Methods of neurophysiological monitoring during brainstem surgery: advantages, limitations, and future perspectives

Surgical treatment of tumors and micromalformations in the brainstem carries significant risks of aggravating neurological symptoms postsurgery. This is primarily due to the high concentration of critical nerve structures within the brainstem. To enhance safety during these procedures, intraoperative neurophysiological monitoring is employed. Currently, various neurophysiological modalities, including mapping techniques and continuous monitoring methods, are utilized in these neurosurgical interventions. In this review, we discuss the potential applications of intraoperative neurophysiological monitoring during brainstem surgeries, highlight the limitations of these methods, and explore the prospects for the development of intraoperative diagnostic techniques. This work may be useful for clinical neurophysiologists and neurosurgeons who perform surgical treatment of patients with tumors and micromalformations of the brainstem.