Safety of intraoperative monitoring in pregnant patient: literature review and brainstem case study.

Abstract Objective Intraoperative neuromonitoring (IONM) is used to assess the integrity of neural pathways and aids in optimizing surgical results and avoiding neurologic injury. However, there are few reports of its use and safety in pregnant patients. We will perform a literature review on IONM in pregnancy. In addition to this review, we will report our experience with IONM in a 20-week pregnant patient that presented with a brainstem tumour, which has not been reported before in the literature. Methods An exhaustive search was done in PubMed and Google Scholar for the literature review. We summarise the modalities and parameters across the full range of IONM that was reported to be safely used in pregnant women. Results The search strategy retrieved 121 studies. Duplicates were removed, and after screening by title and abstract, five studies were left, of which four were case reports, and one was a case report and literature review. Three investigated IONM in pregnant patients with brain tumours and two in pregnant patients with spinal cord disease. In all studies, motor evoked potentials (MEPs) were performed, and no neurological deficits or pregnancy issues were encountered after the surgery. Our case presents a patient with a brainstem tumour were IONM was used and no neurological or pregnancy problems were reported. Modalities used were somatosensory evoked potentials, corticobulbar MEPs, transcranial MEPs, blink reflex, laryngeal abductor reflex, free-run electromyography and electroencephalography. Conclusion Our research suggests that IONM can be safely performed in pregnant patients. References Tyagi M, Bir M, Sharma A, Singh PK, Bindra A, Chandra PS. Intraoperative Neuromonitoring for Spinal Surgery in a Pregnant Patient: Case Report and Literature Review. Neurol India. 2022;70(Supplement):S314–7.