The Role of Intraoperative Neurophysiologic Monitoring in Asleep AVM Resection: Indication or Redundancy?

Intraoperative neurophysiologic monitoring plays a critical role in the safe resection of high-grade or eloquently located AVMs. Although its routine use in low-grade lesions remains debatable, intraoperative neurophysiologic monitoring offers significant intraoperative value by helping surgeons recognize functional limits in real time. In select cases, it enables a strategic shift toward subtotal resection with planned adjuvant radiosurgery, reducing the risk of permanent neurologic deficits.