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Abstract Intramedullary spinal cord tumors (IMSCT) account for about 2%– 4% of tumors of the central nervous system and about 15% of adult intradural tumors. Studies have reported deterioration in neurologic function in patients postoperatively, with rates of dorsal column dysfunction as high as 43.6%–55.1%. These deficits severely affect the postoperative functionality of patients because they are often left with significant morbidity, worse than their preoperative disease burden. In recent years, an increase in the utilization of intraoperative neurophysiological monitoring (IONM) has been noted in an effort to avert these neurological complications. This technology allows intraoperative assessment of spinal cord function through real-time feedback from sensory tracts, motor tracts, and individual nerve roots. Currently, the most commonly employed IONM techniques for spinal procedures include somatosensory sensory evoked potentials (SSEPs), motor-evoked potentials (MEPs), and spontaneous and triggered electromyography (EMG). Despite advancements in the understanding of IONM and the popularity of this technique in modern spine surgery, controversies still exist regarding its effectiveness and the necessity for its use in routine spinal procedures. There are controversies concerning certain IONM combination techniques, but studies found combined motor and somatosensory evoked potential monitoring is most commonly used for spinal cord tumor surgeries. The aim of the present study was to review the efficacy of intraoperative neurophysiological monitoring (IONM) on postSummary 58 operativeoutcomes preventing neurological injury, predicting postoperative neurological deficit and its effect on intraoperative surgeon’s decision making, and to know if it is beneficial or not in intramedullary spinal cord tumors surgeries in adults. This was Observational studies and Non randomized controlled studies. Only studies on human (adults) subjects were included for spinal tumors (Intramedullary). our patients were followed up according to this schedule (immediate post-operative, first day, three days, first month, three months, six months, one yearpost-operative) and the assessment were done by using Oxford grading system. The main results of the study revealed that: Regarding Study characteristics, 9 studies were included 7 were retrospective, 1 non randomized study and 1 prospective study. Regarding Patient’s characteristics, A total of 455 cases were included m\f was 226\229 and mean age was 45 years. Motor deficit was the most common presenting symptom, followed by sensory deficit, pain, urinary symptoms and cranial nerves deficits. Regarding location was mainly in cervical-predominant, cervico-thoracic junction, thoracic spine, thoraco-lumbar junction, Lumbar spine, sacral spine. Mean tumor size was 16.7 mm, Syrinx combined founded in 54 cases As regard Histological diagnosis mainly was Ependymoma, hemangioblastoma,Astrocytoma,Intramedullary lipoma,,Granuloma, Cavernous hemangioma, Vascular lesion. Summary 59 Regarding Neurophysiologic monitoring, 8 studies used SEPs\MEP and 1 study used MEPs. Mean operative time was 336.8 min and mean follow up was 39 mn, total excision occurred in 309 cases, maximum safe resection in 61 cases and biopsy in 8 cases. Regarding Neurophysiologic monitoring efficacy last follow up, Mean Sensitivity (%), Specificity (%), PPV (%) and NPV (%) was 89%, 93.5, 90.6 and 80.3 respectively. Regarding Mc Cormick Scale Score pre and post-operative last follow up, Mean McCormick Scale Score pre was 2.06 which increase to 3.7 at last follow up after treatment. Regarding Neurological status by clinical examination at last follow up, Improved in 72, transient worsening in no cases,no change in 12 cases and progression in 17 cases. Regarding surgical outcome last follow up, surgical revision done in 12 cases and Surgery-related morbidity in 26 cases. The Based on our results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion. |