{"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":1789391579790,"version":"build-2803163510"},"reference-count":60,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,24]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Intramedullary spinal cord tumors (IMSCTs) are typically treated with maximal safe resection, during which neurosurgeons often monitor for neurological injury using muscle motor evoked potential (mMEP) and direct wave (D-wave) neuromonitoring. The predictive value of changes in D-waves for identifying motor outcomes is underexplored. This study evaluated the utility of D-waves for predicting postoperative motor deficits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Patients who underwent resection of a primary IMSCT with mMEP neuromonitoring from 2003 to 2023 at a tertiary care hospital were identified. Patients who underwent D-wave monitoring in addition to mMEP monitoring were compared to those who underwent mMEP monitoring alone using the Mann-Whitney U-test, chi-square test, and Fisher\u2019s exact test. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of D-wave and mMEP monitoring for identifying new neurological deficits immediately postoperatively and at 1 month, 6 months, and last follow-up were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>After matching, 125 patients were included (median age 42.0 years; 57.6% male; median follow-up 34.0 months), of whom 88 had both mMEP and D-wave data. The most common pathologies were ependymoma (64.0%) and astrocytoma (17.6%). Patients who did and did not undergo D-wave neuromonitoring had similar preoperative neurological function, primary pathology, tumor grade, and tumor location. D-wave use was associated with increased gross-total resection (88.6% vs 64.9%, p = 0.002) and reduced mortality (5.7% vs 24.3%, p = 0.007), length of stay (5.0 vs 6.0 days, p = 0.033), and 30-day readmission (2.3% vs 13.5%, p = 0.013) and reoperation (1.1% vs 10.8%, p = 0.012). At the 6-month follow-up, D-wave monitoring alone was superior to mMEP and combination monitoring for detecting new motor deficits. D-wave monitoring had peak sensitivity (77.8%) and NPV (96.5%) at 6 months and peak specificity (95.8%) and PPV (76.9%) in the immediate postoperative period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>D-wave monitoring was associated with reduced mortality and was more accurate than mMEP monitoring alone or combination monitoring for detecting new postoperative neurological deficits. Further prospective studies are needed to validate these results.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.11.spine25124","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:39:39Z","timestamp":1779359979000},"page":"1-10","source":"Crossref","is-referenced-by-count":1,"title":["Utility of direct wave intraoperative neuromonitoring for intramedullary spinal cord tumor resection"],"prefix":"10.3171","author":[{"given":"Kelly","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdel-Hameed","family":"Al-Mistarehi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled J.","family":"Zaitoun","sequence":"additional","affiliation":[{"name":"Jordan University of Science and Technology, Irbid, Jordan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carly","family":"Weber-Levine","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanxuan","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin Z.","family":"Mendelson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noa L.","family":"Ksabi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pritika","family":"Papali","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sushanth","family":"Neerumalla","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical College, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Antar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Hersh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Daniel","family":"Davidar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zach","family":"Pennington","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziya L.","family":"Gokaslan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Warren Alpert Medical School, Providence, Rhode Island;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih-Chun","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-fu Larry","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zucker School of Medicine\/Northwell, Great Neck, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Witham","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Sciubba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zucker School of Medicine\/Northwell, Great Neck, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Jallo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, Florida; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Paul","family":"Wolinsky","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Northwestern Memorial Hospital, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Weingart","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Theodore","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lubelski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"J Neurosurg Spine","first-page":"252","article-title":"Perioperative outcomes and survival after surgery for intramedullary spinal cord tumors: a single-institution series of 302 patients","volume":"37","author":"Hersh AM","year":"2022","unstructured":"Hersh AM, Patel J, Pennington Z,  Perioperative outcomes and survival after surgery for intramedullary spinal cord tumors: a single-institution series of 302 patients. 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Pediatr Neurosurg. 1997;26(5):247\u2013254. doi:10.1159\/000121199"},{"issue":"6","key":"b20","series-title":"Neurosurgery","first-page":"1129","article-title":"Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study","volume":"58","author":"Sala F","year":"2006","unstructured":"Sala F, Palandri G, Basso E,  Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study. 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Yonsei Med J. 2014;55(4):1063\u20131071. doi:10.3349\/ymj.2014.55.4.1063"},{"issue":"3","key":"b28","series-title":"Clin Spine Surg","first-page":"112","article-title":"Diagnostic utility of intraoperative neurophysiological monitoring for intramedullary spinal cord tumors: systematic review and meta-analysis","volume":"31","author":"Azad TD","year":"2018","unstructured":"Azad TD, Pendharkar AV, Nguyen V,  Diagnostic utility of intraoperative neurophysiological monitoring for intramedullary spinal cord tumors: systematic review and meta-analysis. 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