Intraoperative NeuromonitoringFunction in focus

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The preservation of essential functions remains one of the most critical challenges in neurosurgical procedures. Intraoperative neuromonitoring (IONM) is the gold standard for protecting functional structures during surgery. AVALANCHE® PLUS¹ supports clinical teams with intuitive operation and comprehensive modality coverage, bringing a modern, integrated approach to IONM.

Prepare with anatomy-guided confidence

Before the first signal, setup sets the tone. Default configurations and an anatomy-inspired interface help you orient quickly for the planned neurosurgical intervention. Relevant recording sites are visualized up front, while amplifier LEDs guide electrode connections—supporting a clear, structured setup so monitoring and stimulation can begin with confidence.

Map brain functions without obstacles

Interact with function in real time. Intraoperative brain mapping helps you identify functional structures and approach them with confidence. With AVALANCHE® PLUS, you can seamlessly adapt your mapping strategy to the surgical situation. Whether adapting key stimulation parameters or switching between multiple connected stimulation probes, key actions are accessible on the touch screen at all times, so you don't lose sight of the signals.

Streamline and standardize monitoring

Stay oriented as signals evolve. Continuous monitoring supports ongoing awareness of motor, sensory, acoustic and visual pathways—helping you recognize changes as they occur and respond without delay. Repeated stimulation settings and acoustic cues support standardized neuromonitoring, while adjustable view layouts allow you to prioritize the modalities that matter most in each surgical moment.

Maintain functional awareness throughout surgery

1. Preoperative planning

Evaluate preoperative data (nTMS, BOLD mapping, Fibertracking) to determine the required neuromonitoring modalities and strategy.

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2. Monitoring preparation

The anatomy inspired UI helps you select sites & connect electrodes before acquiring a baseline measurement.

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3. Mapping preparation

Interactive illustrations guide your parameter selection for mapping. Optional: combine stimulation and navigation using Brainlab instrument calibration.

4. Monitoring

During surgery, compare the results to the initial baseline measurement. Utilize repeated stimulation and acoustic cues to react to signal changes immediately.

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5. Mapping

Easily adjust the stimulation current to approach critical structures with confidence. Optional: label points of interest in Cranial Navigation using calibrated stimulation probes.

6. Post-operative review

Review your IONM report and labeled points to support your future surgical strategies.

Intraoperative neuromonitoring is indispensable. Certain procedures simply cannot be performed without it. A high-quality neuromonitoring system must be intuitive, safe, and time-efficient—ensuring precision and confidence in the operating room. AVALANCHE® PLUS meets all these requirements.²

Professor Ralph König, MD, Department of Neurosurgery, Schwaben Regional Hospitals, Günzburg, Germany

Explore the cranial workflow with us

Talk to our team about AVALANCHE® PLUS in cranial surgery.

Our 32-channel neuromonitor provides all relevant IONM modalities, such as EMG, MEP, SEP, phase reversal, DCS, EEG, D-wave, TOF, AEP and VEP

Comprehensive modalities

TWISTER® TC¹, the high-current, 12-channel stimulator for transcranial stimulation, offers single train, double train, single pulse and pre-pulse stimulation paradigms

Advanced stimulation

Color- and shape-coded hardware connections facilitate setup

Coded connections

AVALANCHE® PLUS is compatible with our sterile class III neuromonitoring probes

Probe compatibility

Amplifiers with integrated signal conversion and hardware filters are designed for signal quality

Signal quality

Lean setup for an organized O.R.

Neuromonitoring supports patient safety, but it can also add complexity to the operating room. This is why we reduce cable connections to a minimum, with only one connection to the operating table required for AVALANCHE® PLUS and TWISTER® TC, respectively. AVALANCHE® PLUS is designed to reduce clutter by attaching amplifiers directly to the operating table rail, keeping components securely in place throughout the procedure. This supports a more organized O.R. environment, reducing distractions for the surgical team.

Anatomy-guided patient connection

AVALANCHE® PLUS supports patient setup through an interactive, anatomy-guided touchscreen interface. You can select predefined templates or assign individual muscle groups directly within the software. Target muscles, cranial nerves, and stimulation and recording sites for sensory pathways are illustrated in detail, providing you with clear guidance for electrode placement. LED indicators on the amplifier can highlight the correct connection point, supporting accurate and efficient setup.

Streamlined configuration and control

Complex stimulation parameters are visualized clearly, with intelligent default values supporting efficient configuration before monitoring begins. Continuously monitor electrode contact using our traffic-light color system—green, yellow or red—displayed both in the software and directly on the amplifier. During surgery, stimulation parameters and view layouts can be adjusted via quick-access controls while maintaining a full overview of signals at all times.

Assisted reporting and documentation

AVALANCHE® PLUS supports structured documentation by allowing you to prepare surgical reports directly during the procedure. Annotate predefined surgical events or capture screenshots in a single step. Utilize our integrated HL7 interface to automatically populate patient data and export the final report to the patient file.

More to explore

Nexstim nTMS

Map motor and language areas preoperatively with noninvasive stimulation to support informed planning and help preserve critical brain function. 

Learn more

Fibertracking

Visualize patient-specific white matter pathways to better understand functional anatomy and support more informed decisions during cranial procedures. 

Learn more

Cranial Navigation

Access real-time, clinically relevant data during surgery to support focused navigation and confident decision-making. 

Learn more

Not yet commercially available in several countries (CE mark available). Please contact your sales representative.
The statements made by the surgeon represent their personal opinion and experiences. These statements may not be supported by scientific evidence or peer-review research. For verified information about the device, please refer to the manufacturer’s official documentation or consult clinical guidances.

Continue your journey into integrated neuromonitoring

Learn more about AVALANCHE® PLUS with Langer Medical, a Brainlab company.

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