The goal of intraoperative neuromonitoring (IONM) in the surgical resection of intramedullary spinal cord tumors (ISCTs) is to facilitate maximum tumor resection while minimizing iatrogenic neurological deficits. Multiple intraoperative neural mapping and monitoring modalities have been developed to improve the precision and safety of this challenging operation that is associated with the risk of severe postoperative neurological complications. Neurophysiological monitoring methods have vastly improved the intraoperative information available to surgeons, providing them with a continuous functional assessment of the motor system throughout the surgical resection. There is a growing body of publications suggesting that motor pathway monitoring, utilizing a combination of muscle motor evoked potentials (mMEPs) in conjunction with D wave monitoring, is useful in guiding the surgeon on the extent of their surgical resection and accurate in predicting short and long-term postoperative motor function outcomes. Although IMSCTs are rare and recording D waves from the spinal cord is relatively uncommon, studying these neurophysiological methods offers great insight into the physiology of the motor system and the basic mechanisms involved in the generation of transcranial motor evoked potentials, which are commonly used in many different types of surgeries.