Background: Intradural extramedullary spinal cord tumors (ID-EMSCT) make up 40% of all spinal neoplasms. Resection of these tumors is mostly conducted using intraoperative neuromonitoring (IONM). However, the literature shows heterogenous data on its added value for ID-EMSCT. The aim of this study is to define sensitivity and specificity of IONM in ID-EMSCT resection and to study possible correlations between preoperative, intraoperative, and postoperative variables and neurologic outcomes after ID-EMSCT resection. Methods: Data of patients undergoing ID-EMSCT surgeries with IONM from January 2012 until July 2019 were examined. Using neurologic status 6 weeks and 1 year postoperatively, sensitivity and specificity for IONM were calculated. IONM test results and neurologic outcomes were paired to preoperative, intraoperative, and postoperative parameters. Results: Data of 78 patients were analyzed. 6 weeks postoperatively, 14.10% of patients had worse neurologic status, decreasing to 9.84% 1 year postoperatively. Multimodal IONM showed a sensitivity of 0.73 (95% confidence interval [CI], 0.39–0.94) and a specificity of 0.78 (95% CI, 0.66–0.87) after 6 weeks, and a sensitivity of 1.00 (95% CI, 0.54–1.00) and a specificity of 0.71 (95% CI, 0.57–0.82) after 1 year. Conclusions: IONM yielded high to perfect sensitivity and high specificity. However, IONM signals did not always determine the extent of resection, and false-positive results did not always result in incomplete tumor resections, because of surgeons overruling IONM. Therefore, IONM cannot fully replace clinical judgment and other perioperative information.

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World Neurosurgery
Department of Anesthesiology

van der Wal, E.C. (Ewout C.), Klimek, M., Rijs, K. (Koen), Scheltens-De Boer, M., Biesheuvel, K., & Harhangi, B. (2021). Intraoperative Neuromonitoring in Patients with Intradural Extramedullary Spinal Cord Tumor: A Single-Center Case Series. World Neurosurgery. doi:10.1016/j.wneu.2020.12.099