Observational studyNeurosurgical review2026
Diagnostic value of D-wave and motor evoked potentials in intramedullary spinal cord tumor surgery: a temporal analysis of predictive accuracy.
Observational study in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThe surgical resection of intramedullary spinal cord tumors (IMSCTs) is associated with significant morbidity. Intraoperative neuromonitoring (IONM) with transcranial myogenic motor evoked potentials (m-MEP) and D-wave aims to reduce new postoperative motor deficits. Still, their comparative ability to predict short- and long-term outcomes is incompletely defined. We evaluated the diagnostic performance of m-MEP and D-wave monitoring at multiple postoperative time points and examined their influence on intraoperative decision-making.
methodsIn this single-institution observational study (2017-2024), we included 44 patients undergoing resection of IMSCTs with multimodal IONM. Neurological status was assessed using Medical Research Council (MRC) grade and Modified McCormick Scale (MMS) preoperatively, immediately (0-3 days), at discharge (7-14 days), and at ≥ 6 months follow-up. Statistical analyses were used to correlate the postoperative deficits with attenuation of m-MEP and D-wave potentials during surgery. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated and compared using McNemar's test.
resultsMean age was 36.6 ± 15.1 years; mean follow-up was 14.5 ± 7.2 months. IONM attenuation occurred in 20 patients (45.5%): m-MEP drop in 20 (45.5%) and D-wave amplitude reduction in 6 (13.6%); no case had a complete loss of D-wave. Immediate postoperative motor deficits occurred in 72% (MRC) and 38.6% (MMS), declining to 15% and 9% at follow-up, respectively. D-wave attenuation correlated significantly with deficits immediately (p = 0.02) and at discharge (p = 0.027) but not at follow-up (p = 0.257). m-MEPs demonstrated higher sensitivity (51-66%) but lower specificity than D-waves across time points. D-waves showed lower sensitivity (35-75%) but consistently high specificity (95-100%). D-waves demonstrated superior diagnostic accuracy at follow-up compared with m-MEPs (84% vs. 59% on MRC; 93% vs. 64% on MMS; p < 0.001). The PPV of both modalities declined over time, while the NPV and sensitivity improved at the last follow-up. False positives were more common with m-MEPs (30-40%) than with D-waves (0-5%).
conclusionsThe predictive accuracy of IONM varies with time following surgery. m-MEPs are more sensitive for detecting immediate postoperative deficits, while D-waves are more specific and have superior predictive accuracy for long-term motor outcomes. Their complementary roles highlight the importance of multimodal monitoring as a surgical guide rather than a restrictive determinant of resection. CLINICAL TRIAL NUMBER: Not applicable.
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