Neuromonitoring during surgery for metastatic tumors to the spine: Intraoperative interpretation and management strategies

Resection of metastatic tumors of the spine poses great technical challenges, with the potential of creating severe neurologic deficits. Several modalities of electrophysiologic monitoring, including SSEPs and MEPs, have evolved to aid in resection of these tumors. This review has presented additional techniquessuch as mapping of the dorsal columns with antidromic-elicited SSEPs to plan the myelotomy and direct intramedullary stimulationthat help to identify the extent of the tumor margin at its interface with functional tracts. Neuromonitoring can potentially minimize the sensory and motor damage that can occur during resection of metastatic tumors of the spine. Further experience with these techniques should allow improved results following surgical procedures in functionally eloquent areas of the spinal cord during the surgical management of metastatic tumors.