What is the predictive value of intraoperative somatosensory-evoked potential monitoring for postoperative neurological deficit in intramedullary tumor resection?

Abstract

The objective of this study is to determine the accuracy of somatosensory-evoked potential (SSEP) monitoring versus SSEP combined with motor-evoked potential monitoring (MEP) for predicting postoperative neurological deficits following intramedullary tumor resection. A systematic review was conducted to identify the studies examining postoperative neurological deficits following intramedullary tumor resection. The sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated for each of the monitoring modalities (SSEP vs. SSEP/MEP) and presented by forest plots and receiver operating characteristic curves. The total cohort consisted of 303 patients for the SSEP group and 350 patients for the SSEP/MEP combined group. The specificity and sensitivity of SSEP monitoring were 76% and 55%, respectively. The DOR of SSEP monitoring is 5.6 (95% confidence interval [CI], 1.55–20.26, I2 = 0%). The specificity and sensitivity of SSEP/MEP monitoring were 86% and 80%, respectively. The DOR of SSEP/MEP monitoring is 30.32 (95% CI, 6.92–132.85, I2 = 0%). SSEP/MEP intraoperative monitoring offers higher sensitivity, specificity, and DOR for predicting postoperative neurological deficits following intramedullary tumor resection. Patients who had a postoperative neurological deficit were 30 times more likely to exhibit a SSEP or MEP change compared to approximately six times more likely to solely exhibit a SSEP change.