Related Experiment Video
Updated: Jul 30, 2025
Author Spotlight: Assessing the Feasibility of Using Amplitude-Integrated EEG During Neonatal Transport
Published on: June 21, 2024
Pediatric Intraoperative Neurophysiological Monitoring and Long-Term Outcomes in a Developing Country
Daniel San-Juan1, Jenny Angelica Vicuña Vanegas1, Raúl Aguilar López2
1Clinical Neurophysiology Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; and.
Insights
Pediatric intraoperative neurophysiological monitoring (IONM) in developing countries effectively prevents neurological deficits. This study highlights its use in posterior fossa and spine surgeries, showing 100% true negatives and improved outcomes.
Area of Science:
- Neuroscience
- Pediatric Neurosurgery
- Clinical Neurophysiology
Background:
- Pediatric intraoperative neurophysiological monitoring (IONM) is established in developed nations for preventing neurological deficits.
- Limited data exists on IONM's effectiveness and findings in developing countries.
- This study addresses the gap by examining pediatric neurosurgical cases in Mexico.
Purpose of the Study:
- To describe neurophysiological findings and postoperative outcomes in children undergoing neurosurgery in a developing country.
- To evaluate the application and efficacy of pediatric IONM in a single center.
Main Methods:
- Retrospective case series of 35 pediatric patients (≤18 years) undergoing IONM from 2014-2020.
- Data collected included sociodemographics, IONM modalities, intraoperative changes, and short- and long-term outcomes.
- Descriptive statistics were employed to analyze the data.
Main Results:
- IONM use increased fivefold from 2014 to 2020.
- Common pathologies involved the infratentorial cranium (40%) and spine/spinal cord (37.1%).
- 100% true negatives were observed at 24 hours postoperatively, with progressive motor and sensory improvement noted during long-term follow-up.
Conclusions:
- Pediatric multimodal IONM is valuable for neurosurgeries in developing countries, particularly for posterior fossa and spine pathologies.
- The monitoring effectively prevents postoperative sequelae, achieving 100% true negatives.
- This study demonstrates the successful implementation and positive outcomes of IONM in a resource-limited setting.
Purpose:
Pediatric intraoperative neurophysiological monitoring (IONM) has been shown to be effective in preventing and reversing postoperative neurological deficits in developed countries. There are currently no published studies from developing countries that describe neurophysiological findings and postoperative outcomes. Our study aims to address these gaps in children undergoing neurosurgical procedures in a single center.
Methods:
We conducted a retrospective study of case series of children who underwent IONM (2014-2020) in the State of Mexico, Mexico. Sociodemographic characteristics, IONM modalities, changes during procedures, and short-term and long-term postoperative results were recorded. Descriptive statistics were used.
Results:
We included 35 patients (≤18 years of age), 57% (20/35) boys. A relative increase of up to 5 times in the use of IONM is observed from 2014 (5.7%) to 2020 (25.7%) in our center. The most frequent preoperative pathologies were located at the infratentorial cranium (40%), followed by the spine and spinal cord (37.1%). The IONM modalities were as follows: free-running EMG 94.3%, transcranial electrical stimulation motor-evoked potentials 91.4%, somatosensory-evoked potentials 85.7%, triggered EMG 28.6%, EEG 25.7%, and visual-evoked potentials 5.7%. Only in 8.3%, we did not obtain sufficient evoked potential baseline signals. At 24 hours postoperatively true negatives were 100%. Long-term follow-up was completed in 22/35 (63%) at 3 months, 12/35 (34.2%) at 6 months, and 5/35 (14.3%) at 12 months with progressive motor and sensory improvement.
Conclusions:
Pediatric multimodal IONM in neurosurgeries from a single center in a developing country is mainly used in pathologies of the posterior fossa, spine, and spinal cord, with true negatives in 100% of those monitored, preventing and avoiding postoperative sequelae.
More Related Videos
10:22Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy
Published on: December 6, 2016
06:18A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019