary.wiley.com/doi/10.1002/lio2.662

  • Stankovic, Petar; Wittlinger, Jan; Georgiew, Robert; Dominas, Nina; Reimann, Katrin; Hoch, Stephan et al. (2020): Safety of the „Saxophone®“ electrode in parotid surgery for continuous intraoperative neuromonitoring of the facial nerve: results of a pro- and retrospective cohort study. In: European archives of Oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Socie-ties (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery 277 (5), S. 1449–1456. DOI: 10.1007/s00405-020-05803-4.

https://link.springer.com/article/10.1007/s00405-020-05803-4

  • Konschake, Marko; Burger, Florian; Zwierzina, Marit (2019): Peripheral Nerve Anatomy Revisited: Mo-dern Requirements for Neuroimaging and Microsurgery. In: Anatomical record (Hoboken, N.J.: 2007) 302 (8), S. 1325–1332. DOI: 10.1002/ar.24125.

https://anatomypubs.onlinelibrary.wiley.com/doi/10.1002/ar.24125

  • Banaszewski, Jacek; Gaggl, Alexander; Buerger, Heinz; Wierzbicka, Małgorzata; Pabiszczak, Maciej; Pastusiak, Tomasz; Szyfter, Witold (2016): Functional results after total cricoidectomy with medial femoral condyle free flap reconstruction. In: European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery 273 (11), S. 3869–3874.DOI:10.1007/s00405-016-4017-2.

https://link.springer.com/article/10.1007/s00405-016-4017-2

 

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