20/07/2026
Dear Colleges,
We are delighted to share our Short-Term Scholarship Program activities of Dr. Irene Carratalá Nebot.
She completed a visit at the Department of Intraoperative Neuro-Monitoring (IONM) at King’s College Hospital (London).
EMEAC ExCo
A Short-Term Educational Scholarship in Intraoperative Neurophysiological
Monitoring (IONM) at King’s College Hospital
1. Description of the placement
I completed a Short-Term Scholarship in the Department of Intraoperative NeuroMonitoring (IONM) at King’s College Hospital (London), from 1 February to 31 March 2026 (8 weeks), under the supervision of Dr. Ana Mirallave Pescador and Dr. Alba Díaz Baamonde.
2. Activities performed
During the scholarship, I combined daily practical training with the review of monitoring protocols applied to different surgical procedures. I took part in the selection and planning of the most appropriate IONM techniques depending on the type of surgery, as well as in the technical preparation of the setups.
During intraoperative procedures, I learned to set stimulation and recording parameters in different techniques, as well as to supervise the correct recording of signals, including the identification and correction of possible artefacts.
I also participated in the real-time interpretation of neurophysiological signals and in the joint analysis of results obtained from different monitoring techniques. I observed how findings and alerts were communicated to the multidisciplinary team, which helped me understand intraoperative decision-making in real time. I also took part in case discussions and clinical reviews.
In addition, during the rotation I was exposed to different intraoperative monitoring systems and software, which allowed me to become familiar with their configurations and analysis tools. Monitoring and mapping techniques used:- Somatosensory evoked potentials (SSEPs)- Transcranial motor evoked potentials (TcMEPs)- Direct cortical stimulation (DCS)- Free-run electromyography (EMG)- Electroencephalography (EEG)- Visual evoked potentials (VEPs)- Brainstem auditory evoked potentials (BAEPs)- Cortical and subcortical mapping- Cranial nerve mapping- Dorsal column mapping- Phase reversal- D-wave monitoring- Reflex monitoring (blink reflex, trigemino-hypoglossal reflex, laryngeal adductor reflex, bulbocavernosus reflex)- Magnetic therapy Neurosurgical procedures monitored:- Supratentorial tumours- Spinal tumours- Cerebellopontine angle tumours- Posterior fossa tumours- Arnold-Chiari decompression- Cerebral aneurysms- Arteriovenous malformations- Compressive myelopathies- Tethered cord- Awake surgery
3. Competencies acquired
This scholarship allowed me to consolidate my competencies in intraoperative neurophysiological monitoring, especially in the real-time interpretation of signals and their correlation with surgical events. The high exposure to a large volume of procedures facilitated learning and consolidation of different techniques through repetition and systematic observation.
In addition, the rotation significantly expanded my experience in neuro-oncological surgery, with the exposure to procedures that are not common in my home centre, where spinal pathology is more frequent. This complementarity helped me to complete my training especially in techniques related to complex brain surgery, such as cortical and subcortical mapping, cranial nerve mapping, brainstem reflexes monitoring and direct cortical stimulation.
Overall, the experience has helped me develop a broader and more balanced view of different monitoring strategies depending on the type of surgical procedure.
4. Impact in my home departmentThe scholarship at King’s College Hospital has had a very useful impact on my daily clinical practice. We have been able to review and update the monitoring protocols we used in my centre, and also to prepare reference tables with stimulation and recording parameters for the main neurophysiological monitoring techniques, with the aim of optimising signal quality in the operating theatre.
I have also shared different approaches observed during the scholarship, through case discussions and review of specific techniques, with special focus on brainstem reflex monitoring and trigeminal nerve mapping. It has also strengthened communication with the reference team at King’s College Hospital, which
allows access to advice in complex clinical cases.
Overall, I believe this scholarship is contributing in a gradual but significant way to the improvement and updating of daily clinical practice in my centre and to my professional development.
Irene Carratalá Nebot - 24/04/2026