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Neurosurgery

HRV predicts surgical outcomes better than any known clinical factor. The autonomic nervous system (ANS) determines who will recover complete function and who will be left with residual deficit. The answer is not in the preoperative imaging: it lies in the patient’s autonomic state — a variable that almost no neurosurgeon measures systematically.

Non-invasive neuromodulation with NESA XSIGNAL® improves the perioperative physiological response, accelerates recovery and reduces autonomic complications. It does not replace your surgical precision: it enhances it.

Treatment

Non-invasive neuromodulation with NESA XSIGNAL® acts directly on the autonomic nervous system, supporting processes that influence pain, tone, inflammation, microcirculation and sleep quality.

By targeting autonomic regulation, it may help reduce hyperreactivity, improve physiological variability and promote more efficient recovery between sessions.

It integrates as a supportive component within the treatment plan, without interfering with other interventions, and can be tailored to the patient’s profile: symptoms, sleep, pain, stress levels and load tolerance.

Functional objectives

  • More efficient recovery between sessions.
  • Better sleep and more restorative rest.
  • Improved pain control and reduced hypersensitivity.
  • Improved tolerance to therapy and loading.

Applications

Common Clinical Presentations

  • Acute or subacute pain.
  • Post-surgical recovery.
  • Sleep disorders.
  • Elevated physiological stress / hyperarousal.
  • Autonomic dysregulation (sympathetic/parasympathetic imbalance).

As Support for Recovery Processes

  • Post-surgical recovery.
  • Support for microcirculation and tissue perfusion.
  • Inflammation and edema.
  • Low exercise tolerance.

Benefits

  • Support for pain management: acute and persistent.
  • Improved sleep and recovery.
  • Support for inflammatory and edema processes.
  • Support for microcirculation and peripheral vascular comfort.
  • Complementary, non-invasive and drug-free support.
  • Individualised protocols tailored to symptoms and autonomic profile.

Modulate the root. Enhance your treatment

Neuroanatomy of the autonomic nervous system associated with your clinical specialty

IMG-030_Tronco encefalico
IMG-023_Complejo vagal
IMG-012_Insula y corteza cingulada anterior
IMG-003_Menuda espinal_asta dorsal
IMG-026_Nervio vago
IMG-041_Sustancia gris periacueductal_Medula rostral ventromedial
IMG-045_Via corticoespinal_Platicidad post lesion
IMG-043_Vasos sanguineos cerebrales_Sistemas glinfatico

Introducing NESA XSIGNAL®

NESA XSIGNAL® is a non-invasive neuromodulation system that applies very low-intensity microcurrents through electrodes, with protocols oriented towards regulation of the autonomic nervous system. It is designed to integrate into clinical practice as part of the multimodal approach.

In Neurosurgery, the protocols act specifically on the perioperative physiological response, therapeutic load tolerance and reduction of post-surgical autonomic complications.

Testimonials

“I believe that the proper use of NESA in the area of neurosurgery could provide a more complete and effective treatment to the patient, especially in pain management.”
“Since I acquired NESA, I have provided more comprehensive treatments. A patient with lumbar and cervical pain improved notably after each session. NESA allows me to act on the autonomic nervous system and improve my patients’ lives in unexpected ways.”
“NESA improves sleep quality, which enhances pain recovery, reduces nighttime awakenings and reinforces other treatments. Addressing sleep is key to improving well-being and quality of life.”
The impact of regulating the ANS in neurosurgery
When specific work on the autonomic nervous system is incorporated, the effect is usually transversal: less physiological “noise”, better recovery and greater adaptive capacity.

In neurosurgery, this may translate into:
Supporting autonomic balance may expand the patient’s adaptive capacity, allowing local interventions such as manual therapy, exercise or procedures to be better tolerated and more consistent over time.

Key Evidence (3 papers):

  • Frandsen MN, et al. (2022) Preoperative heart rate variability as a predictor of perioperative outcomes: a systematic review without meta-analysis Journal of Clinical Monitoring and Computing. PMID: 35092527 DOI: 10.1007/s10877-022-00819-z
  • Sun J, et al. (2021) Association between postoperative long-term heart rate variability and postoperative delirium in elderly patients undergoing orthopedic surgery Frontiers in Aging Neuroscience. PMID: 34135747 DOI: 10.3389/fnagi.2021.646253
  • Barkhudaryan A, et al. (2025) Autonomic dysfunction after stroke: an overview of recent advances. PMID: 40131648
Persistent pain is associated with both autonomic dysregulation and altered central processing. Supporting autonomic regulation may help reduce hypervigilance and complement pain management strategies.

Key Evidence (3 papers):

  • So V, et al. (2021) Scoping review of the association between postsurgical pain and heart rate variability parameters Pain Reports. PMID: 35155967 DOI: 10.1097/PR9.0000000000000977
  • Rampazo ÉP, et al. (2023) Heart rate variability in adults with chronic musculoskeletal pain: a systematic review. PMID: 37661339
  • Adlan AM, et al. (2014) Autonomic function and rheumatoid arthritis: a systematic review. PMID: 25151910
Sleep is a key modulator of pain, inflammation and tissue repair. Supporting autonomic stability may help promote more restorative sleep patterns and more consistent recovery.

Key Evidence (3 papers):

  • Frandsen MN, et al. (2022) Preoperative heart rate variability as a predictor of perioperative outcomes: a systematic review without meta-analysis Journal of Clinical Monitoring and Computing. PMID: 35092527 DOI: 10.1007/s10877-022-00819-z
  • Cameron S, et al. (2024) Mind and skin: exploring the links between stress and dermatological disease. PMID: 37469218
  • Michalek-Zrabkowska M, et al. (2021) Cardiovascular implications of sleep bruxism: a systematic review. PMID: 34064229
The autonomic nervous system regulates vascular tone and perfusion. Improved regulation may support peripheral comfort, effort tolerance and recovery processes, particularly in patients with coldness, heaviness or reduced perfusion.

Key Evidence (3 papers):

  • Liu X, et al. (2024) Correlation between heart rate variability and perioperative neurocognitive disorders in patients undergoing non-cardiac surgery PLOS One. PMID: 38564647 DOI: 10.1371/journal.pone.0297337
  • Lee JY, et al. (2011) Heart rate variability in men with erectile dysfunction. PMID: 21811698
  • Goernig M, et al. (2008) Peripheral arterial disease alters heart rate variability. PMID: 18684283
Integrating non-invasive neuromodulation as a supportive approach may help address the regulatory component without replacing the primary treatment. The aim is additive: greater stability, improved recovery and better adherence.

Key Evidence (3 papers):

  • Souza R, et al. (2026) Neuromodulation of heart rate variability: a systematic review and meta-analysis Autonomic Neuroscience. PMID: 41506123 DOI: 10.1016/j.autneu.2026.103379
  • Yeom JW, et al. (2025) Transcutaneous auricular vagus nerve stimulation improves sleep quality in chronic insomnia disorder: a double-blind, randomized, sham-controlled trial Sleep Medicine. PMID: 40398066 DOI: 10.1016/j.sleep.2025.106579
  • Alomari MS, et al. (2022) Non-inferior and more feasible transcutaneous tibial nerve stimulation in treating overactive bladder: a systematic review and meta-analysis International Journal of Urology. PMID: 35711082 DOI: 10.1111/iju.14961

Resources

Training courses

Our training work at NESA Academic is aimed at professionals who want to integrate non-invasive neuromodulation and autonomic nervous system regulation into rehabilitation, physiotherapy and reconditioning. The content combines physiology, application criteria by specialty, safety and session design, so that integration is practical and consistent in the clinical setting.

Testimonials

Real cases and experiences from clinics and teams that integrate NESA XSIGNAL® into rehabilitation, physiotherapy and reconditioning. What comes up repeatedly: better rest, reduced reactivity during high-load periods and more sustained treatments over time. We also share clinical meetings where protocols, learnings and case discussions are presented.

News

Articles, bibliography and downloadable materials to go deeper into non-invasive neuromodulation, autonomic nervous system, heart rate variability, vasomotor control and neurovascular health applied to rehabilitation, physiotherapy and reconditioning. A living library to keep clinical criteria up to date and provide context for each indication.