Background: Intramedullary spinal cord tumors (IMSCTs) are rare neoplasms whose management has evolved significantly. Microsurgical resection remains the primary treatment, but the integration of advanced technologies and the strategic use of adjuvant therapies are critical for optimizing outcomes. The comparative impact of these modern approaches on long-term results requires ongoing evaluation. Methods: We conducted a retrospective cohort study of 124 adult patients who underwent primary microsurgical resection of an IMSCT at a single tertiary institution between January 2014 and December 2024. Patients were divided into two groups: Group A (n=58), treated before the routine implementation of IONM (January 2014 -June 2022), and Group B (n=66), treated with multimodal IONM (July 2022- December 2024). Primary outcomes were the rate of gross total resection (GTR) and neurological status change, assessed using the McCormick scale. The secondary outcome was 5-year PFS in patients with high-grade astrocytomas or subtotal resections who received adjuvant therapy. Statistical analysis was performed using Chi-square tests and Kaplan-Meier survival analysis.

Intramedullary Spinal Cord Tumor, Intraoperative Neurophysiological Monitoring, Microsurgery, Adjuvant Radiotherapy, Neurological Outcome, Ependymoma, Astrocytoma.