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Konovalov A, Saripov O, Gadzhiagaev V, Titov O, Lasunin N, Zhumabekov A, Fomichev D, Salvovich ES, Kalinin P, Chaurasia B. Optochiasmatic cavernoma: Surgical treatment and outcomes. J Cerebrovasc Endovasc Neurosurg 2023; 25:411-419. [PMID: 37469030 PMCID: PMC10774677 DOI: 10.7461/jcen.2023.e2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 07/21/2023] Open
Abstract
OBJECTIVE Optochiasmatic cavernoma is an extremely rare cerebral lesion. They account for approximately 1% of all cavernomas of the central nervous system. Reports on this pathology are limited. Abrupt visual deterioration is a common symptom of the disease. Treatment strategy and visual outcomes after different treatment approaches remain a subject for discussion. METHODS Patients operated in a period 2005-2021 were analyzed in this study. All patients preoperatively underwent computed tomography (CT) scan, CT-angiography, and magnetic resonance imaging (MRI). Visual function of the patients was assessed pre-op, post-op and at the follow-up. Duration of visual dysfunction was noted as well. Surgical details were also extracted from medical notes. All patients were followed up, and control MRI was performed one month after operation. We assessed surgical series of optochiasmatic cavernomas published for last 10 years. Further comparative analysis with our data was performed. RESULTS Five patients were included into this study. There were four men and one woman. Mean age comprised 33.8 years (range 20-48 years). Most patients were admitted to our hospital due to visual disturbances (80%). Visual function improved in four patients. Visual function was unchanged in one patient, lacking visual disturbancies pre-op. Complication developed in one patient. CONCLUSIONS Optochiasmatic cavernomas are encountered extremely rare. Despite the use of contemporary diagnostic options, differential diagnosis remains challenging. Full diagnostic work-up is mandatory. After the diagnosis is made, surgical treatment should be considered first. Total microsurgical or endoscopic transsphenoidal removal of the optochiasmatic cavernoma is a relatively safe and effective treatment method facilitating improvement of visual function.
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Affiliation(s)
- Anton Konovalov
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation (BNC), Moscow, Russia
| | - Oleg Saripov
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation (BNC), Moscow, Russia
| | - Vadim Gadzhiagaev
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation (BNC), Moscow, Russia
| | - Oleg Titov
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation (BNC), Moscow, Russia
| | - Nikolay Lasunin
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation (BNC), Moscow, Russia
| | - Abzal Zhumabekov
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation (BNC), Moscow, Russia
| | - Dmitry Fomichev
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation (BNC), Moscow, Russia
| | - Eliava Shalva Salvovich
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation (BNC), Moscow, Russia
| | - Pavel Kalinin
- Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation (BNC), Moscow, Russia
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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Baş G, Taşkıran E, Arslan S, Kemerdere R, Tanrıöver N. Intraoperative visual evoked potential and subcortico-cortical evoked potential monitoring in diffuse low-grade glioma surgery: a case report. Acta Neurol Belg 2023; 123:2365-2370. [PMID: 36648703 DOI: 10.1007/s13760-023-02186-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Affiliation(s)
- Gülçin Baş
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey.
| | - Emine Taşkıran
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Serdar Arslan
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
- Department of Radiology, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Rahşan Kemerdere
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Necmettin Tanrıöver
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
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Carrai R, Martinelli C, Baldanzi F, Gabbanini S, Gori B, Masi G, Troiano S, Bonaudo C, Esposito A, Muscas G, Tola S, Caramelli R, Spalletti M, Lolli F, Grippo A, Bucciardini L, Amadori A, Della Puppa A. Feasibility of Intraoperative Visual Evoked Potential Monitoring by Cortical Strip Electrodes in Patients During Brain Surgery: A Preliminary Study. World Neurosurg 2023; 171:175-180.e0. [PMID: 36521757 DOI: 10.1016/j.wneu.2022.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The role of visual evoked potentials (VEPs) monitoring during neurosurgical procedure in patient remains unclear. The purpose of our study was to determine the feasibility of intraoperative VEP recording using a strip cortical electrode during surgical resection of intracranial lesions. METHODS In this prospective, monocentric, observational study, we enrolled consecutive patients undergoing neurosurgical procedure for intracranial lesions. After dural opening, a cortical strip was positioned on the lateral occipital surface. Flash VEPs were continuously recorded using both subdermal corkscrew electrodes and strip electrodes. An electroretinogram was also recorded to guarantee delivery of adequate flash stimuli to the retina. RESULTS We included 10 patients affected by different intracranial lesions. Flash VEPs were recorded using subdermal corkscrew electrodes in all patients except 1 in whom they were never identified during the recording. Flash VEPs were recorded using strip electrodes in all patients and showed a polyphasic morphology with a significantly larger amplitude compared with that of flash VEPs measured using subdermal corkscrew electrodes. No patient reported worsened postoperative vision and a >50% decrease in the VEPs amplitude was never registered. CONCLUSIONS We have reported for the first time in the literature that VEP monitoring during a neurosurgical procedure is feasible via a cortical strip located on the occipital surface. The technique demonstrated greater stability and a larger amplitude compared with recordings with scalp electrodes, facilitating identification of any changes. Studies with more patients are needed to assess the clinical reliability of the technique.
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Affiliation(s)
- Riccardo Carrai
- SODc Neurophysiopathology, Department Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi University Hospital, Florence, Italy.
| | - Cristiana Martinelli
- SODc Neurophysiopathology, Department Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi University Hospital, Florence, Italy
| | - Fabrizio Baldanzi
- SODc Neurophysiopathology, Department Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi University Hospital, Florence, Italy
| | - Simonetta Gabbanini
- SODc Neurophysiopathology, Department Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi University Hospital, Florence, Italy
| | - Benedetta Gori
- SODc Neurophysiopathology, Department Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi University Hospital, Florence, Italy
| | - Giulia Masi
- SODc Neurophysiopathology, Department Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi University Hospital, Florence, Italy
| | - Simone Troiano
- SODc Neurophysiopathology, Department Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi University Hospital, Florence, Italy
| | - Camilla Bonaudo
- Neurosurgery Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health, AOU Careggi University Hospital, Florence, Italy
| | - Alice Esposito
- Neurosurgery Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health, AOU Careggi University Hospital, Florence, Italy
| | - Giovanni Muscas
- Neurosurgery Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health, AOU Careggi University Hospital, Florence, Italy
| | - Serena Tola
- Neurosurgery Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health, AOU Careggi University Hospital, Florence, Italy
| | - Riccardo Caramelli
- SODc Neurophysiopathology, Department Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi University Hospital, Florence, Italy
| | - Maddalena Spalletti
- SODc Neurophysiopathology, Department Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi University Hospital, Florence, Italy
| | - Francesco Lolli
- SODc Neurophysiopathology, Department Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi University Hospital, Florence, Italy
| | - Antonello Grippo
- SODc Neurophysiopathology, Department Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi University Hospital, Florence, Italy
| | - Luca Bucciardini
- Neuro-Anesthesiology and Intensive Care Unit, AOU Careggi University Hospital, Florence, Italy
| | - Andrea Amadori
- Neuro-Anesthesiology and Intensive Care Unit, AOU Careggi University Hospital, Florence, Italy
| | - Alessandro Della Puppa
- Neurosurgery Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health, AOU Careggi University Hospital, Florence, Italy
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Olmsted ZT, Silverstein JW, Einstein EH, Sowulewski J, Nelson P, Boockvar JA, D'Amico RS. Evolution of flash visual evoked potentials to monitor visual pathway integrity during tumor resection: illustrative cases and literature review. Neurosurg Rev 2023; 46:46. [PMID: 36715828 DOI: 10.1007/s10143-023-01955-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 12/21/2022] [Accepted: 01/23/2023] [Indexed: 01/31/2023]
Abstract
Flash visual evoked potentials (fVEPs) provide a means to interrogate visual system functioning intraoperatively during tumor resection in which the optic pathway is at risk for injury. Due to technical limitations, fVEPs have remained underutilized in the armamentarium of intraoperative neurophysiological monitoring (IONM) techniques. Here we review the evolution of fVEPs as an IONM technique with emphasis on the enabling technological and intraoperative improvements. A combined approach with electroretinography (ERG) has enhanced feasibility of fVEP neuromonitoring as a practical application to increase safety and reduce error during tumor resection near the prechiasmal optic pathway. The major advance has been towards differentiating true cases of damage from false findings. We use two illustrative neurosurgical cases in which fVEPs were monitored with and without ERG to discuss limitations and demonstrate how ERG data can clarify false-positive findings in the operating room. Standardization measures have focused on uniformity of photostimulation parameters for fVEP recordings between neurosurgical groups.
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Affiliation(s)
- Zachary T Olmsted
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, New York, NY, USA.
| | - Justin W Silverstein
- Department of Neurology, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, New York, NY, USA
- Neuro Protective Solutions, New York, NY, USA
| | - Evan H Einstein
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, New York, NY, USA
| | | | - Priscilla Nelson
- Department of Anesthesiology, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, New York, NY, USA
| | - John A Boockvar
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, New York, NY, USA
| | - Randy S D'Amico
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, New York, NY, USA
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Boëx C, Goga C, Bérard N, Al Awadhi A, Bartoli A, Meling T, Bijlenga P, Schaller K. Intraoperative subcortico-cortical evoked potentials of the visual pathway under general anesthesia. Clin Neurophysiol 2021; 132:1381-1388. [PMID: 34023622 DOI: 10.1016/j.clinph.2021.02.399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess whether intraoperative subcortical mapping of the visual pathways during brain surgeries was feasible. METHODS Subcortico-cortical evoked potentials (SCEPs: 30 stimulations/site, biphasic single pulse, 1.3 Hz, 0.2 ms/phase, maximum 10 mA; bipolar probe) were measured in 12 patients for stimulation of the optic radiation, Meyer's loop or optic nerve. Recorded sites were bilateral central, parietal, parieto-occipital, occipital (subdermal scalp electrodes, 5-4000 Hz). The minimum distances from the stimulation locations, i.e. the closest border of the resection cavity to the diffusion tensor imaging based visual pathways, were evaluated postoperatively (smallest distance across coronal, sagittal and axial planes). RESULTS Stimulation elicited SCEPs when the visual tracts were close (≤4.5 mm). The responses consisted of a short (P1, 3.0-5.6 ms; 8/8 patients) and of a middle (P2, 15-21.6 ms; 3/8 patients) latency waveforms. In agreement with the neuroanatomy, ipsilateral occipital responses were obtained for temporal or parietal stimulations, and bi-occipital responses for optic nerve stimulations. CONCLUSIONS For the first time to our knowledge, intraoperative SCEPs were observed for stimulations of the optic radiation and of Meyer's loop. Short latency responses were found in agreement with fast conduction of the visual pathway's connecting myelinated fibers. SIGNIFICANCE The mapping of the visual pathways was found feasible for neurosurgeries under general anesthesia.
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Affiliation(s)
- Colette Boëx
- Department of Neurology, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Cristina Goga
- Departement of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia Bérard
- Department of Neurology, Geneva University Hospitals, Geneva, Switzerland
| | - Abdullah Al Awadhi
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Departement of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Andrea Bartoli
- Departement of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Torstein Meling
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Departement of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Bijlenga
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Departement of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Karl Schaller
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Departement of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
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Levin EA, Kiselev RS, Vasyatkina AG, Semin PA. Electrophysiological reactions to intraoperative irritation of the optic nerve. Case report and review of possible mechanisms. Neurochirurgie 2021; 68:223-227. [PMID: 33845114 DOI: 10.1016/j.neuchi.2021.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/25/2021] [Accepted: 03/06/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intraoperative control of optic nerve function conservation during neurosurgical operations currently relies mainly on visual evoked potential monitoring. Unfortunately, this detects peril only when the visual pathways are already compromised, sometimes irreversibly. In contrast, electrophysiological stimulation mapping of the nerves can be a fully preventive measure. However, direct sensory nerve mapping requires the patient to be awake during surgery, which is unfeasible for surgeries targeting the optic nerve area. Another possible approach to sensory nerve mapping involves unconditioned electrophysiological responses evoked by sensory nerve stimulation. The key point for this approach is the possibility of obtaining such responses for a particular sensory nerve under surgical anesthesia. CASE REPORT A 52-year-old woman presented with meningioma in the area of right optic nerve and chiasm. She underwent microsurgical removal of the tumor through the transciliary supraorbital approach. During surgery, electrodes at the inferior margin of the right orbit repeatedly recorded electrophysiological reactions following contacts and displacements of the right optic nerve by the surgical instruments. CONCLUSIONS The observed reactions suggest that either the unconditioned blink reflex or antidromic electroretinographic response to optic nerve irritation was conserved under total intravenous anesthesia. This observation might be of value for development of intraoperative optic nerve mapping. This in turn could increase patient safety by identifying the exact optic nerve location before any negative impact on it.
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Affiliation(s)
- E A Levin
- Department of Angioneurology and Neurosurgery, Meshalkin National Medical Research Centre, Rechkunovskaya street, 15, 630055 Novosibirsk, Russian Federation.
| | - R S Kiselev
- Department of Angioneurology and Neurosurgery, Meshalkin National Medical Research Centre, Rechkunovskaya street, 15, 630055 Novosibirsk, Russian Federation; Department of Neurosurgery, Meshalkin National Medical Research Centre, Rechkunovskaya street, 15, 630055 Novosibirsk, Russian Federation.
| | - A G Vasyatkina
- Department of Neurosurgery, Meshalkin National Medical Research Centre, Rechkunovskaya street, 15, 630055 Novosibirsk, Russian Federation.
| | - P A Semin
- Department of Neurosurgery, Meshalkin National Medical Research Centre, Rechkunovskaya street, 15, 630055 Novosibirsk, Russian Federation.
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Metwali H, Kniese K, Fahlbusch R. Intraoperative Monitoring of the Integrity of the Anterior Visual Pathways: A Methodologic Review and Meta-Analysis. World Neurosurg 2018; 110:217-225. [DOI: 10.1016/j.wneu.2017.11.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/05/2017] [Accepted: 11/07/2017] [Indexed: 12/25/2022]
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Huberfeld G, Trébuchon A, Capelle L, Badier JM, Chen S, Lefaucheur JP, Gavaret M. Preoperative and intraoperative neurophysiological investigations for surgical resections in functional areas. Neurochirurgie 2017; 63:142-149. [DOI: 10.1016/j.neuchi.2016.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 10/17/2016] [Accepted: 10/31/2016] [Indexed: 01/23/2023]
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Neurophysiological intraoperative monitoring during an optic nerve schwannoma removal. J Clin Monit Comput 2016; 31:1059-1064. [PMID: 27586244 DOI: 10.1007/s10877-016-9932-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/30/2016] [Indexed: 10/21/2022]
Abstract
This paper reports the case of a patient with optic nerve schwannoma and the first use of neurophysiological intraoperative monitoring of visual evoked potentials during the removal of such tumor with no postoperative visual damage. Schwannomas are benign neoplasms of the peripheral nervous system arising from the neural crest-derived Schwann cells, these tumors are rarely located in the optic nerve and the treatment consists on surgical removal leading to high risk of damage to the visual pathway. Case report of a thirty-year-old woman with an optic nerve schwannoma. The patient underwent surgery for tumor removal on the left optic nerve through a left orbitozygomatic approach with intraoperative monitoring of left II and III cranial nerves. We used Nicolet Endeavour CR IOM (Carefusion, Middleton WI, USA) to performed visual evoked potentials stimulating binocularly with LED flash goggles with the patient´s eyes closed and direct epidural optic nerve stimulation delivering rostral to the tumor a rectangular current pulse. At follow up examinations 7 months later, the left eye visual acuity was 20/60; Ishihara score was 8/8 in both eyes; the right eye photomotor reflex was normal and left eye was mydriatic and arreflectic; optokinetic reflex and ocular conjugate movements were normal. In this case, the epidural direct electrical stimulation of optic nerve provided stable waveforms during optic nerve schwannoma resection without visual loss.
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Implantable neurotechnologies: electrical stimulation and applications. Med Biol Eng Comput 2016; 54:63-76. [PMID: 26753775 DOI: 10.1007/s11517-015-1442-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/14/2015] [Indexed: 12/23/2022]
Abstract
Neural stimulation using injected electrical charge is widely used both in functional therapies and as an experimental tool for neuroscience applications. Electrical pulses can induce excitation of targeted neural pathways that aid in the treatment of neural disorders or dysfunction of the central and peripheral nervous system. In this review, we summarize the recent trends in the field of electrical stimulation for therapeutic interventions of nervous system disorders, such as for the restoration of brain, eye, ear, spinal cord, nerve and muscle function. Neural prosthetic applications are discussed, and functional electrical stimulation parameters for treating such disorders are reviewed. Important considerations for implantable packaging and enhancing device reliability are also discussed. Neural stimulators are expected to play a profound role in implantable neural devices that treat disorders and help restore functions in injured or disabled nervous system.
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Shin M, Kondo K, Hanakita S, Suzukawa K, Kin T, Shojima M, Nakagawa D, Saito N. Endoscopic transnasal approach for resection of locally aggressive tumors in the orbit. J Neurosurg 2015; 123:748-59. [PMID: 26052982 DOI: 10.3171/2014.11.jns141921] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECT In recent years, application of endoscopic transnasal surgery (ETS) has been expanded to orbital lesions, and preliminary results have started to be published for medially located soft mass lesions. However, reports on experience with endoscopic intraorbital surgery aimed at resection of invasive skull base tumors remains quite limited. This report presents the authors' experience with ETS for locally aggressive tumors involving the orbit. METHODS ETS was performed for 15 cases of aggressive tumors involving the orbit: 5 meningiomas (meningothelial, n = 3; atypical, n = 1; anaplastic, n = 1), 4 chordomas, 2 chondrosarcomas, and 4 others (metastasis from systemic myxofibrosarcoma, schwannoma, inverted papilloma, and acinic cell carcinoma, n = 1 each). Among these, 9 tumors were located outside the periorbita and 6 inside the periorbita. In 6 intraperiosteal tumors, 5 were intraconal lesions, of which 3 arose in the muscle cone (anaplastic meningioma, optic sheath meningioma, and metastatic myxofibrosarcoma), and 2 meningothelial meningioma had invaded from the sphenoid ridge or the cavernous sinus into the muscle cone through the optic canal and the superior orbital fissure. A case of schwannoma originated around the cavernous sinus and pterygopalatine fossa and extended extraconally into the periorbita. Intraoperatively, ethmoid air cells and the lamina papyracea were removed, and extraperiosteal tumors were safely approached. For intraperiosteal tumors, the periorbita was widely opened, and the tumors were approached through the surgical window between the rectus and oblique muscles. RESULTS Gross-total resection was achieved for 12 of the 15 tumors, including 2 intraconal lesions. After surgery, exophthalmos resolved in all 8 patients with this symptom, and diplopia resolved in 5 of 6 patients. Improvement of visual symptoms was reported by 4 of 5 patients with loss of visual acuity or constriction of the visual field. Postoperatively, 1 patient showed mild, transient worsening of existing facial dysesthesia, and another showed transient ptosis and mild hypesthesia of the forehead on the affected side. All those symptoms resolved within 3 months. No patients showed enophthalmos, worsening of diplopia or visual function, or impairment of olfaction after surgery. CONCLUSIONS ETS appears acceptable as a less-invasive alternative for treating aggressive tumors involving the orbit. For extraperiosteal tumors, gross-total removal can generally be achieved without neurological complications. For intraperiosteal tumors, surgical indications should be carefully discussed, considering the relationship between the tumor and normal anatomy. Wide opening of the periorbital window is advocated to create a sufficient surgical pathway between the extraocular muscles, allowing a balance between functional preservation and successful tumor resection.
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Affiliation(s)
| | - Kenji Kondo
- Otolaryngology, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Keigo Suzukawa
- Otolaryngology, The University of Tokyo Hospital, Tokyo, Japan
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Cortical potentials after electrical intraneural stimulation of the optic nerve during orbital enucleation. Doc Ophthalmol 2012; 125:195-202. [PMID: 22890849 DOI: 10.1007/s10633-012-9346-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 07/22/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of this study was to present cortical potentials after electrical intraneural stimulation of the optic nerve during orbital enucleation due to malignant melanoma of the choroid or the ciliary body. These cortical potentials were related to cortical potentials after electrical epidural stimulation of the optic nerve, recorded during non-manipulative phases of neurosurgery for central skull base tumors. METHODS Cortical potentials were recorded with surface occipital electrode (Oz) in six patients undergoing orbital enucleation under total intravenous anesthesia. Two thin needle stimulating electrodes were inserted inside the intraorbital part of the optic nerve. The electrical stimulus consisted of a rectangular current pulse of varying intensity (0.2-10.0 mA) and duration (0.1-0.3 ms); the stimulation rate was 2 Hz; the bandpass filter was 1-1,000 Hz; the analysis time was 50-300 ms. RESULTS Cortical potentials could not be obtained or were inconsistently elicitable in three patients with longstanding history (>3 months) of severe visual deterioration, while they consisted of several positive and negative deflections in a patient with a short history of mild visual impairment. In two other patients, cortical potentials consisted of N20, P30 and N40 waves. DISCUSSION Cortical potentials after electrical intraneural stimulation of the optic nerve could be recorded in patients with a short history of visual deterioration and without optic nerve atrophy and appear more heterogeneous than cortical potentials after electrical epidural stimulation of the optic nerve, recorded during non-manipulative phases of neurosurgery for central skull base tumors.
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