SynthesisNeurosurgical review2025
Accuracy of intraoperative neurophysiological monitoring in predicting postoperative neurological decline in intradural extramedullary spinal tumor surgery: a systematic review and meta-analysis.
Synthesis in Neurosurgical review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The role of intraoperative neurophysiological monitoring (IONM) in intradural extramedullary (IDEM) tumor surgery remains unestablished. Therefore, the purpose of this study was to systematically review and meta-analyze the recent literature on the accuracy of IONM in the resection of IDEM tumors.The study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Embase, and Cochrane databases were searched for English-language papers published from inception until February 19, 2025. The study was found eligible if it reported the complete data on the accuracy of motor evoked potentials (MEPs), somatosensory evoked potentials (SSEPs), D-wave monitoring, or multimodal IONM (mIONM - defined as a combination of more than one of the abovementioned modalities) in patients with IDEM tumors. Each modality's accuracy was evaluated using the Hierarchical Summary Receiver Operating Characteristic (HSROC) curve for predicting short-term (immediate postoperative) and long-term postoperative deficits (minimum of 3 months after discharge).From a total of 3220 papers, 16 studies met the eligibility criteria. Additionally, one study was found based on references analysis, resulting in the inclusion of 17 papers. MEPs significantly predicted the occurrence of both short-term (AUROC = 0.72; p < 0.0001) and long-term (AUROC = 0.91; p = 0.006) new motor deficits. Conversely, D-wave failed to accurately predict motor deficits (AUROC = 0.83; p = 0.1094, and AUROC = 0 in the short- and long-term observation, respectively). Similarly, SSEPs showed low accuracy in predicting short-term (AUROC = 0.55; p = 0.7461) and long-term (AUROC = 0.53; p = 0.3953) sensory deficits. Conversely, mIONM was found to accurately predict short-term (AUROC = 0.75; p = 0.001) and long-term (AUROC = 0.70; p = 0.005) new neurological deficits.MEPs and mIONM constitute the sole modalities that can accurately predict motor and neurological deficits, respectively. Contrarily, the low sensitivity of SSEPs for predicting sensory deficits underlines its efficacy in IDEM tumor surgery. Although D-wave did not achieve satisfactory accuracy, its application seems reasonable to prevent permanent motor deficits.
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