Mirela V. Simon, M.D., M.Sc.

​Dr. Simon’s clinical and research interests center on complex intraoperative neurophysiologic mapping and monitoring, particularly in high-risk procedures such as oncological, epilepsy and aortic surgeries. A key area of her interests is understanding how neural excitability fluctuates under various pathological and physiological conditions—an essential factor for performing accurate ION procedures. She advocates for a multimodal approach to ION and underscores the importance of its integration within the multidisciplinary environment of the OR. Her perspective is grounded in a solid foundation of clinical neurophysiology, neuroanatomy, and neurology, complemented by extensive experience in clinical practice, teaching, and research in ION. This background underpins her understanding of the critical ION- related factors influencing neurological outcomes, including robust neurophysiological knowledge, reliable methodologies, situational awareness necessary for accurate real-time data interpretation, and effective communication with the ION, surgical, and anesthesia teams.​ 

 

Dr. Simon has served on numerous committees within national and international  Neurophysiology organizations, including the American Board of Clinical Neurophysiology (ABCN), the American Clinical Neurophysiology Society (ACNS), the American Society of Neurophysiological Monitoring (ASNM), and the International Society of Intraoperative Neurophysiology (ISIN). Her roles have encompassed educational initiatives, research task forces, guidelines development, board certification efforts, ethical review panels, and advocacy. These collaborations have provided her with a comprehensive view of the current landscape and future directions of ION both locally and globally.

 

​Education

• Massachusetts General Hospital, Clinical Neurophysiology & Epilepsy

• Boston University Medical Center, Neurology

• Englewood Hospital, Mount Sinai School of Medicine, Internal Medicine

• Harvard School of Public Health, Biostatistics, Study Design & Epidemiology, M.Sc.

• Carol Davila School of Medicine and Pharmacy, Medicine, M.D.​

 

License and Certifications

• Permanent Massachusetts Medical License

• Diplomate, American Board of Psychiatry and Neurology

• Diplomate, American Board of Clinical Neurophysiology​

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Past Professional Positions

• Massachusetts General Hospital & Brigham and Women's Hospital, Director ION Fellowship

• Massachusetts General Hospital, Director, ION Observership

• Massachusetts General Hospital, Director, ION Unit 

 

Innovations

• Edited and Co-Authored one of the first textbooks in ION. This is the first ION textbook that gives a step-by-step, hands-on approach to ION, customized to specific surgical procedures and employing multimodality techniques. The book has had a significant positive impact on formal ION training of neurologists and clinical neurophysiologists in the United States and abroad. Both its first (2010) as well as its second (2019) editions have been well received in the national and international ION community and have been peer-reviewed.

• ION teaching method. Interpretation and decision making in ION occur in real-time and the only reliable way in which they can be performed is via integration within a multidisciplinary context. Dr. Simon developed case presentations that offer live integration of ION within the surgical and anesthesia contexts and founded a well-received course in ION, accredited by Harvard Medical School.

• ​ION protocols. Dr. Simon's protocols and practice model have been implemented successfully not only locally but also nationally and internationally.

• ​Technique for continuous and simultaneous monitoring of corticospinal and thalamocortical tracts via cortical electrodes. Integrity of thalamocortical input to fronto-parietal regions is essential for maintaining a good quality of life, including the ability to walk. This is due not only to its role in the sensory functions, but also in the initiation and modulation of movements. Dr. Simon has demonstrated that in brain tumor surgery, concomitant monitoring of both corticospinal and thalamocortical tracts via direct cortical arrays can be reliably and routinely achieved, informs management and helps preventing postoperative neurologic deficit. The results of her work have been shared in a peer-reviewed publication (Ref # 2). She has presented this work at several national and international conferences.

• Technique for thalamocortical tract mapping in supratentorial surgery. This novel method relies on a collision technique to identify thalamocortical projections to pre- and post-central cortex. Dr. Simon has presented these results at several national and international venues and in a peer-reviewed publication (Ref # 3).

• Technique for mapping of the corticospinal tract in spinal cord surgery. The method allows safe advancement of the cordotomy probe during cordotomy surgery for management of oncologic pain, as well as during the cord un-tethering process in myelomeningocele surgery (Ref # 4).

• Technique for mapping of dorsal columns (DC) in spinal cord surgery. Resection of intramedullary spinal cord tumors carries a significant risk of damage of DC, resulting in sensory deficits and various degrees of sensory abnormalities, including inability to walk. Previous techniques of DC mapping have been technically challenging and time consuming. In comparison. Dr. Simon’s method has proven reliable, efficient, easy to perform, and reproducible across patients and institutions. The technique has been detailed in two papers (Ref # 11,15) , and presented at many national and international meetings. Currently, it is routinely performed locally, nationally and internationally.

• Technique for decreasing the risk of delayed paraplegia in aortic surgery. Delayed paraplegia is a devastating complication of aortic surgery, resulting from inadequate spinal cord perfusion pressure in the postoperative period. Based on the sensitivity of motor evoked responses to spinal cord ischemia, she has developed a technique that allows identification of a safe range of systemic blood pressures to be used for hemodynamic management in ICU. The results of this work have been detailed in a publication (Ref # 7) and presented at national and international conferences. Incorporation of this neuromonitoring strategy in the care of patients undergoing aortic surgery at Massachusetts General Hospital, has resulted in a significant reduction of postoperative paraplegia following these procedures.

• Improved techniques for motor and language mapping in brain surgery.  Accurate mapping of primary eloquent cortex via electrical stimulation is essential for avoidance of neurologic deficit after brain tumor or epilepsy surgery. However, it is possible only when performed at a certain current intensity, i.e. threshold which has a significant inter-individual variability. Dr. Simon has built predictive models for estimation of the latter at an individual level. Further, she has incorporated these results in establishing a multimodal approach to mapping and monitoring eloquent structures; and presented the results of her work at local, national and international venues (Ref # 6,10,13,14,16,17).

• Expanded the use of EEG and Electrocorticography ( ECOG) in ION. EEG and ECoG have been underutilized in ION. She has studied and promoted the use of these techniques in the operating room (Ref # 6,8,9,12,17).

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Scholarship

Books

1. Simon MV. Intraoperative Neurophysiology - A Comprehensive Guide to Monitoring and Mapping. Editorand Co-Author. 2010, 1st Ed; 2019, 2nd Ed. New York, New York. Springer Publishing

Selected Peer-reviewed Publications

(* denotes mentees)

1. Simon MV, Rutkove SB, Ngo L, Fehnel C, Das AS, Sarge T, Bose S, Selim M. Kumar S. Understanding the Variability of the Electrophysiologic Laryngeal Adductor Reflex. Clin Neurophysiol 2024;162:141-150.

2. Simon MV, Curry WT, Jones PS, Cahill DP, Carter BS, Rapalino O, Malik AN, Nahed BV. Intraoperative Thalamocortical Tract Monitoring via Direct Cortical Recordings in Craniotomy. Clin Neurophysiol 2021; 132(7):1416 -1432.

3. Simon MV, Lee DK, Choi BD, Talati PA, Yang JC, Koch MJ, Jones PS, Curry WT. Neurophysiologic Mapping of Thalamocortical Tract in Asleep Craniotomies: Promising Results From an Early Experience. Oper Neurosurg 2021; 20(2): 219 - 225.

4. Tsetsou* S, Butler W, Borges L, Eskandar EN, Fehnel KP, See RB, Simon MV. Dynamic Mapping of the Corticospinal Tract in Open Cordotomy and Myelomeningocele Surgery. J Clin Neurosci. 2020; 74:225 - 231.

5. Skinner SA, Aydinlar EI, Borges LF, Carter BS, Currier BL, Deletis V, Dong C, Dormans JP, Drost G, Fernandez- Conejero I, Hoffman EM, Holdefer RN, Kimaid PAT, Koht A, Kothbauer KF, MacDonald DB, McAuliffe JJ, Morledge DE, Morris SH, Norton J, Novak K, Park KS, Perra JH, Prell J, Rippe DM, Sala F, Schwartz DM, Segura MJ, Seidel K, Seubert C, Simon MV, Soto F, Strommen JA, Szelenyi A, Tello A, Ulkatan S, Urriza J, Wilkinson M. Correction to: Is the New ASNM Intraoperative Neuromonitoring Supervision "Guideline" a Trustworthy Guideline? A Commentary. J Clin Monit Comput 2019; 33(2): 191-192.

6. Dineen* J, Maus D, Muzyka I, See R, Cahill D, Carter B, Curry W, Jones P, Nahed B, Peterfreund R, Simon MV. Factors that Modify the Risk of Intraoperative Seizures Triggered by Electrical Stimulation During Supratentorial Functional Mapping. Clin Neurophysiol 2019; 130 (6): 1058 -1065.

7. See*#RB, Awosika*#O, Cambria RP, Conrad MF, Lancaster RT, Patel VI, Chitilian HV, Kumar S, Simon MV. Extended Motor Evoked Potentials Monitoring Helps Prevent Delayed Paraplegia after Aortic Surgery. Ann Neurol 2016; 79(4): 636 - 645. # share first authorship.

8. Moldovan M, Calin A, Kumaraswamy VM, Braver D, Simon MV. Burst-Suppression Ratio on Electrocorticography Depends on Inter-electrode Distance. J Clin Neurophysiol 2016; 33(2): 127 -132.

9. Karakis* I, Leeman-Markowski BA, Leveroni CL, Kilbride RD, Cash SS, Eskandar EN, Simon MV. Intra-stimulation Discharges: An Overlooked Cortical Electrographic Entity Triggered by Direct Electrical Stimulation. Clin Neurophysiol 2015; 126(5): 882 - 888.

10. Simon MV, Sheth S, Eckhardt C, Kilbride R, Braver D, Williams Z, Curry W, Cahill D, Eskandar E. Phase Reversal Technique Decreases Cortical Stimulation Time During Motor Mapping. J Clin Neuroscience, 2014; 21(6): 1011-1017.

11. Nair*D, Kumaraswamy MV, Braver D, Kilbride R, Borges L,Simon MV. Dorsal Column Mapping via Phase Reversal Method: The Refined Technique and Clinical Applications. Neurosugery 2014; 74(4): 437- 446.

12. Calin* A, Kumaraswamy MV, Braver D, Nair D, Moldovan M, Simon MV. Intraoperative Somatosensory Evoked Potential Monitoring Decreases EEG Burst-Suppression Ratio During Deep General Anesthesia. J Clin Neurophysiol 2014; 31(2): 133 -137.

13. Sheth SA, Eckhardt CA, Walcott BP, Eskandar EN, Simon MV. Factors Affecting Successful Localization of the Central Sulcus Using the Somatosensory Evoked Potential Phase Reversal Technique.Neurosurgery 2013; 72(5): 828 - 834.

14. Simon MV, Cole AJ, Chang EC, Buchbinder BR, Stufflebeam SM, Nozari A, Stemmer-Rachamimov AO, Eskandar EN. An Intraoperative Multimodal Neurophysiologic Approach to Successful Resection of Precentral Gyrus Epileptogenic Lesions. Epilepsia 2012; 53(4): E75 - 79.

15. Simon MV, Chiappa KH, Borges L. Phase Reversal of Somatosensory Evoked Potentials Triggered by Gracilis Tract Stimulation: A New Technique for Neurophysiologic Dorsal Column Mapping. Neurosurgery 2012; 70 (3): E783-788.

16. Wang* SG, Eskandar EN, Kilbride R, Chiappa KH, Curry W, Williams Z, Simon MV. The Variability of Stimulus Thresholds in Electrophysiologic Cortical Language Mapping. J Clin Neurophysiol  2011; 8(2): 210 - 216.

17.  Simon MV, Michaelides C, Wang S, Chiappa KH, Eskandar EN. The effects of EEG Suppression and Anesthetics on Stimulation Thesholds in Functional Cortical Motor Mapping. Clin Neurophysiol. 2010; 121(5): 784 - 792.

 

Accolades

• The first edition of Dr. Simon’s book has been peer-reviewed and noted as “an excellent text in the growing area of intraoperative neurophysiology” (Epilepsy and Behavior); “a comprehensive practical reference for intraoperative neuromonitoring professionals” (Journal of Clinical Neurophysiology); “an instructive well-illustrated and complete review of IOM” (Journal of Neurological Sciences ). Its 2nd Edition received another positive review by Dr. Marc Nuwer, who noted it as “a foundational teaching book necessary for all neuromonitoring services” (Journal of Clinical Neurophysiology).

• Dr.Simon’s new method on dorsal column mapping was praised by international ION leaders, for its feasibility and clinical importance: Drs. Marc Nuwer and Sedat Ulkatan (Neurosugery, 2014 discussion 446).; Drs. Marc Nuwer and Vedran Deletis (Neurosurgery. 2012; 70 (3): E788)

• Dr.Simon’s work on spinal cord and brain mapping have been highlighted in  Advances in Motion. advances.massgeneral.org/contributors/contributor.aspx?id=1304

• Fellow, American Clinical Neurophysiology Society

• Excellence in Innovation Award, Mass General Brigham

• Best Neurology Abstract, MGH Research Day

• Appreciation Award for Neurology Care of Persian Gulf War Veterans, US Department of Veteran Affairs

• Teaching Fellow, Boston University Medical Center

 

Professional Organizations: Membership and Selected Positions

• American Medical Association: Member

• American Academy of Neurology: Member

• American Board of Clinical Neurophysiology: Member, Board of Directors; Immediate Past  President; Past Chair, Committee for NIOM Examination                           

• American Clinical Neurophysiology Society: Fellow; Co-Director, NIOM Courses; Past Co-Director, NIOM Special Interest Group; Past Co-Chair, Research Committee                           

• International Society of Intraoperative Neurophysiology; Secretary, Executive Board; Member, Training Committee; Past Co-Chair, Educational Committee                             

• American Society of Neurophysiological Monitoring ; Member, EEG Guidelines Committee                          

•  NIOM Consortium: Founding Member