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Interpretation Challenges of Intraoperative Neurophysiological Monitoring Waveforms: A Technical Note.

Byeong Ho Oh1, Hyeong Cheol Moon1, Jae Hoon Woo1

  • 1Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.

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|April 26, 2026
PubMed
Summary

Interpreting intraoperative neurophysiological monitoring (IONM) waveforms during surgery can be difficult. Recognizing an "uncertain" category of motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) may improve patient assessment.

Keywords:
Intraoperative neurophysiological monitoringMotor evoked potentialsNeurosurgerySomatosensory evoked potentialsWaveform interpretation

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Area of Science:

  • Neurosurgery
  • Neurophysiology
  • Medical Monitoring

Background:

  • Intraoperative neurophysiological monitoring (IONM) using motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) is crucial for preventing neurological deficits during neurosurgery.
  • Interpreting IONM waveforms is challenging due to ambiguous signals that don't always meet standard alarm criteria.

Purpose of the Study:

  • To present representative patterns of normal, uncertain, and abnormal IONM waveforms.
  • To discuss interpretative challenges associated with ambiguous intraoperative recordings.

Main Methods:

  • A retrospective descriptive review of seven adult patients undergoing neurosurgical procedures with MEP and SEP monitoring.
  • Qualitative categorization of waveforms based on morphology, amplitude, latency, and reproducibility.

Main Results:

  • Normal waveforms showed stable morphology, reproducible amplitudes, and physiologic latency.
  • Abnormal waveforms exhibited significant signal attenuation or loss of reproducible responses.
  • Uncertain waveforms displayed partial amplitude reduction, fluctuating morphology, or limited reproducibility, defying binary classification.

Conclusions:

  • Intraoperative MEP and SEP interpretation often requires more than a simple normal/abnormal framework.
  • Introducing an "uncertain" waveform category can enhance contextual assessment and reflect the dynamic nature of neuromonitoring.