Benefits of Intraoperative Neurophysiological Monitoring (IONM) for the Localization, Mapping, and Resection of Tumors in the Fourth Ventricle: A Literature Review
DOI:
https://doi.org/10.5281/zenodo.10207910Abstract
Although uncommon, fourth ventricular tumors are considered a highly complicated and risky diagnosis. The fourth ventricle, which is part of the ventricular system of the brain, is one of the primary providers of cerebrospinal fluid (CSF), which, apart from supplying nutrients to the nervous system, also acts as a cushion-like substance, thus providing crucial neuroprotective properties to the nervous system. In addition to its saliency, the location of the fourth ventricle presents several challenges for medical professionals and surgeons when treating tumors in that region since crucial cortical areas and cranial nerve nuclei neighbor the limits of this ventricular cavity. Intraoperative Neurophysiological Monitoring (IONM) modalities such as Motor Evoked Potentials (MEPs), Somatosensory Evoked Potentials (SSEP), Brainstem Auditory Evoked Potentials (BAEP), and Electromyography (EMG), etc., play a fundamental role in providing the immediate tools and feedback in which the surgical team can rely on and use as a compass to prevent neural damage and significantly reduce the possibility of postoperative deficits.
The goal of this literature review is to investigate the different types of IONM modalities that have been recorded in the available literature to play a substantial role in surgical procedures involving fourth ventricular tumors and emphasize the importance and the protective critical role that using a multimodality IONM protocol could play in this type of surgeries. Furthermore, it discusses the possible causes, symptoms, statistics, and different types of fourth ventricular tumors, as well as the neuroanatomy delineating this crucial ventricular region.
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