Intraoperative neurophysiological monitoring in pediatric vascular neurosurgery: a review of the literature and institutional case series.

Published literature on IONM in pediatric cerebrovascular surgery is extremely scarce, with only five studies meeting inclusion criteria.

• A scoping review of literature identified only five studies meeting inclusion criteria
• The studies consisted mostly of case reports or small series
• This confirms 'the paucity of literature in this field' of pediatric vascular neurosurgery IONM

Reported IONM experiences in pediatric vascular neurosurgery consistently described the technique as useful for multiple intraoperative functions.

• IONM was described as useful for detecting ischemia
• It assisted in guiding subcortical dissection
• It helped identify safe brainstem or cortical entry zones
• It supported functional preservation during surgery

The institutional case series included 12 pediatric patients with AVM or cavernoma operated with IONM over a 13-year period.

• The series was a retrospective institutional review spanning 13 years
• 8 patients had arteriovenous malformations (AVMs)
• 4 patients had cavernomas
• All cases were operated with intraoperative neurophysiological monitoring

In the institutional AVM cases, IONM enhanced surgical resection safety through multiple specific intraoperative applications.

• IONM guided temporary clipping during AVM surgery
• It facilitated identification of eloquent pathways during nidus dissection
• These applications contributed to enhanced surgical resection safety

In the institutional cavernoma cases, IONM assisted in cortico-subcortical mapping during surgery.

• IONM was used to assist in cortico-subcortical mapping in cavernoma surgery
• This application was noted as a distinct use from those described in AVM surgery
• The technique supported surgical safety in these eloquent-region lesions

IONM is considered a technically feasible adjunct in pediatric vascular neurosurgery that may expand the surgical armamentarium.

• The authors concluded IONM is 'technically feasible and potentially useful' in this population
• The authors stated that 'for these malformations characterized by a high degree of surgical complexity, intraoperative neuromonitoring may further expand the armamentarium available to surgeons'
• The institutional experience supported this conclusion despite the limited published evidence base