Spinal Mapping for Tumor Surgery: An Overview of Relevant Modalities, Clinical Impact, and Future Directions

Sun, 29 Mar 2026 00:00:00 +0300

Intramedullary spinal cord tumor surgery demands precise intraoperative strategies to preserve neurological function while achieving maximal resection. Neurophysiological monitoring and direct spinal cord mapping have emerged as essential tools for guiding surgeons through these complex procedures by providing both functional and anatomical insight. This project examines the complementary contributions of somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), D-waves, electromyography (EMG), train-of-four (TOF) monitoring, and direct cord mapping (DCM) during intramedullary tumor resection. Each modality offers distinct clinical value. SSEPs assess dorsal column sensory pathway integrity and help identify early ischemic or traction-related changes during surgical manipulation. MEPs and D-waves evaluate the functional status of the corticospinal tract and provide rapid detection of motor pathway compromise, with D-waves serving as a strong predictor of long-term postoperative motor outcomes. EMG detects nerve root irritation or mechanical stress, particularly relevant for cauda equina involvement, while TOF monitoring ensures adequate neuromuscular conditions for reliable motor and electromyography responses. DCM enhances anatomical accuracy by identifying the physiological midline and guiding safe myelotomy planning in cases where normal landmarks are distorted. Integration of these modalities creates a comprehensive monitoring framework that combines continuous functional assessment with precise anatomical localization. This multimodal approach allows early recognition of reversible changes, improves communication between surgical and neurophysiological teams, and supports timely intraoperative adjustments to protect critical pathways. The combined use of mapping and monitoring has been associated with improved sensory and motor outcomes by helping surgeons balance the goal of maximal tumor resection with the imperative of neurological preservation. This study highlights that incorporating multiple neurophysiological modalities offers the most robust safety and guidance system for intramedullary spinal cord tumor surgery. The complementary nature of these techniques underscores their importance in modern spinal oncology and supports continued advancement of multimodal intraoperative monitoring practices.

Electroencephalography for Detecting and Predicting Postoperative Delirium: A Systematic Review of Clinical Utility

Audrey Villanueva, Samira Nabizadeh, Deepti Nandakumar, Faisal R Jahangiri — Fri, 20 Mar 2026 00:00:00 +0300

Postoperative delirium (POD) is a major, preventable, neurocognitive complication in geriatric surgical patients, associated with higher complications and prolonged hospitalization. Electroencephalography (EEG) abnormalities, particularly generalized slowing, reduced alpha power, and burst suppression, have long been linked to delirium and may identify brains that are particularly susceptible to POD, or “vulnerable brains”. Recent evidence suggests that intraoperative EEG patterns predict POD risk, while portable and automated EEG systems offer emerging tools for detection and monitoring. This systematic review synthesized findings across the perioperative phases to evaluate the EEG’s role in predicting, diagnosing, and managing POD. Thirty-one studies were analyzed, spanning pre-, intra-, and postoperative EEG applications. Most cohorts included adults aged 60 or older undergoing cardiac, general, orthopedic, or neurovascular procedures. Consistent EEG markers of delirium vulnerability included reduced alpha power and peak frequency, increased delta/theta activity and burst suppression, and decreased spectral edge frequency and entropy. Predictive accuracy ranged from AUC 0.70 to 0.90, with most PODs occurring within 0–48 hours postoperatively. Across studies, EEG signatures: low alpha activity and prolonged burst suppression, preceded clinical symptoms. This supports EEG as an early, objective biomarker of cortical fragility. While single-channel systems improved feasibility, raw and quantitative EEG offered superior sensitivity. Standardized protocols, multicenter validation, and integration with perioperative care systems are needed to translate the EEG-guided monitoring into delirium prevention strategies.

J of Neurophysiological Monitoring

Spinal Mapping for Tumor Surgery: An Overview of Relevant Modalities, Clinical Impact, and Future Directions

Electroencephalography for Detecting and Predicting Postoperative Delirium: A Systematic Review of Clinical Utility