الفهرس 
IntroductionOnly 14 pages are availabe for public view
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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
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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
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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.