1
|
Zauli FM, Revay M, Terzaghi M, Solbiati M, Cassani CM, Cossu M, d'Orio P, Castana L, Cardinale F, Mikulan E, Sartori I. Cortical and subcortical intraoperative-monitoring of the visual pathway under general anesthesia in epilepsy surgery. Clin Neurophysiol 2024; 166:96-107. [PMID: 39142121 DOI: 10.1016/j.clinph.2024.07.011] [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: 12/06/2023] [Revised: 06/05/2024] [Accepted: 07/20/2024] [Indexed: 08/16/2024]
Abstract
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.
Collapse
Affiliation(s)
- Flavia Maria Zauli
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy; Department of Philosophy "P. Martinetti", Università degli Studi di Milano, Milan, Italy; ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy
| | - Martina Revay
- ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy; Department of Medicine, Università di Parma, Parma, Italy.
| | - Michele Terzaghi
- Sleep Medicine Centre, IRCCS Mondino Foundation, Via Mondino, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Michela Solbiati
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy; ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Chiara Maria Cassani
- ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy; Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Parma, Italy; Department of School of Advanced Studies, University of Camerino, Italy
| | - Massimo Cossu
- Department of Neurosurgery, Giannina Gaslini Pediatric Hospital, Genoa, Italy
| | - Piergiorgio d'Orio
- ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy; Department of Medicine, Università di Parma, Parma, Italy
| | - Laura Castana
- ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy
| | - Francesco Cardinale
- ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy; Department of Medicine, Università di Parma, Parma, Italy
| | - Ezequiel Mikulan
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy; Department of Health sciences, Università degli Studi di Milano, Milan, Italy
| | - Ivana Sartori
- ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy
| |
Collapse
|
2
|
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
| |
Collapse
|
3
|
Soumpasis C, Díaz-Baamonde A, Ghimire P, Baig Mirza A, Borri M, Jarosz J, Gullan R, Ashkan K, Bhangoo R, Vergani F, Lavrador JP, Mirallave Pescador A. Intraoperative Neuromonitoring of the Visual Pathway in Asleep Neuro-Oncology Surgery. Cancers (Basel) 2023; 15:3943. [PMID: 37568762 PMCID: PMC10416823 DOI: 10.3390/cancers15153943] [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: 06/12/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
Brain tumour surgery in visual eloquent areas poses significant challenges to neurosurgeons and has reported inconsistent results. This is a single-centre prospective cohort study of patients admitted for asleep surgery of intra-axial lesions in visual eloquent areas. Demographic and clinical information, data from tractography and visual evoked potentials (VEPs) monitoring were recorded and correlated with visual outcomes. Thirty-nine patients were included (20 females, 19 males; mean age 52.51 ± 14.08 years). Diffuse intrinsic glioma was noted in 61.54% of patients. There was even distribution between the temporal, occipital and parietal lobes, while 55.26% were right hemispheric lesions. Postoperatively, 74.4% remained stable in terms of visual function, 23.1% deteriorated and 2.6% improved. The tumour infiltration of the optic radiation on tractography was significantly related to the visual field deficit after surgery (p = 0.016). Higher N75 (p = 0.036) and P100 (p = 0.023) amplitudes at closure on direct cortical VEP recordings were associated with no new postoperative visual deficit. A threshold of 40% deterioration of the N75 (p = 0.035) and P100 (p = 0.020) amplitudes correlated with a risk of visual field deterioration. To conclude, direct cortical VEP recordings demonstrated a strong correlation with visual outcomes, contrary to transcranial recordings. Invasion of the optic radiation is related to worse visual field outcomes.
Collapse
Affiliation(s)
- Christos Soumpasis
- Neurosurgical Department, King’s College Hospital Foundation Trust, London SE5 9RS, UK (K.A.)
| | - Alba Díaz-Baamonde
- Department of Neurophysiology, King’s College Hospital Foundation Trust, London SE5 9RS, UK
| | - Prajwal Ghimire
- Neurosurgical Department, King’s College Hospital Foundation Trust, London SE5 9RS, UK (K.A.)
| | - Asfand Baig Mirza
- Neurosurgical Department, King’s College Hospital Foundation Trust, London SE5 9RS, UK (K.A.)
| | - Marco Borri
- Department of Neuroradiology, King’s College Hospital Foundation Trust, London SE5 9RS, UK (J.J.)
| | - Josef Jarosz
- Department of Neuroradiology, King’s College Hospital Foundation Trust, London SE5 9RS, UK (J.J.)
| | - Richard Gullan
- Neurosurgical Department, King’s College Hospital Foundation Trust, London SE5 9RS, UK (K.A.)
| | - Keyoumars Ashkan
- Neurosurgical Department, King’s College Hospital Foundation Trust, London SE5 9RS, UK (K.A.)
| | - Ranjeev Bhangoo
- Neurosurgical Department, King’s College Hospital Foundation Trust, London SE5 9RS, UK (K.A.)
| | - Francesco Vergani
- Neurosurgical Department, King’s College Hospital Foundation Trust, London SE5 9RS, UK (K.A.)
| | - Jose Pedro Lavrador
- Neurosurgical Department, King’s College Hospital Foundation Trust, London SE5 9RS, UK (K.A.)
| | - Ana Mirallave Pescador
- Department of Neurophysiology, King’s College Hospital Foundation Trust, London SE5 9RS, UK
| |
Collapse
|
4
|
Visual mapping for tumor resection: A proof of concept of a new intraoperative task and a systematic review of the literature. World Neurosurg 2022; 164:353-366. [PMID: 35697231 DOI: 10.1016/j.wneu.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/02/2022] [Accepted: 06/02/2022] [Indexed: 11/21/2022]
Abstract
Homonymous hemianopia has been reported after brain tumor resection with a significant impact on quality of life. Nevertheless, no standardized methods exist for intraoperative optical radiations mapping. The purpose of this article is to describe a new intraoperative task for visual mapping and to review the existing literature.
Collapse
|
5
|
From Focused Ultrasound Tumor Ablation to Brain Blood Barrier Opening for High Grade Glioma: A Systematic Review. Cancers (Basel) 2021; 13:cancers13225614. [PMID: 34830769 PMCID: PMC8615744 DOI: 10.3390/cancers13225614] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Focused Ultrasound (FUS) is gaining a therapeutic role in neuro-oncology considering its novelty and non-invasiveness. Multiple pre-clinical studies show the efficacy of FUS mediated ablation and Blood-Brain Barrier (BBB) opening in high-grade glioma (HGG), but there is still poor evidence in humans, mainly aimed towards assessing FUS safety. METHODS With this systematic review our aim is, firstly, to summarize how FUS is proposed for human HGG treatment. Secondly, we focus on future perspectives and new therapeutic options. Using PRISMA 2020 guidelines, we reviewed case series and trials with description of patient characteristics, pre- and post-operative treatments and FUS outcomes. We considered nine case series (five about tumor ablation and four about BBB opening) with FUS-treated HGG patients between 1991 and 2021. RESULTS Sixty-eight patients were considered in total, mostly males (67.6%), with a mean age of 50.5 ± 15.3 years old. Major complication rates were found in the tumor ablation group (26.1%). FUS has been rarely applied for direct tumoral ablation in human HGG patients with controversial results, but at the best of current studies, FUS-mediated BBB opening is showing good results with very low complication rates, paving the way for a new reliable technique to improve local chemotherapy delivery and antitumoral immune response. CONCLUSIONS FUS can become a complementary technique to surgical resection and standard radiochemotherapy in recurrent HGG. Ongoing trials could provide in the near future more data on FUS-mediated BBB opening impact on progression-free survival, overall survival and potential drug-delivery capacities.
Collapse
|