Intraoperative Neurophysiological Monitoring in Intramedullary Spinal Cord Tumour Surgery
DOI:
https://doi.org/10.5281/zenodo.22310425Keywords:
Intramedullary spinal cord tumour, Intraoperative neurophysiological monitoring, Motor evoked potentials, D-wave, Total intravenous anaesthesiaAbstract
Background: Intramedullary spinal cord tumours (IMSCTs) sit within eloquent tracts, so resection risks worsened weakness.
Intraoperative neurophysiological monitoring (IONM) — somatosensory evoked potentials, the epidural D-wave, muscle motor
evoked potentials (mMEPs) and free-running or triggered electromyography — gives surgeons real-time feedback on cord
integrity. Objective: To review evidence on IONM modalities, alarm criteria, anaesthesia and outcomes in IMSCT surgery.
Methods: Narrative review of cohort studies, systematic reviews, meta-analyses and position statements.
Findings: A historical control study found MEP monitoring roughly halved new severe deficits. D-wave decline beyond 50%
predicts permanent deficit, while isolated mMEP loss is often reversible; intravenous anaesthesia preserves mMEP amplitude far
better than volatile agents. Multicentre cohorts and meta-analyses link protocol-driven IONM to reduced permanent morbidity
across paediatric and adult series. Conclusions: Multimodal IONM, interpreted against explicit D-wave and mMEP criteria under intravenous anaesthesia, is central to safe IMSCT resection, though prospective comparative data remain limited.
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