Evaluating the Diagnostic Benefit of Adding Somatosensory Evoked Potentials to Transcranial Motor-Evoked Potentials Compared to Either Modality Alone in Intramedullary Spinal Cord Tumor Resection: A Systematic Review and Meta-Analysis.

OBJECTIVE

Evaluate the diagnostic accuracy of somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (TcMEPs) in detecting overall neurological deficits when used individually, their pathway-specific accuracy (TcMEPs for motor deficits, SSEPs for sensory deficits), their complementary roles when combined in multimodal intraoperative neurophysiological monitoring (IONM), including cross-modality detection, during intramedullary spinal cord tumor resection.

METHODS

A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies guidelines. PubMed, MEDLINE, Embase, and the Cochrane Library were searched through March 20, 2025. Diagnostic accuracy measures (sensitivity, specificity, and log diagnostic odds ratio) were extracted from 2 × 2 contingency tables. Pooled estimates were calculated using bivariate random-effects models. Comparative analyses between modalities were performed using Z-tests.

RESULTS

We included 29 studies with 1537 cases monitored by IONM, of which 497 (32.3%) experienced postoperative neurological deficits. Multimodal IONM surpassed single modalities in all comparisons with statistical significance, showing superior sensitivity (83.9%, 95% confidence interval: 76.8-89.2) while maintaining high specificity (84.2 95% confidence interval: 66.3-92.3). It demonstrated the lowest negative likelihood ratio (0.29), and strong discriminative performance (log diagnostic odds ratio 3.648, area under the curve 86.6%). Heterogeneity (I2) varied from 0% to 55.6% across modalities.

CONCLUSIONS

Multimodal IONM combining SSEP and TcMEP provides superior diagnostic accuracy compared to TcMEP or SSEP monitoring alone during intramedullary spinal cord tumor resection. Its enhanced ability to detect postoperative neurological deficits supports its routine use as the optimal intraoperative monitoring approach.