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Precision in Practice: A Systematic Review and Meta-Analysis of Intraoperative Neurophysiological Monitoring for
Raja Narendra Divakar Addanki1, Benjamin B Lee1, Katherine M Anetakis1
1Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Journal of Personalized Medicine
|November 26, 2025
Summary
Intraoperative neurophysiological monitoring (IONM) using transcranial motor evoked potentials (TcMEPs) and multimodal approaches are more accurate than somatosensory evoked potentials (SSEPs) for predicting neurological injury during spinal cord tumor surgery. These advanced IONM techniques improve patient outcomes by enabling timely interventions.
Area of Science:
- Neurosurgery
- Neurology
- Medical Technology
Background:
- Intraoperative neurophysiological monitoring (IONM) is crucial for preventing neurological injury during extramedullary spinal cord tumor (EMSCT) resection.
- The diagnostic accuracy of IONM, particularly somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (TcMEPs), requires systematic validation with recent evidence.
Purpose of the Study:
- To evaluate the diagnostic performance of SSEPs, TcMEPs, and multimodal IONM (SSEP + TcMEP) in predicting neurological deficits after EMSCT resection.
- To compare the effectiveness of different IONM modalities in identifying and preventing intraoperative neurological damage.
Main Methods:
- A systematic meta-analysis following PRISMA-DTA guidelines, searching MEDLINE, PubMed, and Ovid up to April 2025.
- Pooled sensitivity, specificity, and reversibility metrics were calculated using bivariate models; quality was assessed via QUADAS-2.
- Bayesian meta-analysis and Z-tests were employed for comparative analysis of IONM modalities.
Main Results:
- Multimodal IONM demonstrated high diagnostic accuracy (AUC 94.2%), followed by TcMEP (AUC 92%) and SSEP (AUC 82%).
- All modalities exhibited high specificity (>95%), indicating a low false-positive rate.
- Reversible TcMEP changes correlated with a lower postoperative deficit rate (11%) compared to SSEPs (35%). Bayesian analysis indicated TcMEP superiority over SSEPs.
Conclusions:
- Current reliance solely on SSEPs for IONM during EMSCT resection is cautioned against.
- Multimodal IONM strategies, incorporating TcMEPs, enhance early detection of neurological injury, facilitating timely surgical intervention and preventing permanent damage.
- While TcMEP and multimodal monitoring show similar accuracy, multimodal approaches remain the standard of care pending further research on TcMEP's standalone reliability.
