REVIEW
Objetivo: Analisar criticamente o estado da arte da Monitorização Neurofisiológica Intraoperatória (MNIO), com foco na experiência e nos desafios do cenário brasileiro, sintetizando evidências de eficácia e examinando barreiras de acesso, custos, treinamento e implicações regulatórias. Métodos: Revisão narrativa da literatura, priorizando estudos sobre a realidade brasileira e latino-americana, com análise de regulamentações profissionais, dados de acesso regional, custos e formação de recursos humanos. Resultados: Evidências indicam que a MNIO reduz déficits neurológicos pós-operatórios em 55–68% em cirurgias de alto risco. No Brasil, 72,3% dos cirurgiões de coluna já utilizaram a técnica, porém apenas 29,6% a aplicam rotineiramente. O acesso é concentrado no Sudeste (77% dos relatos de facilidade), enquanto 68,1% dos cirurgiões referem dificuldades. O custo é a principal barreira na América Latina, afetando 57% dos cirurgiões. A Resolução CFM nº 2.383/2024 define a MNIO como ato médico exclusivo, exige presença médica durante todo o procedimento e qualificação específica (RQE) para diretores técnicos. Conclusão: Apesar da eficácia na redução da morbidade neurocirúrgica, a implementação no Brasil enfrenta desigualdades regionais, barreiras econômicas e escassez de profissionais qualificados. São necessárias ações coordenadas: investimento em infraestrutura, expansão da formação, descentralização e análises de custo-efetividade para garantir acesso equitativo.
Objective: To critically analyze the state of the art of Intraoperative Neurophysiological Monitoring (IONM) with specific focus on the Brazilian experience and challenges, synthesizing clinical evidence of efficacy and exploring barriers to access, costs, training availability, and regulatory implications. Methods: review with emphasis on studies about the Brazilian and Latin American reality, including analysis of professional regulations, regional access data, costs, and human resources training. Results: Evidence demonstrates that IONM reduces postoperative neurological deficits by 55-68% in high-risk surgeries. In Brazil, although 72.3% of spine surgeons have used IONM, only 29.6% employ it routinely. Access is highly concentrated in the Southeast Region (77% of cases reporting ease of access), while 68.1% of surgeons report access difficulties. Cost is the main barrier in Latin America, affecting 57% of surgeons. CFM Resolution No. 2,383/2024 defines IONM as an exclusive medical act, requiring medical presence throughout the procedure and specific qualification (RQE) for technical directors. Conclusion: Although effective in reducing neurosurgical morbidity, its implementation in Brazil faces significant regional disparities, economic barriers, and shortage of qualified professionals. Coordinated actions are needed on multiple fronts: investment in infrastructure, expansion of training programs, decentralization policies, and cost-effectiveness analyses to ensure equitable access to the technology.
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1Department of Neurology and Neurosurgery, Hospital São Lucas, Campo Largo, PR, Brazil.
2Faculdade Evangélica Mackenzie do Paraná, Instituto de Pesquisas Medicas, Curitiba, PR, Brazil.
3Hospital São Lucas, Campo Largo, PR, Brazil.
Received Oct 12, 2025
Accepted Nov 2, 2025
