Intraoperative Neurophysiological Monitoring in Neurosurgery: Early Identification of Functional Deterioration and Prevention of Irreversible Neurological Injury
DOI:
https://doi.org/10.64784/306Palabras clave:
intraoperative neurophysiological monitoring, neurosurgery, cerebral monitoring, motor evoked potentials, somatosensory evoked potentials, cortical stimulation, subcortical stimulation, neurological injury, functional deterioration, neurological preservationResumen
Intraoperative cerebral and neurophysiological monitoring has become an essential strategy for preserving neurological function during neurosurgical procedures involving eloquent cortical regions, subcortical pathways, cerebral vasculature, and other functionally critical structures. This study evaluated the usefulness of intraoperative monitoring for detecting functional deterioration before neurological injury becomes irreversible, with particular emphasis on motor evoked potentials, somatosensory evoked potentials, direct cortical and subcortical stimulation, visual evoked potentials, and corticocortical evoked potentials. A descriptive, analytical, and integrative evidence-review methodology based on the Scientific Method was applied to 20 selected publications addressing intraoperative warning criteria, corrective interventions, reversibility of electrophysiological changes, and postoperative neurological outcomes. Multimodal or general intraoperative neurophysiological monitoring represented 40% of the analyzed publications, followed by direct cortical or subcortical stimulation with 20%. Motor evoked potential reduction or loss was the most frequently identified warning pattern, followed by somatosensory evoked potential amplitude or latency deterioration. Quantitative analysis of motor monitoring demonstrated that a proportion of significant intraoperative changes recovered after corrective intervention, supporting the existence of a potentially reversible period between initial functional deterioration and established neurological injury. Persistent warning signals showed different prognostic values depending on the monitoring modality, with direct cortical stimulation demonstrating a stronger association with persistent postoperative motor deficit than transcranial electrical stimulation in the analyzed cohort. The findings indicate that intraoperative monitoring should be interpreted as a dynamic decision-support system rather than an isolated diagnostic test. Its effectiveness depends on rapid recognition of warning signals, exclusion of technical and physiological confounders, timely corrective action, and multidisciplinary communication. Overall, multimodal neurophysiological monitoring contributes to the early recognition of neurological compromise and may improve functional preservation during high-risk neurosurgical procedures.
Referencias
• Bonosi, L., Torrente, A., Brighina, F., Petralia, C. C. T., Merlino, P., Avallone, C., Gulino, V., Costanzo, R., Brunasso, L., Iacopino, D. G., & Maugeri, R. (2024). Corticocortical evoked potentials in eloquent brain tumor surgery: A systematic review. World Neurosurgery, 181, 38–51. doi:10.1016/j.wneu.2023.10.028.
• Duffau, H. (2005). Intraoperative cortico-subcortical stimulations in surgery of low-grade gliomas. Expert Review of Neurotherapeutics, 5(4), 473–485. doi:10.1586/14737175.5.4.473.
• Greisman, J. D., Dadario, N. B., Park, J., Silverstein, J. W., & D’Amico, R. S. (2022). Subcortical stimulation in brain tumor surgery: A closer look beneath the surface. World Neurosurgery, 161, 55–63. doi:10.1016/j.wneu.2022.02.014.
• Gutzwiller, E. M., Cabrilo, I., Radovanovic, I., Schaller, K., & Boëx, C. (2019). Intraoperative monitoring with visual evoked potentials for brain surgeries. Journal of Neurosurgery, 130(2), 654–660. doi:10.3171/2017.8.JNS171168.
• Guzzi, G., Ricciuti, R. A., Della Torre, A., Lo Turco, E., Lavano, A., Longhini, F., & La Torre, D. (2024). Intraoperative neurophysiological monitoring in neurosurgery. Journal of Clinical Medicine, 13(10), 2966. doi:10.3390/jcm13102966.
• Idrees, M., Malhi, M. M., Haider, M., Mujeeb, M., Tayyab, M., Mahmood, H., & Mohsin, M. (2025). Intraoperative cortico-cortical evoked potential monitoring for tumor resection in eloquent regions: A systematic review. Cureus, 17(9), e91923. doi:10.7759/cureus.91923.
• Levin, E. A. (2025). Intraoperative monitoring of sensory evoked potentials in neurosurgery: A personalized approach. Journal of Personalized Medicine, 15(1), 26. doi:10.3390/jpm15010026.
• Liu, Q., Wang, Q., Liu, H., Wu, W. K. K., & Chan, M. T. V. (2017). Warning criteria for intraoperative neurophysiologic monitoring. Current Opinion in Anaesthesiology, 30(5), 557–562. doi:10.1097/ACO.0000000000000505.
• MacDonald, D. B., Skinner, S., Shils, J., & Yingling, C. (2013). Intraoperative motor evoked potential monitoring: A position statement by the American Society of Neurophysiological Monitoring. Clinical Neurophysiology, 124(12), 2291–2316. doi:10.1016/j.clinph.2013.07.025.
• Metwali, H., Kniese, K., & Fahlbusch, R. (2018). Intraoperative monitoring of the integrity of the anterior visual pathways: A methodologic review and meta-analysis. World Neurosurgery, 110, 217–225. doi:10.1016/j.wneu.2017.11.039.
• Motomura, K., & Saito, R. (2023). Intraoperative functional monitoring in brain tumor surgery. No Shinkei Geka, 51(3), 481–489. doi:10.11477/mf.1436204772.
• Nasi, D., Meletti, S., Tramontano, V., & Pavesi, G. (2020). Intraoperative neurophysiological monitoring in aneurysm clipping: Does it make a difference? A systematic review and meta-analysis. Clinical Neurology and Neurosurgery, 196, 105954. doi:10.1016/j.clineuro.2020.105954.
• Ottenhausen, M., Krieg, S. M., Meyer, B., & Ringel, F. (2015). Functional preoperative and intraoperative mapping and monitoring: Increasing safety and efficacy in glioma surgery. Neurosurgical Focus, 38(1), E3. doi:10.3171/2014.10.FOCUS14611.
• Ryalino, C., Sahinovic, M. M., Drost, G., & Absalom, A. R. (2024). Intraoperative monitoring of the central and peripheral nervous systems: A narrative review. British Journal of Anaesthesia, 132(2), 285–299. doi:10.1016/j.bja.2023.11.032.
• Saito, T., Tamura, M., Chernov, M. F., Ikuta, S., Muragaki, Y., & Maruyama, T. (2018). Neurophysiological monitoring and awake craniotomy for resection of intracranial gliomas. Progress in Neurological Surgery, 30, 117–158. doi:10.1159/000464387.
• Simon, M. V., Curry, W. T., Jones, P. S., Cahill, D. P., Carter, B. S., Rapalino, O., Malik, A. N., & Nahed, B. V. (2021). Intraoperative thalamocortical tract monitoring via direct cortical recordings during craniotomy. Clinical Neurophysiology, 132(7), 1416–1432. doi:10.1016/j.clinph.2021.02.404.
• Thomas, B., & Guo, D. (2017). The diagnostic accuracy of evoked potential monitoring techniques during intracranial aneurysm surgery for predicting postoperative ischemic damage: A systematic review and meta-analysis. World Neurosurgery, 103, 829–840.e3. doi:10.1016/j.wneu.2017.04.071.
• Toleikis, J. R., Pace, C., Jahangiri, F. R., Hemmer, L. B., & Toleikis, S. C. (2024). Intraoperative somatosensory evoked potential (SEP) monitoring: An updated position statement by the American Society of Neurophysiological Monitoring. Journal of Clinical Monitoring and Computing, 38(5), 1003–1042. doi:10.1007/s10877-024-01201-x.
• Viganò, L., Callipo, V., Lamperti, M., Rossi, M., Conti Nibali, M., Sciortino, T., Gay, L., Puglisi, G., Leonetti, A., Cerri, G., & Bello, L. (2022). Transcranial versus direct electrical stimulation for intraoperative motor-evoked potential monitoring: Prognostic value comparison in asleep brain tumor surgery. Frontiers in Oncology, 12, 963669. doi:10.3389/fonc.2022.963669.
• Zhu, F., Chui, J., Herrick, I., & Martin, J. (2019). Intraoperative evoked potential monitoring for detecting cerebral injury during adult aneurysm clipping surgery: A systematic review and meta-analysis of diagnostic test accuracy. BMJ Open, 9(2), e022810. doi:10.1136/bmjopen-2018-022810.
