Role of Intraoperative Neuromonitoring for Meningomyelocele Repair

Objectives:  To determine the impact of multimodal intraoperative neuromonitoring on post-meningomyelocele repair-neurological outcome in patients receiving meningomyelocele repair. Material and Methods:  This retrospective comparative study included 50 patients who underwent primary meningomyelocele repair. The patients were separated into the IONM group (n= 42) and the non-IONM group (n= 8). In a limited number of cases, multimodal neuromonitoring was used and consisted of the following measurements: somatosensory evoked potentials, motor evoked potentials, electromyography, and the bulbocavernosus reflex measurement. The major resultant effect was the occurrence of new postoperative neurological deficits. The statistical analysis was conducted in SPSS, and p < 0.05 was assumed to be significant. Results:  The proportion of neurological impairments postoperatively was significantly less in the IONM than the non-IONM group (7.1% vs. 37.5, p < 0.01). Intraoperative alerts were witnessed in 21.4 percent of observed cases, and a timely surgical change was made. The lack of IONM had been linked with increased chances of neurological worsening (RR = 5.3). There were no differences in the length of operation and blood loss. Conclusion:  This retrospective cohort of multimodal intraoperative neuromonitoring was linked to a reduced incidence of postoperative neurological loss and can potentially become an effective addition during meningomyelocele repair.