The usefulness of multimodal intraoperative neurophysiologic monitoring during brain or spine surgeries

Abstract

Multimodal Intraoperative neurophysiological monitoring (mIONM) has been involved in spinal and brain surgeries, to localize and monitor important neural structures. Also to maintain their structural integrity throughout the operation, minimizing deficits both during and postoperative complications. Several modalities are used in modern IONM, each modality offers a special means of monitoring the performance of the nervous system during surgery. These modalities include Somatosensory-evoked potential, Motor-evoked potential, Electromyography, and others. This study was conducted to evaluate the usefulness of (mIONM) in complex brain and spinal surgeries, through calculating specificity, sensitivity, negative predicted value, and positive predictive value of combined mIONM modalities for postoperative neurological deficit occurrence. This prospective observational cohort study included 50 patients aged ≥ 12 years who underwent cranial or spinal surgery with planned (mIONM). Monitoring included somatosensory evoked potentials, transcranial motor evoked potentials, and free-running and triggered electromyography, according to the surgical indication and neural structures at risk. The primary outcome was new postoperative neurological deficit within 72 h. The study revealed high sensitivity (97.73%), specificity (83.33%), and predictive value for combined SSEP, MEP and EMG monitoring in forecasting neurological outcomes. The value of (mIONM) in enhancing the safety and effectiveness of intricate surgical procedures is affirmed by this study.