E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Intraoperative Neuromonitoring in Turkey: A National Survey of Neurosurgeons Practices and Attitudes
Emine Taskiran✉ ,
Pinar Yalınay Dikmen ,
Elif Ilgaz Aydinlar ,
Baris Kucukyuruk ,
Kubilay Varli ,
Berrin Aktekin
Neurology, Istanbul University-Cerrahpasa Faculty of Medicine; Neurosurgery, İstanbul Üniversitesi-Cerrahpaşa Cerrahpaşa Tıp Fakültesi
DOI: 10.5137/1019-5149.JTN.49567-25.3
Article in Press
Corresponding Author:
Emine Taskiran (dreminetaskiran@gmail.com)
Abstract
Aim
Intraoperative neuromonitoring (IONM) is increasingly used in neurosurgical practice, yet its implementation and training background remain heterogeneous. This study aimed to provide an overview of current IONM practices and attitudes among neurosurgeons in Turkey.
Material and Methods
This cross-sectional survey was conducted using a 28-item, multiple-choice questionnaire developed by the Turkish Neurological Association IONM Working Group. The survey was distributed electronically to members of the Turkish Neurosurgical Society, and participation was voluntary. A total of 58 neurosurgeons responded (response rate: 3.2%). Descriptive statistics were generated, and subgroup comparisons were performed using chi-square tests.
Results
Overall, 94.8% of respondents reported using IONM, with 63.7% indicating weekly or more frequent use. Neurosurgeons who had IONM exposure during residency reported significantly higher usage rates than those without such experience (78.9% vs 53.1%, p = 0.041). IONM tended to be used more frequently when the primary motivation was the expected clinical benefit rather than medicolegal concerns (65.4% vs 48.4%, p = 0.049). In most institutions (60.3%), IONM services were provided predominantly by external vendors. Real-time interpretation of monitoring data was performed exclusively by technicians in 55.2% of cases, whereas 27.5% of respondents reported the presence of neurologists or neurophysiologists in the operating room. Notably, 43.1% reported being unfamiliar with established alarm criteria, and no association was observed between surgical experience and alarm awareness (p = 0.41). The most common responses to IONM alarms were pausing the procedure and modifying the surgical strategy.
Conclusion
Although IONM is widely implemented in Turkey, current practices remain heterogeneous and frequently rely on technician-based interpretation. Early exposure during residency and perceived clinical benefit appear to support more consistent use. These findings highlight the need for structured, multidisciplinary training pathways and the development of national consensus-based standards for IONM practice.
Intraoperative neuromonitoring (IONM) is increasingly used in neurosurgical practice, yet its implementation and training background remain heterogeneous. This study aimed to provide an overview of current IONM practices and attitudes among neurosurgeons in Turkey.
Material and Methods
This cross-sectional survey was conducted using a 28-item, multiple-choice questionnaire developed by the Turkish Neurological Association IONM Working Group. The survey was distributed electronically to members of the Turkish Neurosurgical Society, and participation was voluntary. A total of 58 neurosurgeons responded (response rate: 3.2%). Descriptive statistics were generated, and subgroup comparisons were performed using chi-square tests.
Results
Overall, 94.8% of respondents reported using IONM, with 63.7% indicating weekly or more frequent use. Neurosurgeons who had IONM exposure during residency reported significantly higher usage rates than those without such experience (78.9% vs 53.1%, p = 0.041). IONM tended to be used more frequently when the primary motivation was the expected clinical benefit rather than medicolegal concerns (65.4% vs 48.4%, p = 0.049). In most institutions (60.3%), IONM services were provided predominantly by external vendors. Real-time interpretation of monitoring data was performed exclusively by technicians in 55.2% of cases, whereas 27.5% of respondents reported the presence of neurologists or neurophysiologists in the operating room. Notably, 43.1% reported being unfamiliar with established alarm criteria, and no association was observed between surgical experience and alarm awareness (p = 0.41). The most common responses to IONM alarms were pausing the procedure and modifying the surgical strategy.
Conclusion
Although IONM is widely implemented in Turkey, current practices remain heterogeneous and frequently rely on technician-based interpretation. Early exposure during residency and perceived clinical benefit appear to support more consistent use. These findings highlight the need for structured, multidisciplinary training pathways and the development of national consensus-based standards for IONM practice.
Keywords
intraoperative neuromonitoring
neurology
clinical neurophysiology
neurosurgery
multidisciplinary practice