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The ALM Tube is intended for use as a means of providing both an open airway for patient ventilation and for intraoperative neuromonitoring by recording the EMG activity of the laryngeal musculature when connected to an appropriate neuromonitoring device. This device must be used in connection with the C2 Xplore® or any approved IEC 60601-1, compatible EMG monitoring system with 42802 DIN compatible connectors.

The ALM Tube is an endotracheal intubation tube which combines the function of airway ventilation and intraoperative neuromonitoring purposes regarding recording of electrophysiological signals. It combines the recording of EMG signals from the vocal cords to monitor the recurrent laryngeal nerve or the vagal nerve function during surgical procedures. The product is used intraoperatively and is connected to an appropriate neuromonitoring device for signal recording outside of the sterile field via a connection cable. The connection cable is not part of the delivered package.

The product is used for intraoperative monitoring and testing during surgical procedures · to examine neuronal tissue (central and peripheral nervous system) by recording and stimulation The product can be used during surgical procedures that justify non-therapeutic clinical use of the following modalities or their combinations: - · Measurement: - o Auditory evoked potentials (AEP) - o Electroencephalography (EEG) - o Electrocorticography (ECoG) - o Electromyography (EMG) - o Somatosensory evoked potentials (SSEP) - o Motor evoked potentials (MEP) - o Train of Four (TOF) - · Stimulation: - o Transcranial electrical stimulation (TES) - o Direct cortical and subcortical stimulation (DCS) - o Direct nerve stimulation (DNS) - o Transcutaneous intraoperative nerve stimulation (TINS) - o Direct muscle stimulation (DMS)

The ISIS Headboxes and the ISIS Neurostimulator constitute multimodal intraoperative neuromonitoring systems called ISIS IOM Systems. These systems consist of custom stimulation and recording hardware, a standard laptop or desktop personal computer running an off-the-shelf operating system, and operating software called NeuroExplorer. As an option, these systems mount on device carriers or housings tailored for intraoperative use. The ISIS IOM Systems support the following measurement modalities: - -Auditory Evoked Potentials - -Transcranial and cortical Motor Evoked Potentials - Somatosensory Evoked Potentials - - Free-running and triggered Electromyography - - Electroencephalography - - Train of Four -

The C2 Xplore is designed for use in the operating room to measure and display the neurophysiological signals. The system supports the application of Electromyography (EMG) for the purposes of intraoperative neuromonitoring of the peripheral nervous system. The system is not intended for monitoring life-sustaining functions.

The C2 Xplore is an electromyography (EMG) monitor for the purposes of intraoperative neuromonitoring of the peripheral nervous system. The C2 Xplore assists the surgeon in nerve identification, helping to locate and identify nerves at risk in the surgical field. The device records the EMG activity from the innervated nerves and provides visual and audible feedback for the surgeon, helping to preserve the nerve structures throughout the procedure. The device is equipped with 8 differential amplifier channels and with two independent stimulators. The C2 Xplore is operated via mechanical turning knobs and a touchscreen on the front. The audio feedback is generated by an integrated loudspeaker. The nerve monitoring provides information about the amplitude and latency of the EMG responses.

The Mapping Suction Probe is a surgical instrument that allows the surgeon to remove secretions and test surgical tissue with nerve stimulation simultaneously and with the same instrument is intended for use only by a licensed physician and in conjunction with compatible nerve locator monitor systems.

The Mapping Suction Probe is a surgical instrument which combines surgical suction instrument and a monopolar stimulation probe in one instrument. The stimulation function of the Mapping Suction Probe is used for monopolar stimulation during intraoperative surgical interventions and is connected to electrical stimulators of neuromonitoring devices outside the sterile field via an appropriate integrated connection cable. To ensure a correct monopolar stimulation, a counter electrode is also included in the sterile package which must be placed at the resection marqin. The suction function of the Mapping Suction Probe is used for aspiration during tumor resection and is connected to suction devices via a tube, which is not part of the delivered package.

ISIS Headbox 5042xx products: The products are intended for intraoperative neuromonitoring; for recording of electrophysiological signals and stimulating of nerve and muscle tissues. The products are intended for use in the operating room to measure and display the electrical signals generated by muscle, peripheral nerves and the central nervous system. The products support the clinical application of Electroencephalography (EEG), Electromyography (EMG), Somatosensory Evoked Potentials (SEP), Motor Evoked Potentials (MEP), and Auditory Evoked Potentials (AEP). The products are not intended for monitoring life-sustaining functions. ISIS Neurostimulator 504180: The ISIS Neurostimulator is intended for provision of neurophysiological stimulation when used in surgical procedures and for diagnostics. It is suitable for continuous operation and can be used in the following fields: - Transcranial electrical stimulation (TES) - Direct cortical stimulation (DCS) - Direct nerve stimulation (DNS) - Transcutaneous electrical nerve stimulation (TNS) - Direct muscle stimulation (DMS)

The ISIS Headboxes and the ISIS Neurostimulator constitute multimodality intraoperative neuromonitoring systems called ISIS IOM Systems. These systems consist of custom stimulation and recording hardware, a standard laptop or desktop personal computer running an off-the-shelf operating system, and operating software called NeuroExplorer. As an option, these systems mount on device carriers or housings tailored for intraoperative use. The ISIS IOM Systems support the following measurement modalities: - Auditory Evoked Potentials - Transcranial and cortical Motor Evoked Potentials - Somatosensory Evoked Potentials - Freerunning and triggered Electromyography - Electroencephalography - Train of Four

The C2 NerveMonitor System is intended for intra-operative monitoring and stimulation for localization of cranial and peripheral motor and mixed motor sensory nerves during surgery, including spinal nerve roots. The C2 NerveMonitor device with the interface is only allowed for the surveillance, documentation and functional test of motor nerves. It can be used as an additional helping tool during surgical procedures for diagnostic issues. Its basic functions are similar to those of an EMG diagnostic device. Indications for C2 NerveMonitor System Monitoring Procedures include: Extracranial, Intratemporal, Extratemporal, Neck Dissections, and Upper and Lower Extremities. Indications for C2 NerveMonitor System monitoring of Spinal procedures include: Degenerative Treatments. Pedicle Screw Procedures, Fusion Cages, Orthopedic Surgery, Open and Percutaneous Lumbar and Cervical Surgical Procedures. The system is not intended for monitoring life preserving functions. The system may not be used for diagnosing brain death.

The C2 NerveMonitor System performs intraoperative neurophysiologic monitoring (IONM) for localization and identification of cranial and peripheral motor and mixed motor sensory nerves during surgery, including spinal nerve roots. The C2 NerveMonitor device with the integrated user interface is only allowed for the surveillance, documentation and functional test of motor nerves. It can be used as an additional helping tool during surgical procedures for diagnostic issues. Its basic functions are similar to those of an EMG diagnostic device. The system is not intended for monitoring life preserving functions. The subject device stimulates for evoked responses, records, measures, and provides visual and auditory outputs for the physiological responses received from the patient. The response signals may be stimulated evoked responses or spontaneous electrophysiological action potential signals. The subject software calculates the signal amplitude and latency. The subject device provides a visual display and auditory tones corresponding with the actions performed or signals received. The waveforms are stored in the device internal memory. The user may review the signals after surgery in printed or electronically exported report formats. The C2 NerveMonitor System consists of 4 and 8 Channel C2 NerveMonitor consoles and an optional iPad application as subject of this submission. The system also includes stimulation probe and recording electrodes, laser printer, adapter box, cables, WiFi router, sterile iPad cover, mute sensor, footswitch, and keyboard accessories that are not subject to this submission. The C2 NerveMonitor consoles consist of software, hardware, and electrical components. The software has been updated and is subject to this submission. The software updates introduce optional device connectivity and the signal peak detection algorithm. The connectivity allows for Hospital Information System (HIS) Ethernet network interface, and wireless connection via iPad application. The signal peak detection algorithm supports channel select, synthetic sound, and quantitative measurements displayed during signal receipt features.

The C2 NerveMonitor System is intended for intra-operative monitoring and stimulation for localization and identification of cranial and peripheral motor and mixed motor sensory nerves during surgery, including spinal cord and spinal nerve roots. The C2 NerveMonitor device with the integrated user interface is only allowed for the surveillance, documentation and functional test of motor nerves. It can be used as an additional helping tool during surgical procedures for diagnostic issues. Its basic functions are similar to those of an EMG diagnostic device Indications for C2 NerveMonitor System Monitoring Procedures include: Intracranial, Extracranial, Intratemporal, Extratemporal, Neck Dissections, Thoracic Surgeries, and Upper and Lower Extremities. Indications for C2 NerveMonitor System monitoring of Spinal procedures include: Degenerative Treatments, Pedicle Screw Procedures, Fusion Cages, Rhizotomy, Orthopedic Surgery, Open and Percutaneous Lumbar and Cervical Procedures and Thoracic Surgical Procedures. The system is not intended for monitoring life preserving functions. The system may not be used for diagnosing brain death.

The C2 NerveMonitor System is a multi-channel intraoperative neurophysiological monitor capable of connecting various styles of patient monitoring electrodes and supplying stimulus for evoked responses. The EMG activity monitoring console uses both video and audio output. Responses monitored with the device may originate from operator applied stimulus or from direct or indirect mechanical stimulus occurring during the course of surgery.

The Inomed Adhesive Laryngeal Electrodes are intended to be used as a disposable, selfadhesive electrode attached to an endotracheal tube and positioned for continuous EMG monitoring of the larynx during surgical procedures.

The Inomed Adhesive Laryngeal Electrodes are single used electrodes constructed from an medical grade ink with a conductive polymer film covered by an insulating coating, a connector made of polypropylene: and a cable assembly. The electrodes are designed to monitor the recurrent nerve during thyroid, anterior cervical, carotid endartecrectomy surgery and vagus nerve monitoring during brain surgery. The monitoring is performed with a surface electrode that is attached to an endotracheal tube placed on the vocal cord. A neutral adhesive electrode is placed on the patient's shoulder. Both adhesive electrodes are connected to a reusable recording cable and to the nerve monitor

The ISIS MER System / Elekta MER System is intended to be used during neurosurgery to record and stimulate brain motor and sensory neurons to aid in the placement of depth electrodes.

During neurosurgical interventions the ISIS MER System / Elekta MER System is used for optimal extra cellular recording and deep brain stimulation. The system operates the integrated neurostimulator that delivers impulses similar to the effect of an implanted electrode. Recording and stimulation of up to five channels are possible simultaneously. A sixth channel may be used for EMG recording for optimal patient surveillance.