title: Neuromonitoring for Intramedullary Spinal Cord Tumor Surgery.
abstract: BACKGROUND
  Intramedullary spinal cord tumors (IMSCT) account for about 2%-4% of tumors of the central nervous system. Surgical resection continues to be the most effective treatment modality for most intramedullary tumors, with gross total resection leading to preserved neurologic function and improved survival. However, surgical treatment is often difficult and carries significant risk of postoperative neurologic complications. Intraoperative neuromonitoring has been shown to be of clinical importance in the surgical resection of IMSCT. The main monitoring modalities include somatosensory evoked potentials, transcranial motor evoked potentials via limb muscles or spinal epidural space (D-waves), and dorsal column mapping. These monitoring modalities have been shown to inform surgeons intraoperatively and in many cases, have led to alterations in operative decision.
  
  
  METHODS
  We reviewed the literature on the usefulness of intraoperative neuromonitoring for intramedullary spinal tumor resection and its role in predicting postoperative neurologic deficits. A MEDLINE search was performed (2000-2015) and 13 studies were reviewed. Detailed information and data from the selected articles were assessed and compiled. Data were extracted showing the role of monitoring in outcomes of surgery.
  
  
  CONCLUSIONS
  By using intraoperative somatosensory evoked potentials, transcranial motor evoked potentials, D-waves, and dorsal column mapping, spinal injury could be prevented in most cases, thereby improving postoperative neurologic functioning and outcome in patients undergoing surgery for IMSCT.
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Terence
authors.initials: T
authors.lastname: Verla
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Jared S
authors.initials: JS
authors.lastname: Fridley
authors.affiliation: School of Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Abdul Basit
authors.initials: AB
authors.lastname: Khan
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Rory R
authors.initials: RR
authors.lastname: Mayer
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA; Department of Surgery, American University of Beirut, Riad El-Solh, Beirut, Lebanon. Electronic address: Omeis@bcm.edu.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Omeis
mesh_terms: D004558:Electric Stimulation; D004824:Epidural Space; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D018482:Muscle, Skeletal; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D013120:Spinal Cord Neoplasms / Q000601:surgery*
keywords: Intramedullary tumor; Intraoperative monitoring; Outcomes; Spinal injury