Intraoperative Monitoring During Neurosurgical Procedures and Patient Outcomes

Although intraoperative neuromonitoring has become a standardized practice for many neurological procedures, the evidence supporting its benefit remains contradictory. Here, we summarize the latest evidence of the impact of neuromonitoring on patient outcomes and make recommendations on its use in neurosurgery. Despite some conflicting literature regarding its accuracy in predicting neurological outcomes, current guidelines support the use of intraoperative monitoring in neurosurgery for specific high-risk procedures. Recent studies suggest that using several monitoring modalities, whether unimodally or multimodally, are associated with high sensitivity and specificity for predicting neurological injury in high-risk neurosurgical procedures. Despite inconclusive evidence regarding the routine use of neuromonitoring modalities for spine and brain surgery, there is clear support to recommend neuromonitoring use during high-risk procedures and in patients with specific considerations. All neuromonitoring modalities provide valuable information that should be considered during the surgical decision-making process; however, the information provided by these modalities should not be considered solely diagnostic and should be viewed in the context of other supporting data.