Intramedullary Spinal Tumors Research Articles

Spinal Cord Intramedullary Angiolipoma: Case Report and Literature Review

The spinal intramedullary angiolipoma is extremely rare when compared to other intramedullary spinal tumors. The spinal intramedullary or extramedullary angiolipoma are conventionally divided into non-infiltrating and infiltrating subtype. The authors reported a case of intramedullary spinal cord angiolipoma in adult patient that presented with significant diagnostic challenges to pathologists because of its rarity. The clinical presentation, neurodiagnostic studies, surgical management, and histopathological findings of biopsy are documented in the present report. Keywords: Spinal cord tumor; Intramedullary; Angiolipoma

Anatomical Limitation of Posterior Spinal Myelotomy for Intramedullary Hemorrhage Associated with Ependymoma or Cavernous Malformation of the High Cervical Spine.

Spinal intramedullary tumors such as ependymoma or vascular lesions such as cavernous malformation are often at risk of intramedullary hemorrhage. Surgical procedures involving the high cervical spinal cord are often challenging. This technical note included four patients who presented with acute, subacute, or gradual onset of spinal cord dysfunction associated with intramedullary hemorrhage at the C1 or C1/2 level of the high cervical spine. The mean age was 46.3 years (16-74 years). All patients underwent posterior spinal cord myelotomy of the posterior median sulcus or posterolateral sulcus. It was not to exceed the caudal opening of the fourth ventricle (foramen of Magendie) and was assumed to be as high as the caudal medulla oblongata. Total removal of the intramedullary ependymoma or cavernous malformation occurred in three of four cases, and the remaining case had subtotal removal of the ependymoma. None of the patients showed postoperative deterioration of the neurological condition. Pathological examination of all cases revealed intramedullary hemorrhage was associated with ependymoma or cavernous malformation. Posterior spinal myelotomy should be limited to the caudal opening of the fourth ventricle (foramen of Magendie), that is the caudal medulla oblongata, to avoid the significant deterioration after surgery.

Another Milestone for Spinal Intramedullary Tumor Treatment

Another Milestone for Spinal Intramedullary Tumor Treatment

Cranial nerve and intramedullary spinal malignant peripheral nerve sheath tumor associated with neurofibromatosis-1

Background: Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon but aggressive neoplasms associated with radiation exposure and neurofibromatosis Type I (NF1). Their incidence is low compared to other nervous system cancers, and intramedullary spinal lesions are exceedingly rare. Only a few case reports have described intramedullary spinal cord MPNST.Case Description: We describe the clinical findings, management, and outcome of a young patient with NF1 who developed aggressive cranial nerve and spinal MPNST tumors. This 35-year-old patient had familial NF1 and a history of optic glioma treated with radiation therapy (RT). She developed a trigeminal MPNST that was resected and treated with RT. Four years later, she developed bilateral lower extremity deficits related to an intramedullary cervical spine tumor, treated surgically, and found to be a second MPNST.Conclusion: To the best of our knowledge, this is the first report of cranial nerve and intramedullary spinal MPNSTs manifesting in a single patient, and only the third report of a confined intramedullary spinal MPNST. This unusual case is discussed in the context of a contemporary literature review.

Clinical Prediction Modeling in Intramedullary Spinal Tumor Surgery.

Artificial intelligence is poised to influence various aspects of patient care, and neurosurgery is one of the most uprising fields where machine learning is being applied to provide surgeons with greater insight about the pathophysiology and prognosis of neurological conditions. This chapter provides a guide for clinicians on relevant aspects of machine learning and reviews selected application of these methods in intramedullary spinal cord tumors. The potential areas of application of machine learning extend far beyond the analyses of clinical data to include several areas of artificial intelligence, such as genomics and computer vision. Integration of various sources of data and application of advanced analytical approaches could improve risk assessment for intramedullary tumors.

First local Case Report of a Holocord Pilocytic Astrocytoma – An Uncommon Entity with Management Challenges

Holocord tumors are defined as “Intramedullary spinal tumor extending through the spinal cord with extension from cervicomedullary junction to the conus.” They are uncommon tumors having variable presentation and histology.1,2 Pilocytic astrocytoma (PA) is a slow-growing tumor, mostly benign. It is the diagnosis in 5% to 6% of all intracranial gliomas.3 It is the most common tumor in childhood occurring rarely in the adult population.4 To date, 25 cases of holocord astrocytoma have been reported, of these, 4 were adults and 21 were children. The management of this unusual disease is challenging and debatable.1,5 In this case report, we are describing a case of 14 years old male with holocord grade 1 pilocytic astrocytoma along with its clinical management. To the best of the author’s knowledge, this is the first case of a holocord astrocytoma reported in the country.

Long segment spinal intramedullary dermoid cyst: A case report.

IntroductionSpinal intramedullary dermoid is very rare, accounting for <1% of intraspinal tumors. It can be congenital or acquired. They usually present in 2nd or 3rd decade of life in adults. It may or may not associated with spinal dysraphism. It is asymptomatic in most cases, manifest acutely if it ruptures.Long segment involvement of spinal intramedullary tumor in adult without the history of trauma makes this case unique. Fat suppression imaging helps to distinguish adipose tissue from lesions causing hematomyelia in patients presented with intramedullary hyperintensity in both T1 & T2 sequences of MRI spine.Case presentationWe report here a rare case of 30 years old male who presented to us with sudden urinary retention followed by rapidly progressive quadriparesis and paresthesia in his right arm. In MRI, spinal intramedullary tumor was noted from medulla till D5 vertebra. We performed subtotal excision of tumor and sample sent for histopathology which proved it to be intramedullary spinal dermoid cyst.ConclusionLong segment involvement of spinal intramedullary dermoid cyst in adult without history of trauma makes this case different. Fat suppression imaging must be done in patients with intramedullary hyperintensity in both T1 and T2 sequences of MRI spine. Early diagnosis and appropriate management will be helpful in reducing morbidity.

Intradural extramedullary anaplastic ependymoma in dorsal spinal cord: Case report

Ependymomas are common intramedullary spinal tumors but there are very few reports of this tumour presenting with exophytic growth patterns mimicking as intradural extramedullary (IDEM) tumors [1]. Intradural extramedullary tumors are more of an intra-operative finding rather than a clinical diagnosis. The tumor pathological features are usually benign and they most commonly arise from the central canal of the spinal cord, the conus medullaris or the filum terminale [1]. In contrast, intra and extramedullary ependymomas are reported very rarely and have wide variety of histological features [3]. We present a case of recurrent spinal anaplastic ependymoma with an extramedullary exophytic lesions as well. Intra-operatively there was poor delineation between the lesion and the spinal cord.

Primary intramedullary melanoma of lumbar spinal cord: A case report

BACKGROUNDPrimary intramedullary melanoma is a very rare tumor, most frequently occurring in the cervical and thoracic spinal cord.CASE SUMMARYWe present a rare case in which the primary intramedullary melanoma was located in the lumbar spine. A 56-year-old man complained of progressive intermittent pain in the lumbar area. Thoracic magnetic resonance imaging showed a spinal intramedullary tumor between the L3 and S1 levels. The tumor was resected entirely, and the diagnosis of malignant melanoma was confirmed by histopathology. CONCLUSIONPrimary melanoma of the spinal cord, particularly intramedullary localization, has rarely been reported in the previous literature. We describe a primary malignant melanoma of the lumbar spinal cord and discuss the challenges associated with the diagnosis.

Spinal Tumor Surgery- Our Experiences of 35 Cases in a Peripheral Hospital in Bangladesh

Introduction: Surgical outcome of spinal tumour varies depending on a number of factors such as: site of the tumour, compression within the spinal canal, the histological characteristics of the tumour, the neurological progression and initial response to corticosteroid therapy, patient’s age, comorbidity, tumour extension, involvement of neighboring structures and organs etc.&#x0D; Materials &amp; Methods: The 35 patients with spinal tumour underwent surgery by our team in 10 years (January 2009 - December 2018) were reviewed retrospectively.&#x0D; Results: Analysis of the surgical outcome of our spinal tumour patients was done on different variables like age, sex, presenting symptoms, neuroimaging, comorbidities etc. The aim of surgery was decompression of the spinal cord, total removal of the tumour when possible and spinal stabilization when needed. Out of our 35 patients with spinal tumour, extradural tumour comprises 8, intradural extramedullary tumour 25 and intramedullary tumour 2.&#x0D; Conclusion: The aim of this study is to analyze the data to made conclusion for more effective strategy as per site, size, type, resectibility and histological variety to establish and effective treatment protocol and prevention of per-operative and post-operative complications. Intradural extramedullary tumour can be radically resected with no mortality and minimal peri-operative morbidity. But resection of intramedullary spinal tumour is difficult, hazardous and usually incomplete, so needs much more skilled and meticulous surgical hands.&#x0D; Medicine Today 2021 Vol.33(1): 38-41

Intraoperative contrast-enhanced ultrasound for intramedullary spinal neoplasms: patient series

BACKGROUNDPrimary intramedullary spinal tumors cause significant morbidity and death. Intraoperative ultrasound as an adjunct for localization and monitoring the extent of resection has not been systematically evaluated in these patients; the effectiveness of intraoperative contrast-enhanced ultrasound (CEUS) remains almost completely unexplored.OBSERVATIONSA retrospective case series of patients at a single institution who had consented to the off-label use of intraoperative CEUS was identified. Seven patients with a mean age of 52.8 ± 15.8 years underwent resection of intramedullary tumors assisted by CEUS performed by a single attending neurosurgeon. Histopathological evaluation revealed 3 cases of hemangioblastoma, 1 case of pilocytic astrocytoma, 2 cases of ependymoma, and 1 case of subependymoma. Contrast enhancement correlated with gadolinium enhancement on preoperative magnetic resonance imaging. Intraoperative CEUS facilitated precise lesion localization and myelotomy planning. Dynamic CEUS studies were useful in demonstrating the blood supply to lesions with a dominant vascular pedicle. Regardless of contrast uptake, the differential enhancement between spinal cord tissue and neoplasm assisted in determining interface boundaries.LESSONSIntraoperative CEUS constitutes a useful adjunct for the intraoperative delineation of contrast-enhancing intramedullary tumors and in vivo confirmation of gross-total resection. Systematic investigation is needed to establish the role of CEUS for resection of intramedullary spinal tumors of various pathologies.

Management of Intramedullary Spinal Cord Tumors with 26 Cases in the Department of Neurosurgery of Ibn Sina University Hospital—Rabat

Intramedullary spinal cord tumors are relatively rare neoplasms of all Central Nervous System (CNS) tumors. Their treatment and prognosis are largely dependent on tumor histology and patient functionality. The introduction and breakthroughs of microsurgical techniques have made surgery the mainstay of treatment for intramedullary tumors. We performed a retrospective analysis of 26 cases of primitive intramedullary spinal cord tumors treated between 2013 and 2019 at the Neurosurgery Department of Ibn SINA University Hospital of Rabat. In our patient’s population, the sex ratio was 1.75 showing with a predominance of male over female patients. The median age was 26 years old. The clinical symptomatology is dominated by a slow medullar compression. Spinal magnetic resonance imaging (MRI) was performed for all the patients and led to the positive diagnosis in all cases with a radio-histological correlation in 54.4% of the cases. The treatment was surgical in all cases by laminectomy in posterior access. This surgery has allowed a complete tumoral resection. Histological examination of the tumor was done for all patients and led to diagnosis confirmation in all cases. Understanding intramedullary spinal tumor is imperative to design proper management and obtain optimal patient outcomes. In addition, a meticulous operative technique and the use of surgical adjuncts are essential to accomplish proper tumor removal, diminish the risk of recurrence, and preserve neurologic functions.

Biomechanical modelling of spinal tumour anisotropic growth.

Biomechanical abnormalities of solid tumours involve stiffening of the tissue and accumulation of mechanical stresses. Both abnormalities affect cancer cell proliferation and invasiveness and thus, play a crucial role in tumour morphology and metastasis. Even though, it has been known for more than two decades that high mechanical stresses reduce cancer cell proliferation rates driving growth towards low-stress regions, most biomechanical models of tumour growth account for isotropic growth. This cannot be valid, however, in tumours that grow within multiple host tissues of different mechanical properties, such as the spine. In these cases, structural heterogeneity would result in anisotropic growth of tumours. To this end, we present a biomechanical, biphasic model for anisotropic growth of spinal tumours. The model that accounts for both the fluid and the solid phase of the tumour was used to predict the evolution of solid stress and interstitial fluid pressure in intramedullary spinal tumours and highlight the differences between isotropic and anisotropic growth. Varying the degree of anisotropy, we found considerable differences in the shape of the tumours, leading to tumours of more realistic ellipsoidal shapes.

Poor Prognostic Factors for Surgical Treatment of Spinal Intramedullary Ependymoma (World Health Organization Grade II).

Study DesignSingle-center retrospective study.PurposeWe aimed to explore the postoperative prognostic factors for spinal intramedullary ependymoma.Overview of LiteratureEpendymoma (World Health Organization grade II) is the most frequent intramedullary spinal tumor and is treated by total resection. However, postoperative deterioration of motor function occasionally occurs.MethodsEighty patients who underwent surgical resection at Keio University and Fujita Health University in Tokyo, Japan between 2003 and 2015 with more than 2 years of follow-up were enrolled. A good surgical result was defined as an improvement in the modified McCormick Scale score by one grade or more or having the same clinical grade as was observed preoperatively. Meanwhile, a poor result was defined as a reduction in the McCormick Scale score of one grade or more or remaining in grade IV or V at final follow-up. Univariate and multivariate logistic regression analyses of the following factors were performed in the two groups: sex, age, preoperative Visual Analog Scale (VAS), tumor location, the extent of tumor resection, hemosiderin caps, cavity length, and tumor length on magnetic resonance imaging.ResultsAt final follow-up, 15 patients were included in the poor results group and 65 in the good results group. In the univariate analysis, the factors related to poor results were as follows: higher age, preoperative McCormick Scale score severity, higher preoperative VAS, thoracic location, hemosiderin capped, and non-gross total resection (GTR). A multiple logistic regression analysis was conducted and showed that age, worse preoperative McCormick Scale score, and non-GTR were significant factors for poor prognosis.ConclusionsThe independent risk factors for motor deterioration after ependymoma resection were age, worse preoperative McCormick Scale score, and non-GTR. Early surgery for patients with even mild neurological disorders could facilitate functional outcomes. These results may contribute to determining the optimal timing of surgery for spinal intramedullary ependymoma.

Intraoperative Ultrasound and Contrast-Enhanced Ultrasound in Surgical Treatment of Intramedullary Spinal Tumors

Surgical resection of intramedullary tumors remains technically challenging. The role of intraoperative ultrasound and contrast-enhanced ultrasound (CEUS) in these surgeries has not yet been well defined. This study was aimed to evaluate the potential of intraoperative ultrasonography, especially CEUS, in visualizing intramedullary spinal cord tumors, and to assess the values for improving surgical outcomes. This prospective study recruited 14 patients with intramedullary spinal cord tumor. All patients underwent tumor resection with intraoperative ultrasound and CEUS. The first ultrasonographic scanning was performed before the dural incision. After the dural incision, further ultrasonographic scanning was performed over the surface of the spinal cord. During and after the tumor removal, repeat ultrasonographic scanning was conducted to assess the extent of surgical resection. Follow-up data were collected and analyzed. Seven patients had small tumors involving 1 or 2 spinal segments, and 7 patients showed relatively large tumors involving ≥3 spinal segments. Intraoperatively, ultrasonography was able to visualize the lesion clearly in all cases. Using intraoperative ultrasound with CEUS, the tumor boundaries were clearly defined. After an average follow-up period of 15.93 months, neurologic function improved in 10 cases (71.4%) and remained unchanged in 4 cases (28.6%); there was no deterioration in individual neurologic function. Intraoperative ultrasound is of great value for localizing lesions and determining the extent of dural opening and myelotomy, therefore reducing the invasiveness of spinal surgery for intramedullary tumors. CEUS helps to delineate the tumor margins and perfusion features.

Health-Related Quality of Life After Microscopic Total Removal of Spinal Intramedullary Ependymomas in a Single-Institute 3-Year Prospective Study

Health-related quality of life (HRQOL) after surgery for spinal intramedullary benign encapsulated tumors remains unclear. A single-institute, 3-year, prospective study was conducted to examine HRQOL after microscopic total removal of spinal intramedullary ependymomas using a safe and precise strategy. A cohort of 20 patients with a possible diagnosis of spinal intramedullary benign ependymomas was recruited. Patients who underwent microscopic total removal of the tumor and for whom the pathologic diagnosis was verified as World Health Organization grade II benign ependymoma were included. Sixteen patients (average age, 48.7 years) were eligible for study analysis. Careful assessment was performed for all patients before and 6-12 months after surgery. The 36-Item Short Form Health Survey was used to assess HRQOL, with the surveyor recording answers as reported by the individual patient. Average total HRQOL score was 431.1 before surgery and was maintained at 434.2 at 6-12 months postoperatively. Patients with mild functional symptoms tended to demonstrate a higher total HRQOL score preoperatively compared with patients with moderate to severe functional symptoms. A strong correlation was noted between postoperative functional conditions and preservation of HRQOL. This is the first study focusing on HRQOL after microscopic total removal of spinal intramedullary ependymomas. This study suggested that radical surgery using a safe and precise strategy appears justifiable and that preservation of neurologic function after surgery may lead to maintenance of postoperative HRQOL.

Surgical management of spinal intramedullary tumors: Ten-year experience in a single institution

Despite their rare occurrence, intramedullary spinal cord tumors can cause considerable morbidity and mortality without treatment. Timing of surgery, extent of resection and selection of favorable treatment option are important considerations for a good surgical outcome. In this clinical study, we report our patient series and convey our treatment strategy. We retrospectively reviewed 91 patients with primary intramedullary spinal cord tumors who underwent microsurgical resection at our institution between 2008 and 2018. Data were collected consisting of age, sex, location and histology of tumor, extent of resection, presenting symptoms and neurological outcomes. Modified McCormick Scale was used to assess neurological status of patients. 47 female and 44 male patients were followed-up for a mean period of 35.7 months. The most frequent pathological diagnosis was ependymoma in 56 patients, followed by astrocytoma in 21 and hemangioblastoma in 5 patients. The rest of the tumors consisted of 3 cavernomas, 3 mature cystic teratomas, 2 PNET, one epidermoid tumor. Gross total resection was achieved in 67 patients, while subtotal resection and biopsy was performed in 15 and 9 respectively. The most commonly involved localization was cervical (n = 39), followed by thoracic region (n = 24). Despite immediate postoperative worsening of neurological status, a great number of patients improved at the last follow-up. Gross total resection remains the primary goal of treatment while adjuvant radiation and/or chemotherapy may be alternative options for high grade tumors. Preoperative neurological status was the most important and the strongest predictor of functional outcome.

Role of Diffusion Tensor Imaging Parameters in the Characterization and Differentiation of Infiltrating and Non-Infiltrating Spinal Cord Tumors

Background and PurposeRecent attempts to utilize diffusion tensor imaging (DTI) to identify the extent of microinfiltration of a tumor in the brain have been successful. It was therefore speculated that this technique could also be useful in the spinal cord. The aim of this study was to differentiate between infiltrating and noninfiltrating intramedullary spinal tumors using DTI-derived metrics.Material and MethodsThe study group consisted of 6 patients with infiltrating and 12 with noninfiltrating spinal cord tumors. Conventional magnetic resonance imaging (MRI) with gadolinium administration was performed followed by DTI. Fractional anisotropy (FA), diffusivity (TRACE) and apparent diffusion coefficient (ADC) were measured in the enhancing tumor mass, peritumoral margins, peritumoral edema and normal appearing spinal cord. The results were compared using non-parametric Mann–Whitney U test with statistical significance p < 0.05.ResultsIn peritumoral margins the FA values were significantly higher in the noninfiltrating compared to the infiltrating tumors (p < 0.007), whereas TRACE values were significantly lower (p < 0.017). The results were similar in peritumoral edema. The FA values in the tumor mass showed no significant differences between the two groups while TRACE showed a statistically significant difference (p < 0.003). There was no statistical difference in any parameters in normal appearing spinal cord.ConclusionQuantitative analysis of DTI parameters of spinal cord tissue surroundings spinal masses can be useful for differentiation between infiltrating and non-infiltrating intramedullary spinal tumors.

Comparative clinical study on seldom segment with multiple segment intramedullary primary spinal cord tumors.

Several clinical studies were performed on multi-segment intramedullary primary spinal cord tumors. However, no clinical study focused on the relationship between different vertebral segments intramedullary tumors involvement and neurological functions, as well as prognosis of the patients. This prospective study was performed to compare clinical analysis on neurological functions and prognosis of the patients with intramedullary spinal cord primary tumors. A prospective cohort study was performed in a single medical center, Neurosurgical Department, Peking University Third Hospital. Between Jan. 1, 2010 and Dec. 30, 2015, 135 patients underwent microsurgery for intramedullary primary spinal cord tumors. The intramedullary tumor length occupying 3 or more vertebral body levels was considered as multiple segments intramedullary primary spinal cord tumor, and occupying one or two vertebral body levels considered as seldom segments. Preoperative and postoperative functions were assessed using IJOA (improved Japanese orthopaedic association) scoring system, and analyzed using the appropriate statistical tests. Among the 135 patients, 52 cases had seldom segments intramedullary primary spinal cord tumors, and 83 cases had multiple segments. In the seldom group, 32 (62%) patients presented with normal urine and stool function, 8 (15%) patients with severe dysfunction, 7 (14%) with slight dysfunction, and 5 (9%) with incontinence, and 30 (58%) patients demonstrated various degrees of limbs weakness. The preoperative IJOA scores of the patients were 16.9±2.4. The postoperative IJOA scores at the end of 3 months were 16.6±2.3. The current IJOA scores until the end of the follow-up were 17.5±4.4. In the multiple group, 37 (45%) patients presented with normal urine and stool functions, 26 (31%) patients with slight dysfunction, 11 (13%) with severe dysfunction, and 9 (11%) with incontinence, and 62 (75%) patients demonstrated various degrees of limbs weakness. The preoperative IJOA scores of the patients were 15.6±3.4. The postoperative IJOA scores at the end of 3 months were 15.5±3.8. The current IJOA scores until the end of the follow-up were 16.9±5.8. The difference of presenting urine and stool dysfunction (Z=-1.35, P=0.18) was not statistically significant between the different patient groups. However, the difference of presenting limbs weakness (Z=-2.06, P=0.04) was statistically significant between the two groups. Most patients with multiple segment intramedullary tumors suffered from various limbs weakness. The difference of the preoperative IJOA score (P=0.02) and the postoperative early IJOA score (P=0.004) of the patients was statistically significant between the seldom and multiple segments groups. Preoperative and early postoperative neurological function of the patients was better with seldom segments tumor than with multiple segments tumor. Most patients with multi-segment intramedullary tumors experienced various limbs weakness. However, the difference of long-term neurological function (P=0.12) between the seldom and multiple segments groups was not statistically significant. The neurological function of the patients with multiple segments intramedullary tumor was remarkably improved after physical therapy. Perioperative neurological function of the patients with seldom segments primary tumor was superior to that of the patients with multiple segments primary tumor, especially for limb strength. The neurological function of the patients with multiple segments intramedullary primary tumor was remarkably improved after physical therapy during long-term follow-up.

Intramedullary spinal cord tumors: the value of intraoperative neurophysiological monitoring in a series of 57 cases from two Italian centers.

Intramedullary spinal cord tumors are rare lesions of the central nervous system. Anatomical, molecular and radiological features are well defined, but correct management is still matter of debate. Pertinent literature has reported conflicting opinions regarding the use of intraoperative electrophysiological monitoring (IONM) in the surgical treatment of this kind of lesions, recently. We report a retrospective study from two Italian centers, in order to highlight the usefulness of IONM in the management of intramedullary lesions. We performed a retrospective review of patients with intramedullary spinal tumor who underwent surgical resection from February 2011 to February 2018 in two different institutions. Clinical and radiological data, lesion features, timing of symptom onset and IONM findings were recorded. The IONM included somatosensory-evoked potentials (SSEP), motor-evoked potentials (MEP) and D-Wave whenever possible. We evaluated the outcome according to the Modified McCormick scale. We also evaluated the accuracy and relevance of surgical outcomes for each evoked potential (SSEP, MEP, D-Wave). A total of 57 patients were included. A gross total removal was achieved in 46 cases. Neurological follow-up was assessment at 3 days, and 3 and 6 months after surgery. Comparing the preoperative status and 6 months follow-up: the modified McCormick scale showed a neurological stability for 30 patients (52.63%), a worsening of neurological status for 7 patients (12.28%) and an improvement for 20 patients (35.08%). IONM presented high accuracy (sensibility of 100% and specificity of 95.65%) and significantly predicted postoperative permanent motor deficits (P<0.0001; AUC=0.978). D-Wave appeared to have significant greater predictive value than MEP and especially SSEP alone (0.967 vs 0.722 vs 0.542; P=0.044 and P<0.001 respectively). The gold standard in the intramedullary lesion treatment is maximal safe resection with good neurological outcome, as shown in our patients. The use of IONM is helpful in intramedullary tumors resection in order to minimize postoperative neurological deficits and our analysis suggests that the use of D-Wave presents a statistically significant higher accuracy for predicting postoperative deficits than SSEP and MEP alone.