Benefits and Risks of Intraoperative Neuromonitoring for Intramedullary Spinal Cord Tumors. A Technical Report

Intramedullary spinal cord tumors (IMSCT) are a rare condition that can have adverse effects on both the sensory and motor tracts, as well as the gray and white matter of the spinal cord. One type of IMSCT, known as ependymomas, is typically seen in adults, and is characterized by an enhancing mass with clear borders extending outward from the central canal's ependymal lining. In this study, over 800 patients have undergone intramedullary spinal cord tumor surgeries with intraoperative neurophysiological monitoring (IONM), and the majority have successfully overcome any postoperative deficits.

Multimodal IONM techniques, such as Somatosensory Evoked Potentials (SSEPs), Motor Evoked Potentials (MEPs), Epidural recordings (D-waves), Electromyography (EMG), Bulbocavernosus Reflex (BCR), and Train of Four (TOF), were used to monitor the procedures. While intramedullary spinal tumors can be challenging to treat, early surgery can lead to better outcomes. Intraoperative modalities like D-waves and MEPs have shown promise in reducing neurological outcomes, but more research is needed to understand their effectiveness fully.