The Utility of Intraoperative Neuromonitoring in Pediatric Surgical Oncology

Barrie S. Rich*, Erin G. Brown, David H. Rothstein, Reto M. Baertschiger, G. Adam Jackson, Jonathan P. Roach, Bindi Naik-Mathuria, Elisabeth T. Tracy, Peter Mattei, Richard D. Glick, Peter F. Ehrlich, Jennifer H. Aldrink, David Rodeberg, Timothy B. Lautz

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Background: Intraoperative nerve monitoring (IONM) is a technique used to decrease the possibility of nerve-associated morbidity and damage to nearby neural structures during complex surgical procedures. The use and potential benefits of IONM in pediatric surgical oncology are not well-described. Methods: An overview of the current literature was performed to elucidate the various techniques that may be useful to pediatric surgeons for resection of solid tumors in children. Results: The physiology and common types of IONM relevant to the pediatric surgeon are described. Important anesthetic considerations are reviewed. Specific applications for IONM that may be useful in pediatric surgical oncology are then summarized, including its use for monitoring the recurrent laryngeal nerve, the facial nerve, the brachial plexus, spinal nerves, and lower extremity nerves. Troubleshooting techniques regarding common pitfalls are then proposed. Conclusion: IONM is a technique that may be beneficial in pediatric surgical oncology to minimize nerve injury during extensive tumor resections. This review aimed to elucidate the various techniques available. IONM should be considered as an adjunct for the safe resection of solid tumors in children in the proper setting with the appropriate level of expertise. A multidisciplinary approach is advised. Additional studies are necessary to further clarify the optimal use and outcomes in this patient population. Levels of Evidence: Level III.

Original languageEnglish (US)
Pages (from-to)1708-1714
Number of pages7
JournalJournal of pediatric surgery
Issue number9
StatePublished - Sep 2023


  • IONM
  • Intraoperative nerve monitoring
  • Pediatric surgical oncology

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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