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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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Pojda-Wilczek D, Maruszczyk W, Sirek S. Flash visual evoked potentials (FVEP) in various stimulation conditions. Doc Ophthalmol 2018; 138:35-42. [PMID: 30470955 PMCID: PMC6349809 DOI: 10.1007/s10633-018-9663-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 11/06/2018] [Indexed: 11/28/2022]
Abstract
Aim To compare flash visual evoked potentials (FVEP) elicited using a Ganzfeld bowl (G), Mini Ganzfeld (MG) and Flash Goggles (GG) with eyes open and closed. Patients and method The study group comprised 17 volunteers with mean age of 30 years; all of them were examined with the Roland Consult electrophysiological diagnostic system. Active electrodes were placed at O1 and O2. With the G and MG stimulators, the flash generated by white-light-emitting diodes (LEDs) presented standard flash of 3 cd s m−2. The GG used red LED flash of 3 cd s m−2. Stimulus frequency of 1.0 Hz, low-pass filter of 1.0 Hz and high-pass filters of 100 Hz (G); 50 Hz (MG); 30 Hz (GG) were used. P2 amplitude and latency were compared by the means of the Wilcoxon matched-pairs signed-rank test. Results After right eye stimulation (from O1; n = 17), the mean amplitudes of P2, elicited with the G, MG and GG, were 13, 7 and 10 µV, respectively. The respective latencies were 129, 114 and 110 ms. Hence, the difference between the results obtained with these stimulators was statistically significant (p < 0.05). The mean P2 amplitudes, acquired by the means of the G, MG and GG, were 13 µV, 7 µV and 10 µV for open eyes, and 11 µV, 8 µV and 8 µV for closed eyes. The respective latencies were 129, 114 and 110 ms for eyes open, and 127, 125 and 121 ms for eyes closed. These results of the MG (latency only) and GG (latency and amplitude) stimulation differed significantly (p < 0.05). Conclusion The amplitudes and latencies of the FVEP P2 elicited with different stimulators are not suitable for comparison. Closing the eye during the examination had a significant effect on the components of FVEP waveform elicited with the Flash Goggle and on the latency of P2 elicited with the MG.
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Affiliation(s)
- Dorota Pojda-Wilczek
- Ophthalmology Clinic and Department of Ophthalmology, University Clinical Centre, School of Medicine in Katowice, Medical University of Silesia in Katowice, Ceglana 35, 40-514, Katowice, Poland.
| | - Wojciech Maruszczyk
- Ophthalmology Clinic and Department of Ophthalmology, University Clinical Centre, School of Medicine in Katowice, Medical University of Silesia in Katowice, Ceglana 35, 40-514, Katowice, Poland
| | - Sebastian Sirek
- Ophthalmology Clinic and Department of Ophthalmology, University Clinical Centre, School of Medicine in Katowice, Medical University of Silesia in Katowice, Ceglana 35, 40-514, Katowice, Poland
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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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Kamio Y, Sakai N, Sameshima T, Takahashi G, Koizumi S, Sugiyama K, Namba H. Usefulness of intraoperative monitoring of visual evoked potentials in transsphenoidal surgery. Neurol Med Chir (Tokyo) 2014. [PMID: 25070017 PMCID: PMC4533496 DOI: 10.2176/nmc.oa.2014-0023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Postoperative visual outcome is a major concern in transsphenoidal surgery (TSS).
Intraoperative visual evoked potential (VEP) monitoring has been reported to have
little usefulness in predicting postoperative visual outcome. To re-evaluate its
usefulness, we adapted a high-power light-stimulating device with electroretinography
(ERG) to ascertain retinal light stimulation. Intraoperative VEP monitoring was
conducted in TSSs in 33 consecutive patients with sellar and parasellar tumors under
total venous anesthesia. The detectability rates of N75, P100, and N135 were
94.0%, 85.0%, and 79.0%, respectively. The mean latencies and
amplitudes of N75, P100, and N135 were 76.8 ± 6.4 msec and 4.6 ± 1.8
μV, 98.0 ± 8.6 msec and 5.0 ± 3.4 μV, and 122.1
± 16.3 msec and 5.7 ± 2.8 μV, respectively. The amplitude was
defined as the voltage difference from N75 to P100 or P100 to N135. The criterion for
amplitude changes was defined as a > 50% increase or 50%
decrease in amplitude compared to the control level. The surgeon was immediately
alerted when the VEP changed beyond these thresholds, and the surgical manipulations
were stopped until the VEP recovered. Among the 28 cases with evaluable VEP
recordings, the VEP amplitudes were stable in 23 cases and transiently decreased in 4
cases. In these 4 cases, no postoperative vision deterioration was observed. One
patient, whose VEP amplitude decreased without subsequent recovery, developed vision
deterioration. Intraoperative VEP monitoring with ERG to ascertain retinal light
stimulation by the new stimulus device was reliable and feasible in preserving visual
function in patients undergoing TSS.
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Affiliation(s)
- Yoshinobu Kamio
- Department of Neurosurgery, Head and Neck Surgery, Hamamatsu University School of Medicine
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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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Intraoperative monitoring of the visual function using cortical potentials after electrical epidural stimulation of the optic nerve. Acta Neurochir (Wien) 2011; 153:1919-27. [PMID: 21818643 DOI: 10.1007/s00701-011-1098-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 07/19/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Central skull base meningiomas commonly present with visual deficit, and their removal often leads to improvement of visual function. However, the incidence of postoperative visual deterioration has been reported to be up to 10%. Intraoperative monitoring using flash visual evoked potential has only recently been used with success. Cortical potentials (CP) after electrical epidural stimulation of the optic nerve (ON) were correlated with ON manipulation due to central skull base tumor removal to contribute to improvement of the intraoperative monitoring of the visual function. METHODS Blunt needle stimulating electrodes were attached epidurally alongside ON in an unroofed optic canal and used for delivering a rectangular current pulse (intensity 0.2-5.0 mA; duration 0.1-0.3 ms; rate 2 Hz). CPs after electrical epidural stimulation of ON were recorded with corkscrew electrodes at O(z) with the reference electrode at F(z). RESULTS P20 and N30 amplitudes were significantly lower (p < 0.05) during tumor removal associated with ON manipulation than in other phases of surgery; the amplitude reductions were reversible in all cases. There were no significant changes in P20, N30 and P40 latencies during the surgery. Immediate postoperative visual function was unchanged in all patients. CONCLUSIONS P20 and N30 amplitude changes seem to reliably correspond with the manipulation of ON during anterior skull base tumor removal. Reversible reduction of P20 and N30 amplitude was associated with unchanged immediate postoperative visual function. No correlation between intraoperative variation of CP and newly acquired postoperative visual deficit can presently be made.
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