title: Intraoperative neurophysiological mapping and monitoring in spinal tumor surgery: sirens or indispensable tools?
abstract: Spinal tumor (ST) surgery carries the risk of new neurological deficits in the postoperative period. Intraoperative neurophysiological monitoring and mapping (IONM) represents an effective method of identifying and monitoring in real time the functional integrity of both the spinal cord (SC) and the nerve roots (NRs). Despite consensus favoring the use of IONM in ST surgery, in this era of evidence-based medicine, there is still a need to demonstrate the effective role of IONM in ST surgery in achieving an oncological cure, optimizing patient safety, and considering medicolegal aspects. Thus, neurosurgeons are asked to establish which techniques are considered indispensable. In the present study, the authors focused on the rationale for and the accuracy (sensitivity, specificity, and positive and negative predictive values) of IONM in ST surgery in light of more recent evidence in the literature, with specific emphasis on the role of IONM in reducing the incidence of postoperative neurological deficits. This review confirms the role of IONM as a useful tool in the workup for ST surgery. Individual monitoring and mapping techniques are clearly not sufficient to account for the complex function of the SC and NRs. Conversely, multimodal IONM is highly sensitive and specific for anticipating neurological injury during ST surgery and represents an important tool for preserving neuronal structures and achieving an optimal postoperative functional outcome.
authors.affiliation: Divisions of 1 Neurosurgery.
authors.forename: Antonino
authors.initials: A
authors.lastname: Scibilia
authors.affiliation: Neurology, and.
authors.forename: Carmen
authors.initials: C
authors.lastname: Terranova
authors.affiliation: Neurology, and.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Rizzo
authors.affiliation: Divisions of 1 Neurosurgery.|Department of Clinical and Experimental Medicine, University of Messina, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Raffa
authors.affiliation: Neurology, and.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Morelli
authors.affiliation: Divisions of 1 Neurosurgery.
authors.forename: Felice
authors.initials: F
authors.lastname: Esposito
authors.affiliation: Anesthesiology; and.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Mallamace
authors.affiliation: Anesthesiology; and.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Buda
authors.affiliation: Divisions of 1 Neurosurgery.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Conti
authors.affiliation: Neurology, and.
authors.forename: Angelo
authors.initials: A
authors.lastname: Quartarone
authors.affiliation: Divisions of 1 Neurosurgery.
authors.forename: Antonino
authors.initials: A
authors.lastname: Germanò
mesh_terms: D019054:Evoked Potentials, Motor / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods* / Q000639:trends; D019635:Neurosurgical Procedures / Q000379:methods* / Q000639:trends; D013120:Spinal Cord Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery
keywords: BCR = bulbocavernosus reflex; CST = corticospinal tract; D wave; D wave = direct wave; DCM = dorsal column mapping; DNS = direct nerve stimulation; EXDST = extradural spinal tumor; IDEMSCT = intradural-extramedullary SC tumor; IMSCT = intramedullary spinal cord tumor; IONM = intraoperative neurophysiological monitoring and mapping; MEP = motor evoked potential; NPV = negative predictive value; NR = nerve root; PPV = positive predictive value; SC = spinal cord; SSEP = somatosensory evoked potential; ST = spinal tumor; electromyography; frEMG = free-running electromyography; intraoperative monitoring; mIONM = multimodal IONM; mMEP = muscle MEP; motor evoked potential; somatosensory evoked potential; spinal tumor surgery