Intraoperative Neuromonitor for Thyroid, Maxilofacial & Carotid Surgery

Continuous neuromonitoring for ongoing monitoring of the recurrent laryngeal nerve on THYROID surgery.  

Functional integrity check of motor nerves in THYROID, ENT and MAXILOFACIAL surgeries

Oxygen perfusion monitoring in CAROTID surgeries

AVALANCHE®  SI 2 – faster, powerful and well-prepared for the digital future in your OR. The smooth glass front matches the overall modern appearance and highlights the rich colours of the new screen display. It is highly intuitive to operate – exactly what you would expect from a state-of-the-art device. Driven by Windows 10 IoT, the latest Microsoft operating system, your neuromonitor will easily integrate into your hospital information system.

The AVALANCHE® is the indispensable and modern tool for intraoperative neuromonitorion (IONM) over the last 15 years.

Neuromonitoring in THYROID surgery

Protect the vocal cord nerves from accidental injury!

Pathological changes in a thyroid gland or tissue scarred through multiple surgical interventions may lead to changes in the anatomical position of a nerve, which can pose a challenge to the surgeon, depending on their experience. There is an increased risk of paresis in the vocal cord nerve, the laryngeal recurrent nerve, with sometimes serious repercussions on the patient’s quality of life.

The CONTINUOUS NEUROMONITORING, with the permanent stimulation of the vagus nerve with the SAXOFONE ELECTRODE (which literally happens in the background), critical signal changes, such as those indicating a strain of the recurrent laryngeal nerve, can be noticed before it is too late.

Optionally, surgeons can display the long-term trend lines of the critical measuring parameters amplitude and latency. New situations that arose for the first time during surgery can be analysed post-operatively and compared to other cases on the basis of the saved recorded signals.

You can also pre-program Beeps to help the surgical team to respond quickly to critical changes in neural function!

Neuromonitoring in ENT & OM surgery

Intraoperative neuromonitoring (IONM) using AVALANCHE® SI helps to identify motoneurons and monitor their function during surgery.

Although tumours of the parotid gland are less common than other tumours, several thousands of operations are carried out in all world every year to partially or entirely remove the parotid gland. The risk of damaging the delicate branches of the facialis nerve is substantial. Damage to just one of those delicate structures during surgery may mean a disastrous outcome for the patient. Immediate physical consequences such as failure of closing an eyelid or a drooping corner of the mouth, alterations in the sense of taste, or reduced tear and saliva secretion often affect the psychological well-being of the patient.

Fields of application:

  • Identification and function check of the facialis nerve in parotid surgery, mastoidectomy, insertion of cochlea implants and middle ear surgery.
  • Monitoring of cranial motor nerves during tumour resection in the oral cavity, ear, neck, nose and the base of the skull.

** AEP (Auditive Evoked Potentials) to assess the auditory pathway also available!

Neuromonitoring in CAROTID surgery

International studies have shown that CEA is the standard method for treating symptomatic carotid stenosis with over 70% congestion. During surgery, the plaque causing the stenosis is excised from the open artery. The artery is then closed with a patch. Blood flow is interrupted by temporarily clamping the carotid. However, care must be taken to avoid hypoxia in the affected hemisphere.

This can easily be monitored in regional anaesthesia. We all know the little yellow squeaky duck given to a cooperative and alert patient during vascular surgery. The patient squeezes the duck at regular intervals to let the surgeon know that brain activity is intact.

But what about patients under general anaesthesia?

Somatosensory evoked potentials (SEPs) could be measured continuously by a neuromonitor.


Our slogan the art of neuromonitoring has expressed our own expectations for our product for many years, but we are particularly proud to have our performance recognised by independent experts. Our AVALANCHE® SI 2 received the coveted PLUS X Award seal of approval in 2021 in 4 categories:

High Quality
Ease of Use

The PLUS X Award takes a unique approach. In contrast to many competitors whose recognitions mainly focus on design, the PLUS X Award follows a different philosophy. A high-calibre jury comprising representatives of various industry sectors rigorously examines the nominated products. That makes the PLUS X Award seals of approval not just a benchmark for the best products, but also an unmistakable sign of brand quality.