Recording compound action potentials from the optic nerve in man and monkeys

Cortical and subcortical intraoperative-monitoring of the visual pathway under general anesthesia in epilepsy surgery

OBJECTIVE

The purpose of this study was to evaluate the applicability of visual evoked potentials (VEP) for intraoperative visual pathway monitoring in epilepsy surgery of the posterior hemispheric quadrant (PHQ) and to correlate it with post-operative visual field status.

METHODS

VEP monitoring was performed in 16 patients (12 females, 7 children). Flash-induced VEP were recorded with strip electrodes from the banks of the calcarine cortex. Latency and amplitude of the first component of VEP (V1-lat, V1-amp) were monitored. Evaluation of the visual field was performed pre- and post-operatively in all patients.

RESULTS

All procedures were successfully completed without adverse events. In 10 patients the strip covered both the inferior and superior calcarine banks, while only one bank was sampled in 6 cases (inferior in 4, superior in 2). Considering one of the two calcarine banks, at the end of the resection VEP had disappeared in 4 patients, whereas a decrease >33.3% in 4 and <20% of V1-amp was recorded in 5 and in 4 cases respectively. The percentage of V1-amp reduction was significantly higher for the patients who experienced a post-operative visual field reduction (p < 0.001). Post-operative visual field deficits were found in patients presenting a reduction >33.3% of V1-amp.

CONCLUSIONS

VEP monitoring is possible and safe in epilepsy surgery under general anesthesia.

SIGNIFICANCE

Intraoperative recording of VEP from the banks of the calcarine cortex allows monitoring the integrity of post-geniculate visual pathways during PHQ resections for epilepsy and it is pivotal to prevent disabling visual field defects, including hemianopia and inferior quadrantanopia.

Intraoperative subcortico-cortical evoked potentials of the visual pathway under general anesthesia

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.

Electrical activity of sensory pathways in female and male geriatric Rhesus monkeys (Macaca mulatta), and its relation to oxidative stress

Synapses loss during aging has been related to decreased neuronal excitability and reduced electrophysiological activity in the nervous system, as well as to increased brain damage. Those physiological and biochemical alterations have been related to the oxidative stress increase associated with old age. The main substrate of lipid peroxidation (LPX) in the central and peripheral nervous systems are the myelin sheaths, and their damage generates a delayed nerve conduction velocity. However, studies in which the neural conduction velocity is related to changes in the redox state are still lacking. Therefore, our aim was to correlate the sensory neural pathways delay in healthy geriatric Rhesus monkeys (Macaca mulatta) with the oxidative stress associated with physiological aging. Twenty-four monkeys were divided into four groups according to age and gender. Auditory, visual, and somatosensory evoked potentials were obtained. Superoxide dismutase, catalase, and glutathione peroxidase enzymatic activity, as well as LPX, were determined from blood samples. Our results showed significant differences between the older and younger age groups in all neural generators of the different sensory pathways evaluated, along with an increase in LPX and the antioxidant enzymatic activities. It suggests that, even though the enzymatic activity was found to be higher in older monkeys, probably as a compensatory effect, it was not enough to avoid LPX damage and the declined electric activity associated with age.

Cortical potentials after electrical intraneural stimulation of the optic nerve during orbital enucleation

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.

Intraoperative monitoring of the visual function using cortical potentials after electrical epidural stimulation of the optic nerve

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.

Direct epidural electrical stimulation of the optic nerve: a new method for intraoperative assessment of function

Intraoperative visual system monitoring of lesions with a close relationship to the optic apparatus by using light flashes reportedly is difficult to perform, and the results are too unreliable to interpret. The authors used direct epidural electrical stimulation of the optic nerve (ON) during surgery instead of light flashes.

Four patients were included in this feasibility study. In 3 patients—1 each harboring a planum sphenoidale meningioma, a tuberculum sellae meningioma, and an intraorbital ON sheath meningioma—2 stimulating needle electrodes were placed on each side of the ON just anterior to the optic canal, before unroofing the optic canal and an extradural anterior clinoidectomy. In the fourth patient, who harbored a frontotemporal astrocytoma, stimulation was applied at the exit of the ON from the canal. The electrically induced visual evoked potentials (eVEPs) were recorded from the scalp before, during, and after tumor removal.

A typical eVEP consisted of N20 and N40 waves. The amplitude of the N40 wave varied up to 25% prior to tumor removal. In the patient with a symptomatic tuberculum sellae meningioma, the decompressive effect of opening the optic canal and the impact of manipulation during piecemeal tumor removal were detected by the eVEPs. In the patient with an ON sheath meningioma and light sensation, only the N20 wave was observed.

Epidural electrical stimulation of the ON is a safe means of providing a stable signal and real-time information on nerve conduction during surgery. It may be a useful adjunct in improving visual outcomes postoperatively. Further clinical studies are necessary.

Temporal distribution of the ganglion cell volleys in the normal rat optic nerve

We describe experiments on behaving rats with electrodes implanted on the cornea, in the optic chiasm, and on the visual cortex; in addition, two red light-emitting diodes (LED) are permanently attached to the skull over the left eye. Recordings timelocked to the LED flashes reveal both the local events at each electrode site and the orderly transfer of visual information from retina to cortex. The major finding is that every stimulus, regardless of its luminance, duration, or the state of retinal light adaptation, elicits an optic nerve volley with a latency of about 10 ms and a duration of about 300 ms. This phenomenon has not been reported previously, so far as we are aware. We conclude that the retina, which originates from the forebrain of the developing embryo, behaves like a typical brain structure: it translates, within a few hundred milliseconds, the chemical information in each pattern of bleached photoreceptors into a corresponding pattern of ganglion cell neuronal information that leaves via the optic nerve. The attributes of each rat ganglion cell appear to include whether the retinal neuropile calls on it to leave after a stimulus and, if so when, within a 300-ms poststimulus epoch. The resulting retinal analysis of the scene, on arrival at the cortical level, is presumed to participate importantly in the creation of visual perceptual experiences.

Short latency visual evoked potentials in occupational exposure to organic solvents

OBJECTIVES

Short latency visual evoked potentials (SVEP), in response to high-intensity flashes from light emitting diodes (LED), were used to detect subclinical effects along the visual pathway in four groups of subjects with different levels of exposure to gasoline, all within legally acceptable limits.

METHODS

Potentials and exposure levels were obtained from 31 subjects with different occupational exposure levels to gasoline fumes, as well as from 17 non-exposed control subjects. SVEP were recorded from four electrode sites (infra-orbital, Cz, Pz, Oz), in response to flashes presented to each eye in turn from goggle-mounted LEDs. SVEP components were defined after digital filtering, which eliminated the high-frequency oscillatory potentials and accentuated five major components: a periocular P30, attributed to the retina; a fronto-central N50, attributed to the optic nerve; centro-parietal P65 and N85, attributed to the optic tracts and radiation; and an occipital, cortical P105.

RESULTS

The latencies of successive SVEP components of the exposed subjects showed a significant latency prolongation compared to controls, beginning with activity attributed to the optic nerve and increasing cumulatively with the later components. Retinal components were not affected by the exposure to organic solvents. Among the exposed groups, differences in latency prolongation corresponded to occupational exposure.

CONCLUSION

The low-frequency components of SVEP were reliably measured and proved to be sensitive to subclinical effects of organic solvents on conduction along the visual pathway. These components are likely to be sensitive to other subcortical visual pathway lesions, but their clinical promise needs further verification.

Visual evoked oscillatory responses of the human optic tract

Optic tract oscillatory responses directly recorded during posteroventral pallidotomy were investigated to reveal their features with respect to extracranially recorded visual oscillations and to clarify their contributions to scalp-recorded or far-field visual evoked potentials. Oscillatory responses of the optic tract consisting of early and subsequent late oscillations were recorded in all patients. Early oscillations consist of five negative and positive peaks, and late oscillations consist of two to four negative and positive peaks. The frequency of the first peak of early oscillations (103.0+/-9.2 Hz, n = 14) was significantly lower than that of others (t test, P<0.006), but there were no significant differences among other peaks (t test, P>0.4). This difference was not observed among peaks of late oscillations (t test, P>0.3). As a whole, the frequency of early oscillations (123.9+/-16.7 Hz, n = 70) was significantly higher than that of late oscillations (66.3+/-13.7 Hz, n = 41) (t test, P = 0.0001). Intracerebral recording of the optic responses with the same band filter of scalp-recorded visual evoked potentials (10 Hz to 1 KHz) showed prominent negative (No) and positive (Po) waves, whereas responses obtained over the scalp at Oz and Cz consisted of negative (NI), positive (PI), negative (NII), and positive (PII) waves. Comparisons between No and PI and Po and NII showed overall phase reversal relations between them, but there were significantly different peak latencies between them (t test, P<0.001) except that between Po (116.7+/-11.7 msec, n = 5) and NII of Cz recording (118.4+/-9.4 msec, n = 5) (t test, P<0.3). Our study in conjunction with other studies on visual oscillations revealed that a relatively constant frequency of oscillations is traveling in the subcortical visual system and is probably playing an important role in generating stationary or fixed peaks of the far-field potentials of visual evoked potentials.

The relationship between the putative optic pathway potential and the electroretinogram

The putative optic pathway flash visual evoked potential (FVEP) and the electroretinogram (ERG) were recorded consecutively in the lightly anesthetised rat. The purpose was to test the hypothesis that the optic pathway FVEP is only an artifact created by distorted volume-conducted retinal activity. A comparison of the timing of the ERG with that of the optic pathway FVEP confirmed this suspicion. It is shown that there is a close temporal correspondence between individual subcomponents of the optic pathway potential and those of the ERG (i.e., the a-wave, b-wave, and the oscillatory potentials). In addition, it was found that when ERG currents are recorded far field from the vicinity of the optic nerve or tract, they acquire a triphasic positive-negative-positive waveform, thereby heightening the illusion that the optic pathway FVEP is a genuine compound action potential. It is concluded that experimental findings derived from the recording of the optic pathway FVEP must be treated with caution.

Visual evoked potentials in the vicinity of the optic tract during stereotactic pallidotomy

We recorded visual evoked responses in eight patients with Parkinson's disease, using a depth electrode either at or below the stereotactic target in the ventral part of the globus pallidus internus (GPi), which is located immediately dorsal to the optic tract. Simultaneously, scalp visual evoked potentials (VEPs) were also recorded from a mid-occipital electrode with a mid-frontal reference electrode. A black-and-white checkerboard pattern was phase reversed at 1 Hz; check size was 50 min of arc . Pallidal VEPs to full field stimulation showed an initial positive deflection, with a latency of about 50 ms (P50), followed by a negatively with a mean latency of 80 ms (N80). The mean onset latency of P50 was about 30 ms. P50 and N80 were limited to the ventralmost of the GPi and the ansa lenticularis. Left half field stimulation evoked responses in the right ansa lenticularis region while right half field stimulation did not, and vice versa. These potentials thus seemed to originate posterior to the optic chiasm. The scalp VEPs showed typical triphasic wave forms consisting of N75, P100 and N145. The location of the recording electrode in the ansa lenticularis region did not modify the scalp VEP. These results suggest that P50 and N80 are near-field potentials reflecting the compound action potentials from the optic tract. Therefore, N75 of the scalp VEPs may represent an initial response of the striate cortex but not of the lateral geniculate nucleus.

Short latency visual evoked potentials to flashes from light-emitting diodes

Short latency visual evoked potentials (SVEPs) have been described in response to high-intensity, strobe flashes. High-intensity flashes can now be generated from goggle-mounted light emitting diodes (LEDs) and the SVEPs to such flashes have been shown to be reproducible across subjects, avoiding photic spread to the examination room and acoustical artifacts from the strobe stimulator. In this study, SVEPs from multichannel records are described in terms of normative latencies and amplitudes, as well as scalp distributions, to explore their generators. Potentials were recorded from 10 young male subjects, from 16 scalp locations, in response to flashes from goggle-mounted LEDs. Flashes were presented to each eye in turn, as well as binocularly. The latencies, scalp distributions and intersubject variabilities of the LED evoked SVEPs were similar to those obtained with strobe flashes. SVEP components were divided into 3 groups, according to their latency and the electrodes at which they were recorded with the largest amplitudes: periocular (under 40 msec latency), fronto-central (40-55 msec) and parieto-occipital (55-80 msec latency). The scalp distributions observed in this study suggest subcortical generators along the visual pathway, beginning at the retina. The use of goggle-mounted LEDs should promote routine evaluation of the integrity of the visual pathway between retina and cortex using SVEPs.

Oscillatory potentials of visual evoked potentials using source derivation technique in rabbits

The topographic distribution of epidurally recorded flashed visual evoked potentials (VEPs) in unanesthetized rabbits was studied using 2 montages. VEPs with linked ears reference and source derivation were compared. With the linked-ears reference, N34 of VEPs which consisted of slow potentials and superimposed oscillations were recorded diffusely over the head. When source derivation was used, the slow negative potentials of N34 present on the recordings in P3 and P4 were not obtained in F3, Fz and F4. In a digital filtering study of the oscillatory potentials, N34 in oscillatory potentials which were recorded diffusely over the head were localized to the visual cortex by source derivation. It was concluded that N34 in the oscillatory potentials generated from the visual cortex are enhanced and localized with source derivation.

Topographic analysis of visual evoked potentials from flash and pattern reversal stimuli: evidence for "travelling waves"

In this mapping study of the entire scalp area, the responses to flash (FL) and pattern reversal (PR) stimuli were studied in 34 normal subjects. The N70, P100, N135 and P180 were similar from both stimuli but with some differences in amplitude and latency, especially the variability of the latency of P100 from FL. A polarity inversion was usually seen for all components, especially at opposite ends of the scalp and a zero-potential was noted for all four components near Cz Pz. Evidence is seen that the frontal N100 is likely not the other end of a dipole involving the posterior P100. Lateral components as P120, N150 and N200 were also described. The major finding was evidence of "travelling" waves that appear to move in both the AP and PA directions throughout the scalp that eventually arrive on the posterior regions and appear as N70, P100, N135 and P180.