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

• Published in: Brain & spine Vol. 4; p. 102796
• Main Authors: Ricciuti, Riccardo Antonio, Mancini, Fabrizio, Guzzi, Giusy, Marruzzo, Daniele, Dario, Alessandro, Puppa, Alessandro della, Ricci, Alessandro, Barbanera, Andrea, Talacchi, Andrea, Schwarz, Andreas, Germanò, Antonino, Raco, Antonino, Colamaria, Antonio, Santoro, Antonio, Boccaletti, Riccardo, Conti, Carlo, Cenci, Nunzia, Cossandi, Christian, Bernucci, Claudio, Lucantoni, Corrado, Costella, Giovanni Battista, Garbossa, Diego, Zotta, Donato Carlo, De Gonda, Federico, Esposito, Felice, Giordano, Flavio, D'Andrea, Giancarlo, Piatelli, Gianluca, Zona, Gianluigi, Spena, Giannantonio, Tringali, Giovanni, Barbagallo, Giuseppe, Giussani, Carlo, Gladi, Maurizio, Landi, Andrea, Lavano, Angelo, Morabito, Letterio, Mastronardi, Luciano, Locatelli, Marco, D'Agruma, Michele, Lanotte, Michele Maria, Montano, Nicola, Santonocito, Orazio Santo, Pompucci, Angelo, de Falco, Raffaele, Randi, Franco, Bruscella, Sara, Sartori, Ivana, Signorelli, Francesco, Tosatto, Luigino, Trignani, Roberto, Esposito, Vincenzo, Innocenzi, Gualtiero, Paolini, Sergio, Vitiello, Vincenzo, Cavallo, Michele Alessandro, Sala, Francesco
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2024; Elsevier
• Subjects: Awake surgery; Brain tumors; Eloquent areas; IOM; PEM; PES; Awake surgery; PEM; IOM; Eloquent areas; Brain tumors; PES
• ISSN: 2772-5294; 2772-5294
• DOI: 10.1016/j.bas.2024.102796

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. 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. 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. 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. 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. [Display omitted] •Despite the diffusion of IOM in the neurosurgical practice, no specific neurosurgical guidelines exist and the complexity of IOM may lead to significant differences across centers.•In Italy, the vast majority of Neurosurgical centers perform IOM with high level of specialization and in 83% of cases, neurosurgeons describe the IOM implementation by their Institution as satisfying.•Even centers that perform high volume of IOM express the need for a better internal organization and for an improvement of team coordination, in particular with neurophysiologists.•Trust in the value of IOM seems to increase with its use and experience. This may reflect the fact that as neurosurgeon became more familiar with IOM, they can better appreciate the value of the different IOM techniques.•The survey provides a snapshot of the state of the art in Italy and it could be a starting point to address future strategies to implement a consensus on the practice of IOM.