{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T13:12:59Z","timestamp":1789391579927,"version":"build-2803163510"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The purpose of this study was to evaluate the technical feasibility, accuracy, and relevance on surgical outcome of D-wave monitoring combined with somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) during resection of intradural extramedullary (IDEM) spinal tumors.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Clinical and intraoperative neurophysiological monitoring (IONM) data obtained in 108 consecutive patients who underwent surgery for IDEM tumors at the Institute for Scientific and Care Research \u201cASMN\u201d of Reggio Emilia, Italy, were prospectively entered into a database and retrospectively analyzed. The IONM included SSEPs, MEPs, and\u2014whenever possible\u2014D-waves. All patients were evaluated using the modified McCormick Scale at admission and at 3, 6, and 12 months of follow-up .<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>A total of 108 patients were included in this study. A monitorable D-wave was achieved in 71 of the 77 patients harboring cervical and thoracic IDEM tumors (92.2%). Recording of D-waves in IDEM tumors was significantly associated only with a preoperative deeply compromised neurological status evaluated using the modified McCormick Scale (p = 0.04). Overall, significant IONM changes were registered in 14 (12.96%) of 108 patients and 9 of these patients (8.33%) had permanent loss of at least one of the 3 evoked potentials. In 7 patients (6.48%), the presence of an s18278 caudal D-wave was predictive of a favorable long-term motor outcome even when the MEPs and\/or SSEPs were lost during IDEM tumor resection. However, in 2 cases (1.85%) the D-wave permanently decreased by approximately 50%, and surgery was definitively abandoned to prevent permanent paraplegia. Cumulatively, SSEP, MEP, and D-wave monitoring significantly predicted postoperative deficits (p = 0.0001; AUC = 0.905), with a sensitivity of 85.7% and a specificity of 97%. Comparing the area under the receiver operating characteristic curves of these tests, D-waves appeared to have a significantly greater predictive value than MEPs and especially SSEPs alone (0.992 vs 0.798 vs 0.653; p = 0.023 and p &lt; 0.001, respectively). On multiple logistic regression, the independent risk factors associated with significant IONM changes in the entire population were age older than 65 years and an anterolateral location of the tumor (p &lt; 0.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>D-wave monitoring was feasible in all patients without severe preoperative motor deficits. D-waves demonstrated a statistically significant higher ability to predict postoperative deficits compared with SSEPs and MEPs alone and allowed us to proceed with IDEM tumor resection, even in cases of SSEP and\/or MEP loss. Patients older than 65 years and with anterolateral IDEM tumors can benefit most from the use of IONM.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.7.spine18278","type":"journal-article","created":{"date-parts":[[2018,11,16]],"date-time":"2018-11-16T17:38:51Z","timestamp":1542389931000},"page":"259-267","source":"Crossref","is-referenced-by-count":64,"title":["Intraoperative neurophysiological monitoring for intradural extramedullary spinal tumors: predictive value and relevance of D-wave amplitude on surgical outcome during a 10-year experience"],"prefix":"10.3171","volume":"30","author":[{"given":"Reza","family":"Ghadirpour","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Parma, and Department of Neurosurgery, Institute for Scientific and Care Research \u201cASMN\u201d of Reggio Emilia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Nasi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Parma, and Department of Neurosurgery, Institute for Scientific and Care Research \u201cASMN\u201d of Reggio Emilia;"},{"name":"Department of Neurosurgery, Umberto I General Hospital, Universit\u00e0 Politecnica delle Marche, Ancona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrado","family":"Iaccarino","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Parma, and Department of Neurosurgery, Institute for Scientific and Care Research \u201cASMN\u201d of Reggio Emilia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Romano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Parma, and Department of Neurosurgery, Institute for Scientific and Care Research \u201cASMN\u201d of Reggio Emilia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"Motti","sequence":"additional","affiliation":[{"name":"Department of Neurophysiology, IRCCS \u201cArcispedale Santa Maria Nuova\u201d of Reggio Emilia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossella","family":"Sabadini","sequence":"additional","affiliation":[{"name":"Department of Neurophysiology, IRCCS \u201cArcispedale Santa Maria Nuova\u201d of Reggio Emilia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franco","family":"Valzania","sequence":"additional","affiliation":[{"name":"Department of Neurophysiology, IRCCS \u201cArcispedale Santa Maria Nuova\u201d of Reggio Emilia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franco","family":"Servadei","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Humanitas Research Hospital and University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Clin Orthop Surg","doi-asserted-by":"publisher","first-page":"165","DOI":"10.4055\/cios.2009.1.3.165","article-title":"The surgical treatment for spinal intradural extramedullary tumors","volume":"1","author":"Ahn DK","year":"2009","unstructured":"Ahn DK, Park HS, Choi DJ, Kim KS, Kim TW, Park SY: The surgical treatment for spinal intradural extramedullary tumors. 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