Safety and Efficacy of Intraoperative Neuromonitoring: An Umbrella Review.

Objective: Intraoperative neuromonitoring (IONM) plays a crucial role in several surgical procedures. This study aimed to review the safety and efficacy evidence of IONM technology. Methods: A comprehensive search was conducted in databases, including PubMed, Scopus, Web of Science core collection, Embase, and Cochrane library. Systematic reviews and meta-analyses assessing clinical outcomes, safety, and diagnostic accuracy in patients undergoing neurosurgery with and without IONM were included. Methodological quality was assessed using the JBI tool. The present umbrella review followed the PRISMA guidelines. Results: A total of 48 systematic reviews and meta-analyses were included in this study. The evidence demonstrated that IONM is clinically effective in reducing the risk of temporary recurrent laryngeal nerve paralysis and overall recurrent laryngeal nerve injury after thyroidectomy. Moreover, the use of IONM during aneurysm surgery was associated with fewer neurological complications. In carotid endarterectomy surgery, the combined assessment of electroencephalogram (EEG) and somatosensory-evoked potentials (SSEP) as warning criteria exhibited higher sensitivity compared to EEG or SSEP alone. Notably, bispectral index (BIS)-guided anesthesia did not show a reduction in consciousness risk. In procedures such as spinal, cervical, tumor resection, lumbar surgery, and deformity correction surgeries, IONM techniques demonstrated relative sensitivity in detecting surgery-related nerve damage. Conclusion: Due to the heterogeneity in study types, variable warning thresholds, and limited strong clinical evidence, the efficacy of IONM remains uncertain and necessitates further investigation in this field. Future prospective studies and large-scale randomized controlled trials are necessary to establish a definitive conclusion.