Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 16:4:102796.
doi: 10.1016/j.bas.2024.102796. eCollection 2024.

The "state of the art" of intraoperative neurophysiological monitoring: An Italian neurosurgical survey

Riccardo Antonio Ricciuti  1 , Fabrizio Mancini  2 , Giusy Guzzi  3 , Daniele Marruzzo  1 , Alessandro Dario  4 , Alessandro Della Puppa  5 , Alessandro Ricci  6 , Andrea Barbanera  7 , Andrea Talacchi  8 , Andreas Schwarz  9 , Antonino Germanò  10 , Antonino Raco  11 , Antonio Colamaria  12 , Antonio Santoro  13 , Riccardo Boccaletti  14 , Carlo Conti  15 , Carlo Conti  16 , Nunzia Cenci  2 , Christian Cossandi  17 , Claudio Bernucci  18 , Corrado Lucantoni  19 , Giovanni Battista Costella  20 , Diego Garbossa  21 , Donato Carlo Zotta  22 , Federico De Gonda  23 , Felice Esposito  24 , Flavio Giordano  25   26 , Giancarlo D'Andrea  27 , Gianluca Piatelli  28 , Gianluigi Zona  29 , Giannantonio Spena  30 , Giovanni Tringali  31 , Giuseppe Barbagallo  32 , Carlo Giussani  33 , Maurizio Gladi  34 , Andrea Landi  35 , Angelo Lavano  3 , Letterio Morabito  36 , Luciano Mastronardi  37 , Marco Locatelli  38 , Michele D'Agruma  39 , Michele Maria Lanotte  40 , Nicola Montano  41 , Orazio Santo Santonocito  42 , Angelo Pompucci  43 , Raffaele de Falco  44 , Franco Randi  45 , Sara Bruscella  46 , Ivana Sartori  47 , Francesco Signorelli  48 , Luigino Tosatto  49 , Roberto Trignani  50 , Vincenzo Esposito  51 , Gualtiero Innocenzi  51 , Sergio Paolini  51 , Vincenzo Vitiello  52 , Michele Alessandro Cavallo  53 , Francesco Sala  54
Affiliations

The "state of the art" of intraoperative neurophysiological monitoring: An Italian neurosurgical survey

Riccardo Antonio Ricciuti et al. Brain Spine. .

Abstract

Introduction: Intraoperative Neurophysiological Monitoring (IOM) is widely used in neurosurgery but specific guidelines are lacking. Therefore, we can assume differences in IOM application between Neurosurgical centers.

Research question: The section of Functional Neurosurgery of the Italian Society of Neurosurgery realized a survey aiming to obtain general data on the current practice of IOM in Italy.

Materials and methods: A 22-item questionnaire was designed focusing on: volume procedures, indications, awake surgery, experience, organization and equipe. The questionnaire has been sent to Italian Neurosurgery centers.

Results: A total of 54 centers completed the survey. The annual volume of surgeries range from 300 to 2000, and IOM is used in 10-20% of the procedures. In 46% of the cases is a neurologist or a neurophysiologist who performs IOM. For supra-tentorial pathology, almost all perform MEPs (94%) SSEPs (89%), direct cortical stimulation (85%). All centers perform IOM in spinal surgery and 95% in posterior fossa surgery. Among the 50% that perform peripheral nerve surgery, all use IOM. Awake surgery is performed by 70% of centers. The neurosurgeon is the only responsible for IOM in 35% of centers. In 83% of cases IOM implementation is adequate to the request.

Discussion and conclusions: The Italian Neurosurgical centers perform IOM with high level of specialization, but differences exist in organization, techniques, and expertise. Our survey provides a snapshot of the state of the art in Italy and it could be a starting point to implement a consensus on the practice of IOM.

Keywords: Awake surgery; Brain tumors; Eloquent areas; IOM; PEM; PES.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image 1
Graphical abstract
See this image and copyright information in PMC

References

    1. Abboud T., Asendorf T., Heinrich J., Faust K., Krieg S.M., Seidel K., Mielke D., Matthies C., Ringel F., Rohde V., Szelényi A. Transcranial versus direct cortical stimulation for motor-evoked potentials during resection of supratentorial tumors under general anesthesia (the TRANSEKT-trial): study protocol for a randomized controlled trial. Biomedicines. 2021;9(10):1490. - PMC - PubMed
    1. Alshekhlee A., Mehta S., Edgell R.C., Vora N., Feen E., Mohammadi A., Kale S.P., Cruz-Flores S. Hospital mortality and complications of electively clipped or coiled unruptured intracranial aneurysm. Stroke. 2010;41(7):1471–1476. - PubMed
    1. Al-Adli N.N., Young J.S., Sibih Y.E., Berger M.S. Technical aspects of motor and language mapping in glioma patients. Cancers. 2023;15(7):2173. - PMC - PubMed
    1. American Association of Electrodiagnostic Medicine. AAEM position statements. Who is qualified to practice electrodiagnostic medicine? Muscle Nerve Suppl. 1999;8:S263–S265. - PubMed
    1. Bejjani G.K., Nora P.C., Vera P.L., Broemling L., Sekhar L.N. The predictive value of intraoperative somatosensory evoked potential monitoring: review of 244 procedures. Neurosurgery. 1998;43(3):491–498. ; discussion 498-500. - PubMed