INTRAOPERATIVE SPINAL CORD MONITORING AND NEUROPROTECTION STRATEGIES IN TUMOR SURGERY

In spinal tumor surgery, avoiding damage to healthy anatomical tissue is one of the most important fac-tors for surgical success. Neural damage and the resulting complications can lead to adverse outcomes that permanently affect the patient’s life. The development of methods to protect neural tissue, advanc-es in surgical techniques, examinations performed during surgery, and the use of auxiliary instruments contribute to successful outcomes. The use of intraoperative neuro-monitoring (IONM) in spinal tumor surgeries has been reported to be effective in detecting neurological damage and reducing morbidity. IONM is very important for surgical safety in spinal tumor surgery, deformity surgery, degenerative spinal surgery, and conus medullaris/cauda equina surgery. Behavioral and electrophysiological tests are used to assess the patient neurologically during surgery. Behavioral tests include the wakefulness test and the clonus test; the clonus test is rarely used routinely and is difficult to perform. Electro-physiological tests include somatosensory evoked potentials (SEP), motor evoked potentials (MEP), brainstem auditory evoked potentials (BAEP), visual evoked potentials (VEP), probe local stimulation and measurement of selective muscle responses, and electromyography (EMG) tests.