Direct Wave Intraoperative Neuromonitoring for Spinal Tumor Resection: A Focused Review

Area of Science:

• Neurosurgery
• Neurophysiology
• Spinal Cord Research

Background:

• Surgical resection of intramedullary spinal cord tumors is challenging due to the spinal canal's constraints and risk of neurological injury.
• Intraoperative neurophysiological monitoring (IONM) is crucial for assessing neural pathway integrity and optimizing surgical strategies during these procedures.

Purpose of the Study:

• To review the utility of Direct waves (D-waves) for monitoring during spinal cord tumor resection.
• To highlight neuroanatomical and neurophysiological insights, technical considerations, and limitations of D-wave monitoring.
• To explore the role of D-waves in multimodal monitoring and as prognostic biomarkers for motor function recovery.

Main Methods:

• Review of current literature on D-wave monitoring in spinal cord tumor surgery.
• Analysis of neuroanatomical and neurophysiological principles underlying D-wave monitoring.
• Discussion of technical aspects, limitations, and integration with other IONM techniques like motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs).

Main Results:

• D-waves provide immediate feedback on the integrity of the lateral corticospinal tract.
• Multimodal monitoring with D-waves and MEPs can guide tumor resection extent and provide intraoperative warnings.
• D-wave monitoring correlates with postoperative motor function recovery, serving as a prognostic biomarker.

Conclusions:

• D-wave intraoperative neurophysiological monitoring is a valuable tool for spinal cord tumor resection.
• D-wave monitoring enhances clinical decision-making by providing real-time functional data and prognostic information.
• Integration of D-waves into surgical practice can improve safety and optimize outcomes for patients with intramedullary spinal cord tumors.