{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T16:17:02Z","timestamp":1783354622921,"version":"3.54.6"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006702","name":"Universidade Do Estado Do Rio De Janeiro","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006702","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurosurg Rev"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    The role of intraoperative neurophysiological monitoring (IONM) in intradural extramedullary (IDEM) tumor surgery is uncertain. While IONM is standard in intramedullary and deformity procedures, its impact on neurological outcomes in IDEM resections has not been systematically evaluated.\u00a0To assess whether IONM reduces early postoperative neurological morbidity in IDEM tumor surgery.\u00a0We conducted a PROSPERO-registered systematic review and meta-analysis (CRD420251119538) in accordance with PRISMA 2020. Comparative studies of IDEM resections with versus without IONM were included. Outcomes were harmonized into a binary \u201cnew neurological deficit\u201d at discharge. Risk of bias was assessed with ROBINS-I, and certainty of evidence with GRADE. Pooled odds ratios (ORs) were calculated using a random-effects model.\u00a0Four retrospective cohorts comprising 602 patients (306 with IONM, 296 without) were analyzed. In absolute terms, early postoperative neurological deficits occurred in 19\/306 patients (6.2%) in the IONM group versus 45\/296 patients (15.2%) in the non-IONM group. Pooled analysis showed a significant reduction in early postoperative neurological deficits with IONM compared to no IONM group (OR 0.39, 95% CI 0.20\u20130.75;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.005; I\u00b2 = 22%), corresponding to an absolute risk reduction of 9.2% (NNT\u2009\u2248\u200911). Sensitivity analysis revealed dependence on certain large studies. Risk of bias was moderate-to-serious, and certainty of evidence was rated low.\u00a0IONM use was associated with lower odds of early postoperative neurological deficits in IDEM tumor surgery, and the effect is based on low-certainty observational evidence. These findings are hypothesis-generating and support selective rather than universal use of IONM, particularly in higher-risk cases. Prospective multicenter studies with standardized outcomes, longer follow-up, and cost-effectiveness analyses are needed to define its optimal role.\n                  <\/jats:p>","DOI":"10.1007\/s10143-026-04159-3","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T23:31:37Z","timestamp":1772148697000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Intraoperative neurophysiological monitoring versus no monitoring in intradural extramedullary tumor surgery: a systematic review and meta-analysis of early postoperative neurological outcomes"],"prefix":"10.1007","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6863-8997","authenticated-orcid":false,"given":"Eduardo Mendes","family":"Correa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Othavio","family":"Lopes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Carrion","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dom\u00eanica Baroni Coelho","family":"de Oliveira Ferreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"George","family":"Div\u00e9rio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Henrique Costa","family":"Ferreira-Pinto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio","family":"Nigri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"issue":"3","key":"4159_CR1","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1097\/BSD.0000000000000644","volume":"31","author":"TD Azad","year":"2018","unstructured":"Azad TD, Pendharkar AV, Pan J, Chen J, Feng AY, Tamura RS et al (2018) Intraoperative neurophysiological monitoring for intramedullary spinal cord tumor resection: a systematic review and meta-analysis. Clin Spine Surg 31(3):112\u2013119. https:\/\/doi.org\/10.1097\/BSD.0000000000000644","journal-title":"Clin Spine Surg"},{"issue":"24","key":"4159_CR2","doi-asserted-by":"publisher","first-page":"7588","DOI":"10.3390\/jcm13247588","volume":"13","author":"L Caba\u00f1es-Mart\u00ednez","year":"2024","unstructured":"Caba\u00f1es-Mart\u00ednez L, Men\u00e9ndez-Garc\u00eda A, Maza-Bustillo M, Morales F, Carrasco-Garc\u00eda I, L\u00f3pez-Gonz\u00e1lez F et al (2024) Intraoperative neurophysiological monitoring in intradural extramedullary spinal tumor surgery: functional outcomes and prognostic factors. J Clin Med 13(24):7588. https:\/\/doi.org\/10.3390\/jcm13247588","journal-title":"J Clin Med"},{"issue":"5","key":"4159_CR3","doi-asserted-by":"publisher","first-page":"E9","DOI":"10.3171\/2020.2.FOCUS2015","volume":"48","author":"AJ Clark","year":"2020","unstructured":"Clark AJ, Safaee MM, Oh T, Barber J, Lad SP, Dahdaleh NS et al (2020) Intraoperative neurophysiological monitoring in contemporary spinal surgery: a systematic review of clinical outcomes and cost-effectiveness. Neurosurg Focus 48(5):E9. https:\/\/doi.org\/10.3171\/2020.2.FOCUS2015","journal-title":"Neurosurg Focus"},{"key":"4159_CR4","doi-asserted-by":"publisher","first-page":"598619","DOI":"10.3389\/fneur.2020.598619","volume":"11","author":"F Cofano","year":"2020","unstructured":"Cofano F, Bertero L, Di Perna G, Massaro F, Tardivo V, Ajello M et al (2020) Intraoperative neurophysiological monitoring and spinal intradural extramedullary tumors: a single-center experience with a focus on long-term functional outcome. 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Any financial or institutional support received by the authors was unrelated to the conduct of the present study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosure"}},{"value":"not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human ethics and consent to participate"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"251"}}