Advancements in intraoperative monitoring techniques in neurosurgical practice: a systematic review

Abstract

Intraoperative monitoring (IOM) has become a vital component of contemporary neurosurgery, significantly reducing neurological deficits and improving surgical outcomes. This systematic review aims to evaluate recent advancements in IOM techniques in neurosurgical practice. A thorough literature search was conducted using major medical databases, including PubMed, Scopus, EMBASE, and CINAHL, to identify relevant studies without temporal restrictions, focusing on articles in English. The search targeted studies related to various IOM modalities, neurovascular monitoring, intracranial pressure (ICP) monitoring, depth of anesthesia monitoring, and advancements in electrophysiological techniques. Initially, 760 records were identified, with 629 remaining after duplicate removal. Following a screening process, 127 articles were assessed for eligibility, resulting in 78 studies included in the qualitative analysis. The review highlights significant advancements in IOM techniques, which are essential for improving patient outcomes and reducing neurological deficits. Innovations in electrophysiological monitoring, such as somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), and electromyography (EMG), have enhanced the sensitivity and specificity of IOM, allowing for real-time detection of neural damage. Furthermore, multimodal monitoring strategies that incorporate techniques like Doppler ultrasound, intraoperative MRI, and CT have proved effective in assessing neural integrity, ultimately improving the safety and efficacy of complex neurosurgical procedures. IOM is essential for ensuring patient safety and favorable surgical outcomes in neurosurgery. While advancements in IOM techniques and multimodal approaches offer substantial benefits, challenges related to standardization and technology integration remain. Continued research and development are crucial for addressing these issues and improving IOM practices, thereby enhancing patient care in neurosurgery.