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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] [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.
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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
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Ma J, Wang J, Li Y, Fu Y, Li Y, Qiao H, Han R. Effect of desflurane anesthesia on flash visual evoked potential monitoring in patients undergoing spine surgery: study protocol for a randomized controlled trial. Trials 2024; 25:362. [PMID: 38840210 PMCID: PMC11155073 DOI: 10.1186/s13063-024-08211-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Flash visual evoked potentials (FVEPs) are a reliable method for protecting visual function during spine surgery in prone position. However, the popularization and application of FVEPs remain limited due to the unclear influence of various anesthetics on FVEPs. Exploring the effects of anesthetic drugs on FVEP and establishing appropriate anesthesia maintenance methods are particularly important for promoting and applying FVEP. According to the conventional concept, inhaled narcotic drugs significantly affect the success of FVEP monitoring, FVEP extraction, and interpretation. Nonetheless, our previous study demonstrated that sevoflurane-propofol balanced anesthesia was a practicable regimen for FVEPs. Desflurane is widely used in general anesthesia for its rapid recovery properties. As the effect of desflurane on FVEP remains unclear, this trial will investigate the effect of different inhaled concentrations of desflurane anesthesia on amplitude of FVEPs during spine surgery, aiming to identify more feasible anesthesia schemes for the clinical application of FVEP. METHODS/ DESIGN A total of 70 patients undergoing elective spinal surgery will be enrolled in this prospective, randomized controlled, open-label, patient-assessor-blinded, superiority trial and randomly assigned to the low inhaled concentration of desflurane group (LD group) maintained with desflurane-propofolremifentanil-balanced anesthesia or high inhaled concentration of desflurane group (HD group) maintained with desflurane-remifentanil anesthesia maintenance group at a ratio of 1:1. All patients will be monitored for intraoperative FVEPs, and the baseline will be measured half an hour after induction under total intravenous anesthesia (TIVA). After that, patients will receive 0.5 minimum alveolar concentration (MAC) of desflurane combined with propofol and remifentanil for anesthesia maintenance in the LD group, while 0.7-1.0 MAC of desflurane and remifentanil will be maintained in the HD group. The primary outcome is the N75-P100 amplitude 1 h after the induction of anesthesia. We intend to use the dual measure evaluation, dual data entry, and statistical analysis by double trained assessors to ensure the reliability and accuracy of the results. DISCUSSION This randomized controlled trial aims to explore the superiority effect of low inhaled concentration of desflurane combined with propofolremifentanil-balanced anesthesia versus high inhaled concentration of desflurane combined with remifentanil anesthesia on amplitude of FVEPs. The study is meant to be published in a peer-reviewed journal and might guide the anesthetic regimen for FVEPs. The conclusion is expected to provide high-quality evidence for the effect of desflurane on FVEPs and aim to explore more feasible anesthesia schemes for the clinical application of FVEPs and visual function protection. TRIAL REGISTRATION This study was registered on clinicaltrials.gov on July 15, 2022. CLINICALTRIALS gov Identifier: NCT05465330.
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Affiliation(s)
- Jiajia Ma
- Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, PR China
| | - Jing Wang
- Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, PR China
| | - Yun Li
- Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, PR China
| | - Yuxuan Fu
- Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, PR China
| | - Yang Li
- Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, PR China
| | - Hui Qiao
- Department of Electrophysiology, Beijing Neurosurgical Institute, Beijing, 100070, People's Republic of China
| | - Ruquan Han
- Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, PR China.
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Mattogno PP, D'Alessandris QG, Rigante M, Granata G, Di Domenico M, Perotti V, Montano N, Giordano M, Chiloiro S, Doglietto F, Olivi A, Lauretti L. Reliability of intraoperative visual evoked potentials (iVEPs) in monitoring visual function during endoscopic transsphenoidal surgery. Acta Neurochir (Wien) 2023; 165:3421-3429. [PMID: 37733080 PMCID: PMC10624729 DOI: 10.1007/s00701-023-05778-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/23/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To refine a reliable and reproducible intraoperative visual evoked potentials (iVEPs) monitoring protocol during endoscopic transsphenoidal surgery. To assess the reliability of baseline iVEPs in predicting preoperative visual status and perioperative iVEP variation in predicting postoperative visual outcome. METHODS Sixty-four patients harboring tumors of the pituitary region were included. All patients underwent endoscopic endonasal approach (EEA) with iVEPs monitoring, using a totally intravenous anesthetic protocol. Ophthalmological evaluation included visual acuity and visual field studies. RESULTS Preoperatively, visual acuity was reduced in 86% and visual field in 76.5% of cases. Baseline iVEPs amplitude was significantly correlated with preoperative visual acuity and visual field (p = 0.001 and p = 0.0004, respectively), confirming the reliability of the neurophysiological/anesthetic protocol implemented. Importantly, perioperatively the variation in iVEPs amplitude was significantly correlated with the changes in visual acuity (p < 0.0001) and visual field (p = 0.0013). ROC analysis confirmed that iVEPs are an accurate predictor of perioperiative visual acuity improvement, with a 100% positive predictive value in patients with preoperative vision loss. CONCLUSIONS iVEPs during EEA is highly reliable in describing preoperative visual function and can accurately predict postoperative vision improvement. SIGNIFICANCE iVEPs represent a promising resource for carrying out a more effective and safe endoscopic transsphenoidal surgery.
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Affiliation(s)
- Pier Paolo Mattogno
- Institute of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore - Roma, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Quintino Giorgio D'Alessandris
- Institute of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore - Roma, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Mario Rigante
- Department of Otorhinolaryngology, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore - Roma, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Giuseppe Granata
- Department of Neurology, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore - Roma, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Michele Di Domenico
- Institute of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore - Roma, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Valerio Perotti
- Department of Anesthesiology, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore - Roma, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Nicola Montano
- Institute of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore - Roma, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Martina Giordano
- Institute of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore - Roma, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Sabrina Chiloiro
- Pituitary Unit, Department of Endocrinology and Metabolism, Fondazione Policlinico Gemelli IRCCS - Università Cattolica del Sacro Cuore - Roma, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Francesco Doglietto
- Institute of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore - Roma, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore - Roma, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Liverana Lauretti
- Institute of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore - Roma, Largo A. Gemelli 8, 00168, Rome, Italy
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Shah HA, Begley SL, Unadkat P, Kelly Hugo K, Schulder M. Direct-cortical visual evoked potential monitoring during brain tumor resection. J Clin Neurosci 2023; 115:1-7. [PMID: 37454439 DOI: 10.1016/j.jocn.2023.06.014] [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: 02/12/2023] [Revised: 06/05/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Visual evoked potential (VEP) recording is traditionally regarded as an unreliable evoked potential monitoring technique, precluding widespread use in intracranial neurosurgery. However, VEPs can serve as a useful intraoperative adjunct for real-time detection of mechanical damage to optic apparatuses. The low obtainability and prognostic utility of VEPs are associated with transcranial recording, which typically provides non-focal information and poor signal-to-noise ratio. Direct cortical VEP (DC-VEP) recordings may offer a solution. METHODS We evaluated the obtainability of DC-VEPs as well as their prognostic utility in predicting postoperative visual function deterioration in a series of brain tumor patients undergoing craniotomies for tumor resection. Patient records were retrospectively reviewed for all consecutive patients undergoing brain tumor resections with DC-VEP monitoring. Pre- and postoperative visual fields were characterized from patient charts and associated with the presence of intraoperative monitoring alerts to determine the sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of DC-VEPs in detecting postoperative visual field deficits. RESULTS Twenty-two patients (9 male, 13 female) were included, with a median age of 60 years. DC-VEPs were reliably detected in 19 of 23 included surgeries (82.6%). The reported sensitivity, specificity, PPV, and NPV in detecting postoperative visual field deficits was 60%, 92.9%, 75%, and 86.7%, respectively. There was a statistically significant association between monitoring alerts and the presence of visual field deterioration by Fischer's exact test (p = 0.0374). CONCLUSIONS DC-VEPs can be reliably obtained and are useful for detecting mechanical injury to optic areas and tracts during tumor resection.
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Affiliation(s)
- Harshal A Shah
- Department of Neurological Surgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, United States.
| | - Sabrina L Begley
- Department of Neurological Surgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, United States
| | - Prashin Unadkat
- Department of Neurological Surgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, United States; Elmezzi Graduate School of Molecular Medicine, Feinstein Institutes of Medical Research, Manhasset, NY, United States
| | | | - Michael Schulder
- Department of Neurological Surgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, United States
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Zhang H, Xu M, Liu M, Song X, He F, Chen S, Ming D. Biological current source imaging method based on acoustoelectric effect: A systematic review. Front Neurosci 2022; 16:807376. [PMID: 35924223 PMCID: PMC9339687 DOI: 10.3389/fnins.2022.807376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Neuroimaging can help reveal the spatial and temporal diversity of neural activity, which is of utmost importance for understanding the brain. However, conventional non-invasive neuroimaging methods do not have the advantage of high temporal and spatial resolution, which greatly hinders clinical and basic research. The acoustoelectric (AE) effect is a fundamental physical phenomenon based on the change of dielectric conductivity that has recently received much attention in the field of biomedical imaging. Based on the AE effect, a new imaging method for the biological current source has been proposed, combining the advantages of high temporal resolution of electrical measurements and high spatial resolution of focused ultrasound. This paper first describes the mechanism of the AE effect and the principle of the current source imaging method based on the AE effect. The second part summarizes the research progress of this current source imaging method in brain neurons, guided brain therapy, and heart. Finally, we discuss the problems and future directions of this biological current source imaging method. This review explores the relevant research literature and provides an informative reference for this potential non-invasive neuroimaging method.
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Affiliation(s)
- Hao Zhang
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China
| | - Minpeng Xu
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Brain Science and Neural Engineering, Academy of Medical Engineering and Translational Medicine, Tianjin International Joint Research Centre for Neural Engineering, Tianjin University, Tianjin, China
| | - Miao Liu
- Tianjin Key Laboratory of Brain Science and Neural Engineering, Academy of Medical Engineering and Translational Medicine, Tianjin International Joint Research Centre for Neural Engineering, Tianjin University, Tianjin, China
| | - Xizi Song
- Tianjin Key Laboratory of Brain Science and Neural Engineering, Academy of Medical Engineering and Translational Medicine, Tianjin International Joint Research Centre for Neural Engineering, Tianjin University, Tianjin, China
| | - Feng He
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Brain Science and Neural Engineering, Academy of Medical Engineering and Translational Medicine, Tianjin International Joint Research Centre for Neural Engineering, Tianjin University, Tianjin, China
| | - Shanguang Chen
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Brain Science and Neural Engineering, Academy of Medical Engineering and Translational Medicine, Tianjin International Joint Research Centre for Neural Engineering, Tianjin University, Tianjin, China
- National Key Laboratory of Human Factors Engineering, China Astronaut Research and Training Center, Beijing, China
| | - Dong Ming
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Brain Science and Neural Engineering, Academy of Medical Engineering and Translational Medicine, Tianjin International Joint Research Centre for Neural Engineering, Tianjin University, Tianjin, China
- *Correspondence: Dong Ming
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Baucher G, Troude L, Roux A, Loundou A, Boucekine M, Meling T, Roche PH. Predictors of visual function after resection of skull base meningiomas with extradural anterior clinoidectomy. Neurosurg Rev 2022; 45:2133-2149. [PMID: 35006456 DOI: 10.1007/s10143-021-01716-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 11/24/2021] [Accepted: 12/08/2021] [Indexed: 01/22/2023]
Abstract
Skull base meningiomas threatening the optic nerves may require performing an extradural anterior clinoidectomy (EAC) to optimally decompress the optic pathways. The present study evaluated the functional results and morbidity after surgical resection of skull base meningiomas including EAC, focusing on visual acuity (VA) and oculomotricity. Eighty-seven consecutive patients harboring skull base meningiomas who underwent surgical resection that included an EAC between 2003 and 2020 were retrospectively analyzed (86% women, median age 53 years). Decreased visual acuity (DVA) was graded as functional (VA ≥ 5/10) and nonfunctional (VA < 5/10). Statistical analyses were performed on VA and oculomotor nerve (OcN) dysfunction. Ninety surgical procedures were performed. Meningiomas were located at the anterior clinoid process (39%), cavernous sinus (31%), and spheno-orbital (30%) levels. Patients with a preoperative functional vision (normal or functional DVA) had a 90.9% (IC95% = [84.0; 97.8]) probability of preserving it at 6 months and an 84.8% (IC95% = [76.2; 93.5]) probability at last follow-up. Patients with preoperative nonfunctional vision (nonfunctional DVA or blindness) had a 19.0% (IC95% = [2.3; 35.8]) probability of recovery of functional vision at 6 months and a 23.8% (IC95% = [5.6; 42.0]) probability at last follow-up. Preoperative DVA was significantly associated with early postoperative DVA in univariate analyses (p = 0.04). Concerning the OcN, 65% of the patients experienced a postoperative dysfunction, and 78% of those cases recovered. Our study confirms EAC as a useful technical option for skull base meningiomas threatening the optic nerve, especially relevant for patients with preoperative functional vision, and supports early surgical management for these meningiomas.
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Affiliation(s)
- Guillaume Baucher
- Assistance Publique - Hôpitaux de Marseille, Hôpital Universitaire Nord, Neurochirurgie adulte, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France.
| | - Lucas Troude
- Assistance Publique - Hôpitaux de Marseille, Hôpital Universitaire Nord, Neurochirurgie adulte, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France
| | - Alexandre Roux
- Service de Neurochirurgie, GHU Paris - Hôpital Sainte-Anne, Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Anderson Loundou
- Faculté de Médecine, Unité d'aide Méthodologique, Aix-Marseille Université, Marseille, France
| | - Mohamed Boucekine
- Faculté de Médecine, Unité d'aide Méthodologique, Aix-Marseille Université, Marseille, France
| | - Torstein Meling
- Hôpitaux Universitaires de Genève, Deparment of Neurosurgery, Université de Genève, Geneva, Switzerland
| | - Pierre-Hugues Roche
- Assistance Publique - Hôpitaux de Marseille, Hôpital Universitaire Nord, Neurochirurgie adulte, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France
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Hardian RF, Ogiwara T, Sato A, Fujii Y, Suzuki Y, Hanaoka Y, Miyata M, Kamiya K, Sasaki T, Goto T, Hongo K, Horiuchi T. Comparison Between Conventional Flash and Off-Response Intraoperative Visual Evoked Potential Monitoring for Endoscopic Endonasal Surgery. Oper Neurosurg (Hagerstown) 2021; 21:516-522. [PMID: 34528094 DOI: 10.1093/ons/opab329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/18/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Intraoperative flash stimulation visual evoked potential (VEP) monitoring has been used for endoscopic endonasal approach (EEA). Recently, off-response VEP, which is recorded when the light stimulus is turned off, was introduced to monitor visual function intraoperatively. OBJECTIVE To evaluate off-response VEP monitoring in comparison with the conventional flash stimulation VEP monitoring for EEA. METHODS From March 2015 to March 2020, 70 EEA surgeries with intraoperative VEP monitoring (140 eyes) were performed. Light stimuli were delivered by a pair of goggle electrodes. Recording electrodes were placed on the scalp over the occipital region. The warning signal was prompted by a reduction of the peak-to-peak amplitude of the VEP by more than 50% compared to the initial amplitude. Visual function was assessed pre- and postoperatively. Results of flash and off-response VEP monitoring were compared. RESULTS VEP was recorded in 134 eyes. Warning signal occurred in 23 eyes (transient in 17 eyes and permanent in 6 eyes). Two eyes showed permanent VEP attenuation for flash VEP monitoring, in which one patient had postoperative visual function deterioration. Four eyes showed permanent VEP attenuation for off-response VEP monitoring, where 2 patients had postoperative visual function deterioration. Sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 98.9%, 50%, and 100%, respectively, for flash stimulation VEP, and 100%, 97.8%, 50%, and 100%, respectively, for off-response VEP. CONCLUSION VEP monitoring was useful to monitor visual function in EEA surgery. Off-response VEP monitoring was not inferior to conventional flash stimulation VEP monitoring.
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Affiliation(s)
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Atsushi Sato
- Department of Neurosurgery, Ina Central Hospital, Ina, Japan
| | - Yu Fujii
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yota Suzuki
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Maki Miyata
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Neurosurgery, Ina Central Hospital, Ina, Japan
| | - Keisuke Kamiya
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Neurosurgery, Ina Central Hospital, Ina, Japan
| | - Tetsuo Sasaki
- Department of Neurosurgery, Ina Central Hospital, Ina, Japan
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Neurosurgery, Ina Central Hospital, Ina, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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Ma J, Xiong W, Guo D, Wang A, Qiao H, Han R. Effects of Sevoflurane-Propofol-Balanced Anesthesia on Flash Visual Evoked Potential Monitoring in Spine Surgery: A Randomized Noninferiority Trial. Anesth Analg 2021; 134:1054-1061. [PMID: 34543246 DOI: 10.1213/ane.0000000000005742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Intraoperative flash visual evoked potential (FVEP) can be used to monitor visual function during spine surgery. However, it is limited due to the previous perception of its sensitivity to inhalation anesthesia. We conducted this trial to test the noninferiority of sevoflurane-propofol-balanced anesthesia (BA) versus popular propofol-based total intravenous anesthesia (TIVA) on the amplitude of FVEP during spine surgery. METHODS A total of 60 patients undergoing spine surgery were randomized to receive either sevoflurane-propofol-balanced anesthesia (BA group) or propofol-based total intravenous anesthesia (TIVA group) for anesthesia maintenance. We titrated the propofol plasma concentration to keep the bispectral index (BIS) values between 40 and 50. The primary outcome was the P100-N145 amplitudes of FVEP at 120 minutes after induction of anesthesia. The noninferiority margin (δ) was defined as 10% of the P100-N145 amplitude at 120 minutes after induction in the TIVA group. If the confidence interval (CI) for mean differences of P100-N145 amplitude at 120 minutes after induction between BA and TIVA groups lied above the lower limit of -δ with P < .025, we defined BA group was noninferior to TIVA group. RESULTS Fifty-nine patients were included in the final analysis. The amplitude of P100-N145 at 120 minutes after anesthesia induction in group BA was noninferior to group TIVA (3.8 [1.3] µV vs 3.2 [1.6] µV, -δ = -0.32, mean difference, 0.57, 95% CI, -0.18 to 1.33, P for noninferiority = .015). CONCLUSIONS The effect of 0.5 minimum alveolar concentration (MAC) of sevoflurane-propofol-balanced anesthesia on the P100-N145 amplitude of FVEP was noninferior to that of propofol-based TIVA under comparable BIS range.
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Affiliation(s)
- Jiajia Ma
- From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wei Xiong
- From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dongze Guo
- Department of Electrophysiology, Beijing Neurosurgical Institute, Beijing, People's Republic of China
| | - Anxin Wang
- Department of Statistics, China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Hui Qiao
- Department of Electrophysiology, Beijing Neurosurgical Institute, Beijing, People's Republic of China
| | - Ruquan Han
- From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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Jashek-Ahmed F, Cabrilo I, Bal J, Sanders B, Grieve J, Dorward NL, Marcus HJ. Intraoperative monitoring of visual evoked potentials in patients undergoing transsphenoidal surgery for pituitary adenoma: a systematic review. BMC Neurol 2021; 21:287. [PMID: 34301198 PMCID: PMC8299587 DOI: 10.1186/s12883-021-02315-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transsphenoidal surgery is the gold standard for pituitary adenoma resection. Although rare, a serious complication of surgery is worsened vision post-operatively. OBJECTIVE To determine whether, in patients undergoing transsphenoidal surgery for pituitary adenoma, intraoperative monitoring of visual evoked potentials (VEP) is a safe, reproducible, and effective technological adjunct in predicting postoperative visual function. METHODS The PubMed and OVID platforms were searched between January 1993 and December 2020 to identify publications that (1) featured patients undergoing transsphenoidal surgery for pituitary adenoma, (2) used intraoperative optic nerve monitoring with VEP and (3) reported on safety or effectiveness. Reference lists were cross-checked and expert opinion sought to identify further publications. RESULTS Eleven studies were included comprising ten case series and one prospective cohort study. All employed techniques to improve reliability. No safety issues were reported. The only comparative study included described a statistically significant improvement in post-operative visual field testing when VEP monitoring was used. The remaining case-series varied in conclusion. In nine studies, surgical manipulation was halted in the event of a VEP amplitude decrease suggesting a widespread consensus that this is a warning sign of injury to the anterior optic apparatus. CONCLUSIONS Despite limited and low-quality published evidence regarding intra-operative VEP monitoring, our review suggests that it is a safe, reproducible, and increasingly effective technique of predicting postoperative visual deficits. Further studies specific to transsphenoidal surgery are required to determine its utility in protecting visual function in the resection of complex pituitary tumours.
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Affiliation(s)
- Farizeh Jashek-Ahmed
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK.
| | - Ivan Cabrilo
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Jarnail Bal
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Brett Sanders
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Joan Grieve
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Neil L Dorward
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Hani J Marcus
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
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10
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Maryashev SA, Ogurtsova AA, Dombaanay BS, Eliseeva NM, Baev AA, Pitskhelauri DI. [Occipital gliomas. Case report and literature review]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:93-100. [PMID: 33306304 DOI: 10.17116/neiro20208406193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The authors report intraoperative mapping with cortical visual evoked potentials during occipital tumor resection. This approach was valuable to reduce the risk of visual cortex and visual pathways damage and, accordingly, the likelihood of postoperative visual impairment. The peculiarity of this case is registration of clear cortical visual evoked potentials in various positions before and after tumor resection. Intraoperative monitoring was valuable to avoid damage to visual cortex and visual pathways during tumor resection. There was no postoperative visual deterioration. Moreover, we observed partial recovery of visual fields after resection of occipital malignant tumor.
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Affiliation(s)
| | | | | | | | - A A Baev
- Burdenko Neurosurgical Center, Moscow, Russia
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11
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Abussuud Z, Ahmed S, Paluzzi A. Surgical Approaches to the Orbit: A Neurosurgical Perspective. Skull Base Surg 2020; 81:385-408. [PMID: 33209566 DOI: 10.1055/s-0040-1713941] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Orbital pathologies can be complex to manage surgically. In this article, we describe some of the most common and relevant approaches to orbital tumours. For each approach we describe the appropriate indications, surgical technique, potential complications, and illustrate a case example.
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Affiliation(s)
- Zeid Abussuud
- Department of Neurosurgery (Honorary), Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Shahzada Ahmed
- Department of ENT, Queen Elizabeth Hospital Birmingham, United Kingdom
| | - Alessandro Paluzzi
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, United Kingdom
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12
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Aldana E, Álvarez López-Herrero N, Benito H, Colomina MJ, Fernández-Candil J, García-Orellana M, Guzmán B, Ingelmo I, Iturri F, Martín Huerta B, León A, Pérez-Lorensu PJ, Valencia L, Valverde JL. Consensus document for multimodal intraoperatory neurophisiological monitoring in neurosurgical procedures. Basic fundamentals. ACTA ACUST UNITED AC 2020; 68:82-98. [PMID: 32624233 DOI: 10.1016/j.redar.2020.02.010] [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: 01/24/2020] [Revised: 02/04/2020] [Accepted: 02/18/2020] [Indexed: 01/27/2023]
Abstract
The present work aims to establish a guide to action, agreed by anaesthesiologists and neurophysiologists alike, to perform effective intraoperative neurophysiological monitoring for procedures presenting a risk of functional neurological injury, and neurosurgical procedures. The first section discusses the main techniques currently used for intraoperative neurophysiological monitoring. The second exposes the anaesthetic and non-anaesthetic factors that are likely to affect the electrical records of the nervous system structures. This section is followed by an analysis detailing the adverse effects associated with the most common techniques and their use. Finally, the last section describes a series of guidelines to be followed upon the various intraoperative clinical events.
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Affiliation(s)
- E Aldana
- Anestesiología y Reanimación, Hospital Vithas Xanit Internacional, Benalmádena, Málaga, España
| | - N Álvarez López-Herrero
- Neurofisiología, Servicio de Neurocirugía, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - H Benito
- Anestesiología y Reanimación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - M J Colomina
- Anestesiología y Reanimación, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Universitat de Barcelona, Barcelona, España
| | | | - M García-Orellana
- Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - B Guzmán
- Neurofisiología clínica, Hospital Clínico Universitario Lozano de Blesa, Zaragoza, España
| | - I Ingelmo
- Anestesiología y Reanimación, Hospital Universitario Ramón y Cajal, Madrid, España
| | - F Iturri
- Anestesiología y Reanimación, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - B Martín Huerta
- Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - A León
- Neurofisiología, Servicio de Neurología, Parc de Salut Mar, Barcelona, España
| | - P J Pérez-Lorensu
- Neurofisiología Clínica, Unidad de Monitorización Neurofisiológica Intraoperatoria, Hospital Universitario de Canarias, Tenerife, España
| | - L Valencia
- Anestesiología y Reanimación, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España
| | - J L Valverde
- Anestesiología y Reanimación, Hospital Vithas Xanit Internacional, Benalmádena, Málaga, España
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13
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Intraoperative visual evoked potential monitoring for optic pathway glioma in an infant: A case description. Clin Neurophysiol 2020; 131:1772-1774. [PMID: 32504939 DOI: 10.1016/j.clinph.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 11/21/2022]
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14
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Nowicki KW, Johnson SA, Goldschmidt E, Balzer J, Gross BA, Friedlander RM. Visual Evoked Potentials and Intraoperative Awakening in Ophthalmic Artery Sacrifice During Aneurysm Clipping: 2 Cases and Literature Review. World Neurosurg 2020; 139:395-400. [PMID: 32376380 DOI: 10.1016/j.wneu.2020.04.196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Complete aneurysm obliteration is the goal of aneurysm treatment. In selected cases, a neck remnant may be left to preserve a critical branch. Literature on ophthalmic artery sacrifice in the treatment of cerebral aneurysms and subsequent risk of vision loss is limited. CASE DESCRIPTION Herein, we describe 2 cases where the ophthalmic artery originated from the aneurysm dome, resulting in a situation where we either incompletely obliterate the aneurysm or sacrifice the ophthalmic artery in order to completely clip the lesion, risking visual function. CONCLUSIONS We report for the first time the use of visual evoked potential monitoring and intraoperative awakening to test visual function following intentional ophthalmic artery sacrifice to demonstrate gross vision preservation.
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Affiliation(s)
- Kamil W Nowicki
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Stephen A Johnson
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ezequiel Goldschmidt
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jeffrey Balzer
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Bradley A Gross
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Robert M Friedlander
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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15
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Qerama E, Korshoej AR, Petersen MV, Brandmeier R, von Oettingen G. Latency-shift of intra-operative visual evoked potential predicts reversible homonymous hemianopia after intra-ventricular meningioma surgery. Clin Neurophysiol Pract 2019; 4:224-229. [PMID: 31886448 PMCID: PMC6921212 DOI: 10.1016/j.cnp.2019.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/18/2019] [Accepted: 10/31/2019] [Indexed: 12/01/2022] Open
Abstract
Amplitude of intraoperative VEPs is used to monitor the function of optic radiation during neurosurgery. We present a case where significant unilateral latency shift of the P100 component was observed. VEP latency shifts may predict visual outcome during surgery for tumors close to the optic radiation.
Objectives Intraoperative visual evoked potentials (VEPs) are used to monitor the function of optic radiation during neurosurgery with the P100 amplitude decrement as a predictor of post-operative visual deficit. However, there is currently no evidence of early VEP changes indicating reversible visual field affection. Methods In this case report, we used VEPs during surgery for a benign meningioma located in the atrium of the right lateral ventricle. The tumor was accessed through a transcortical approach via a two-centimeter corticotomy in the lateral aspect of the superior parietal lobule. We performed flash VEPs and simultaneous recordings of electroretinography alongside with multimodal intraoperative monitoring. Results We observed a significant and sustained unilateral latency shift of the P100 component of VEPs, while amplitudes temporarily dropped to 80% of baseline but recovered entirely at the end of surgery. After the operation, the patient had a left-sided lower-quadrant anopia, which recovered completely during the following three months. Diagnostic VEP with pattern reversal monocular full field stimulation at one month postoperatively showed normal latencies bilaterally. Conclusion Our case indicates that the VEP (P100) latency may be a new and valuable indicator (in addition to VEP amplitude) of the visual pathways. Significance Monitoring VEPs may be useful to detect an imminent injury and a potentially reversible functional deficit.
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Affiliation(s)
- Erisela Qerama
- Aarhus University Hospital, Department of Neurophysiology, Aarhus, Denmark.,Aarhus University, Department of Clinical Medicine, Aarhus, Denmark
| | - Anders R Korshoej
- Aarhus University Hospital, Department of Neurosurgery, Aarhus, Denmark.,Aarhus University, Department of Clinical Medicine, Aarhus, Denmark
| | - Mikkel V Petersen
- Aarhus University, Center for Functional and Integrative Neuroscience, Aarhus, Denmark
| | - Richard Brandmeier
- Richards Brandmeier, Electroneurophysiology Consultant, Biomedical Engineer, Lausanne, Switzerland
| | - Gorm von Oettingen
- Aarhus University Hospital, Department of Neurosurgery, Aarhus, Denmark.,Aarhus University, Department of Clinical Medicine, Aarhus, Denmark
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Qiao N, Song M, Ye Z, He W, Ma Z, Wang Y, Zhang Y, Shou X. Deep Learning for Automatically Visual Evoked Potential Classification During Surgical Decompression of Sellar Region Tumors. Transl Vis Sci Technol 2019; 8:21. [PMID: 31788350 PMCID: PMC6871542 DOI: 10.1167/tvst.8.6.21] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022] Open
Abstract
Purpose Detection of the huge amount of data generated in real-time visual evoked potential (VEP) requires labor-intensive work and experienced electrophysiologists. This study aims to build an automatic VEP classification system by using a deep learning algorithm. Methods Patients with sellar region tumor and optic chiasm compression were enrolled. Flash VEP monitoring was applied during surgical decompression. Sequential VEP images were fed into three neural network algorithms to train VEP classification models. Results We included 76 patients. During surgical decompression, we observed 68 eyes with increased VEP amplitude, 47 eyes with a transient decrease, and 37 eyes without change. We generated 2,843 sequences (39,802 images) in total (887 sequences with increasing VEP, 276 sequences with decreasing VEP, and 1680 sequences without change). The model combining convolutional and recurrent neural network had the highest accuracy (87.4%; 95% confidence interval, 84.2%–90.1%). The sensitivity of predicting no change VEP, increasing VEP, and decreasing VEP was 92.6%, 78.9%, and 83.7%, respectively. The specificity of predicting no change VEP, increasing VEP, and decreasing VEP was 80.5%, 93.3%, and 100.0%, respectively. The class activation map visualization technique showed that the P2-N3-P3 complex was important in determining the output. Conclusions We identified three VEP responses (no change, increase, and decrease) during transsphenoidal surgical decompression of sellar region tumors. We developed a deep learning model to classify the sequential changes of intraoperative VEP. Translational Relevance Our model may have the potential to be applied in real-time monitoring during surgical resection of sellar region tumors.
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Affiliation(s)
- Nidan Qiao
- Shanghai Pituitary Tumor Center, Shanghai Neurosurgical Research Institute, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China & Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mengju Song
- Department of Ophthalmology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China & Putuo Oculopathy Dental Disease Prevention & Cure Clinic, Shanghai, China
| | - Zhao Ye
- Shanghai Pituitary Tumor Center, Shanghai Neurosurgical Research Institute, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenqiang He
- Shanghai Pituitary Tumor Center, Shanghai Neurosurgical Research Institute, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zengyi Ma
- Shanghai Pituitary Tumor Center, Shanghai Neurosurgical Research Institute, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yongfei Wang
- Shanghai Pituitary Tumor Center, Shanghai Neurosurgical Research Institute, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuyan Zhang
- Department of Ophthalmology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xuefei Shou
- Shanghai Pituitary Tumor Center, Shanghai Neurosurgical Research Institute, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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17
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Miyagishima T, Tosaka M, Yamaguchi R, Nagaki T, Ishii N, Kojima T, Yoshimoto Y. Extended endoscopic endonasal resection of craniopharyngioma using intraoperative visual evoked potential monitoring: technical note. Acta Neurochir (Wien) 2019; 161:2277-2284. [PMID: 31402418 DOI: 10.1007/s00701-019-04028-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND To avoid deterioration of visual function, extended endoscopic endonasal transsphenoidal surgery (TSS) for craniopharyngioma was performed with visual evoked potential (VEP) monitoring using light-emitting diodes (LEDs). METHODS The position of the optic chiasm was carefully evaluated on the preoperative midsagittal magnetic resonance (MR) images. Intraoperatively, direct and sharp dissection of the tumor from the optic chiasm was performed under VEP monitoring with LEDs through extended endoscopic endonasal TSS. If the VEP finding changed and became unstable, the operator were informed and stopped the surgical manipulation for the optic chiasm to recover. After 5-10 min, recovery of VEP findings was checked and the procedure resumed. RESULTS Extended endoscopic endonasal TSS with VEP monitoring was performed in consecutive 7 adult patients with newly diagnosed suprasellar craniopharyngiomas with maximum diameters of 25-41 mm (mean 33.7 mm). VEPs were stable throughout the surgery in 5 cases, but showed temporary instability and amplitude decrease in 2 cases, although the VEPs had recovered at the end of the surgery. Visual function, evaluated using visual impairment score, was improved after surgery in all patients. Gross total removal was achieved in 5 cases, and subtotal removal (90%) in 2 cases. CONCLUSIONS Intraoperative VEP monitoring is the only way to test visual function during surgery, and may be important and helpful in extended endoscopic endonasal TSS, which requires direct dissection between the optic nerve and craniopharyngioma under the endoscope.
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Muscas G, Battista F, Lastrucci G, Della Puppa A. An Alternative Route to the Posterior Half of the Third Ventricle: The Transoccipital Horn Approach. Technical Note. World Neurosurg 2019; 132:223-229. [PMID: 31518749 DOI: 10.1016/j.wneu.2019.08.255] [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: 05/02/2019] [Revised: 08/30/2019] [Accepted: 08/31/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Lesions arising or abutting in the posterior half of the third ventricle are approached through established routes to avoid damage of essential brain structures. Occasionally, the features of the lesion require rethinking these traditional routes and tailoring the surgical approach to cause fewer debilitating sequelae to the patient. We introduce a modification of previously described transcortical approaches to lesions of the posterior third ventricle. The technique and possible indications are discussed. METHODS Two cases of posterior third ventricle tumors are presented. In both patients, a small posterior fossa and large tentorial veins located along the surgical route, as well as the position of the lesion underneath the internal cerebral veins, encouraged the concept of a novel transoccipital horn approach that was developed to access the tumor with less postoperative deficits. RESULTS Both lesions were removed with transitory postoperative visual deficits. CONCLUSIONS The transoccipital horn approach is a feasible alternative to other surgical routes to the posterior part of the third ventricle in cases of particularly challenging anatomy and tumor characteristics. It allows reaching the lesion along its major axis, fully exploiting the natural space created by the tumor in its growth and avoiding the internal cerebral veins.
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Affiliation(s)
- Giovanni Muscas
- Departments of Neurosurgery, Neuroscience, Psychology, Pharmacology, and Child Health, University of Florence, Careggi, Florence, Italy.
| | - Francesca Battista
- Departments of Neurosurgery, Neuroscience, Psychology, Pharmacology, and Child Health, University of Florence, Careggi, Florence, Italy
| | - Giancarlo Lastrucci
- Departments of Neurosurgery, Neuroscience, Psychology, Pharmacology, and Child Health, University of Florence, Careggi, Florence, Italy
| | - Alessandro Della Puppa
- Departments of Neurosurgery, Neuroscience, Psychology, Pharmacology, and Child Health, University of Florence, Careggi, Florence, Italy
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Intraoperative Flash Visual Evoked Potential Recording and Relationship to Visual Outcome. Can J Neurol Sci 2019; 46:295-302. [PMID: 30867080 DOI: 10.1017/cjn.2019.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the relationship between intraoperative flash visual evoked potential (FVEP) monitoring and visual function. METHODS Intraoperative FVEPs were recorded from electrodes placed in the scalp overlying the visual cortex (Oz) after flashing red light stimulation delivered by Cadwell LED stimulating goggles in 89 patients. Restrictive filtering (typically 10-100 Hz), optimal reject window settings, mastoid reference site, total intravenous anesthetic (TIVA), and stable retinal stimulation (ensured by concomitant electroretinogram [ERG] recording) were used to enhance FVEP reproducibility. RESULTS The relationship between FVEP amplitude change and visual outcome was determined from 179 eyes. One eye had a permanent intraoperative FVEP loss despite stable ERG, and this eye had new, severe postoperative visual dysfunction. Seven eyes had transient significant FVEP change (>50% amplitude decrease that recovered by the end of surgery), but only one of those had a decrease in postoperative visual acuity. FVEP changes in all eight eyes (one permanent FVEP loss plus seven transient FVEP changes) were related to surgical manipulation. In each case the surgeon was promptly informed of the FVEP deterioration and took remedial action. The other eyes did not have FVEP changes, and none of those eyes had new postoperative visual deficits. CONCLUSIONS Our FVEP findings relate to visual outcome with a sensitivity and specificity of 1.0. New methods for rapidly acquiring reproducible FVEP waveforms allowed for timely reporting of significant FVEP change resulting in prompt surgical action. This may have accounted for the low postoperative visual deficit rate (1%) in this series.
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Feng R, Schwartz J, Loewenstern J, Kohli K, Lenina S, Ultakan S, Iloreta AM, Govindaraj S, Bederson J, Banik R, Shrivastava R. The Predictive Role of Intraoperative Visual Evoked Potentials in Visual Improvement After Endoscopic Pituitary Tumor Resection in Large and Complex Tumors: Description and Validation of a Method. World Neurosurg 2019; 126:e136-e143. [PMID: 30794978 DOI: 10.1016/j.wneu.2019.01.278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/27/2019] [Accepted: 01/30/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND With the advent of extensive endoscopic approaches for pituitary tumors, there has also been an increase in surgery for larger and more complex tumors. Intraoperative manipulation during endoscopic resection of sellar tumors poses potential risk in postoperative visual function in this tumor population. This study proposes a method of accurate intraoperative monitoring of visual evoked potentials (VEPs) and its role in predicting visual function outcomes. METHODS Intraoperative VEPs were monitored for 42 resections from a single surgical team, with average tumor size of 2.84 cm. Changes in VEP amplitude and latency in excess of 50% were considered significant. Preoperative and postoperative visual information was obtained from ophthalmology and hospital records, along with patient demographics, comorbidities, and tumor characteristics. RESULTS Patients were stratified as experiencing deteriorations in VEPs that did not restore to baseline (n = 4), deteriorations in VEPs that did restore to baseline (n = 6), no change in VEPs (n = 31), and improvement in VEPs (n = 1). Correlation between VEP changes and postoperative visual fields was measured through univariate ordered logistic regression. Improved intraoperative VEP measurements were associated with odds ratio (OR) of visual field improvement of 3.15 (95% confidence interval, 1.15-8.59). Specifically, changes in VEP amplitude were positively associated with visual field improvement with OR of 4.35 (OR, 1.29-14.7). No association was observed between VEPs and other patient or tumor characteristics. CONCLUSION Changes in VEP amplitude during endoscopic sellar tumor resection correlate with postoperative visual function. Intraoperative VEP monitoring can serve an important role in preventing postoperative visual field loss.
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Affiliation(s)
- Rui Feng
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Jeffrey Schwartz
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joshua Loewenstern
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Karan Kohli
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Svetlana Lenina
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sedat Ultakan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alfred-Marc Iloreta
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Satish Govindaraj
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rudrani Banik
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raj Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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21
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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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22
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Role of presurgical functional MRI and diffusion MR tractography in pediatric low-grade brain tumor surgery: a single-center study. Childs Nerv Syst 2018; 34:2241-2248. [PMID: 29802593 DOI: 10.1007/s00381-018-3828-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/13/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE Presurgical functional MRI (fMRI) and diffusion MRI tractography (dMRI tractography) are widely employed to delineate eloquent brain regions and their connections prior to brain tumor resection in adults. However, such studies are harder to perform in children, resulting in suboptimal neurosurgical care in pediatric brain tumor surgery as compared to adults. Thus, our objective was to assess the feasibility and the influence of presurgical advanced MR imaging on neurosurgical care in pediatric brain tumor surgery. METHODS Retrospective analyses of 31 presurgical fMRI/dMRI tractography studies were performed in children with low-grade tumors near eloquent brain regions at our site between 2005 and 2017. RESULTS In only 3/31 cases, imaging results were not interpretable (10%). All 28 successful imaging sessions were used for neurosurgical risk assessment. Based on this, surgery was canceled in 2/28 patients, and intention to treat was changed in 5/28 patients. In 4/28 cases, the surgical approach was changed and in 10/28, electrode placement for intraoperative neurophysiological monitoring was guided by imaging results. Gross total resection (GTR) was planned in 21/28 cases and could be achieved in 15/21 (71%). Despite highly eloquent tumor location, only four children suffered from a mild permanent neurological deficit after the operation. CONCLUSIONS We demonstrate that presurgical fMRI/dMRI tractography can have a profound impact on pediatric brain tumor management, optimizing preoperative risk-assessment and pre- as well as intraoperative decision-making. We believe that these tools should be offered to children suffering from eloquent brain tumors as part of a comprehensive operative work-up.
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Wilke M, Groeschel S, Lorenzen A, Rona S, Schuhmann MU, Ernemann U, Krägeloh‐Mann I. Clinical application of advanced MR methods in children: points to consider. Ann Clin Transl Neurol 2018; 5:1434-1455. [PMID: 30480038 PMCID: PMC6243383 DOI: 10.1002/acn3.658] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/10/2018] [Accepted: 08/10/2018] [Indexed: 12/11/2022] Open
Abstract
The application of both functional MRI and diffusion MR tractography prior to a neurosurgical operation is well established in adults, but less so in children, for several reasons. For this review, we have identified several aspects (task design, subject preparation, actual scanning session, data processing, interpretation of results, and decision-making) where pediatric peculiarities should be taken into account. Further, we not only systematically identify common issues, but also provide solutions, based on our experience as well as a review of the pertinent literature. The aim is to provide the clinician as well as the imaging scientist with information that helps to plan, conduct, and interpret such a clinically-indicated exam in a way that maximizes benefit for, and minimizes the burden on the individual child.
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Affiliation(s)
- Marko Wilke
- Department of Pediatric Neurology and Developmental MedicineChildren's HospitalTuebingenGermany
- Children's Hospital and Department of NeuroradiologyExperimental Pediatric NeuroimagingTuebingenGermany
| | - Samuel Groeschel
- Department of Pediatric Neurology and Developmental MedicineChildren's HospitalTuebingenGermany
- Children's Hospital and Department of NeuroradiologyExperimental Pediatric NeuroimagingTuebingenGermany
| | - Anna Lorenzen
- Department of Pediatric Neurology and Developmental MedicineChildren's HospitalTuebingenGermany
- Children's Hospital and Department of NeuroradiologyExperimental Pediatric NeuroimagingTuebingenGermany
| | - Sabine Rona
- Department of NeurosurgeryUniversity HospitalTuebingenGermany
| | | | - Ulrike Ernemann
- Department of Diagnostic and Interventional NeuroradiologyUniversity HospitalUniversity of TübingenTuebingenGermany
| | - Ingeborg Krägeloh‐Mann
- Department of Pediatric Neurology and Developmental MedicineChildren's HospitalTuebingenGermany
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Gutzwiller EM, Cabrilo I, Radovanovic I, Schaller K, Boëx C. Intraoperative monitoring with visual evoked potentials for brain surgeries. J Neurosurg 2018; 130:654-660. [PMID: 29600911 DOI: 10.3171/2017.8.jns171168] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/28/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to determine the performance of intraoperative visual evoked potentials (VEPs) in detecting visual field changes. METHODS Assessments of VEPs were performed with simultaneous retinal responses by using white light-emitting diodes protected from scialytic microscope lights. The alarm criterion was a reproducible decrease in amplitude of the VEP P100 wave of 20% or more. Visual fields were assessed preoperatively and 1 month postsurgery (Goldmann perimetry). RESULTS The VEPs were analyzed for 29 patients undergoing resection of a brain lesion. In 89.7% of patients, steady VEP and retinal responses were obtained for monitoring. The absence of alarm was associated in 94.4% of cases with the absence of postoperative visual changes (specificity). The alarms correctly identified 66.7% of cases with any postoperative changes and 100% of cases with changes more severe than just a discrete quadrantanopia or deterioration of an existing quadrantanopia (sensitivity, new diffuse deterioration < 2 dB). In 11.5% of patients, a transitory VEP decrease with subsequent recovery was observed without postoperative defects. CONCLUSIONS Intraoperative VEPs were performed with simultaneous recording of electroretinograms, with protection from lights of the operating room and with white light-emitting diodes. Intraoperative VEPs were shown to be reliable in predicting postoperative visual field changes. In this series of intraaxial brain procedures, reliable intraoperative VEP monitoring was achieved, allowing at minimum the detection of new quadrantanopia. The standardization of this technique appears to be a valuable effort in regard to the functional risks of homonymous hemianopia.
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Affiliation(s)
| | | | - Ivan Radovanovic
- 2Division of Neurosurgery, Toronto Western Hospitals, Krembil Neuroscience Center, University Health Network and University of Toronto, Ontario, Canada
| | | | - Colette Boëx
- 3Neurology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; and
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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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Soffin EM, Emerson RG, Cheng J, Mercado K, Smith K, Beckman JD. A pilot study to record visual evoked potentials during prone spine surgery using the SightSaver™ photic visual stimulator. J Clin Monit Comput 2017; 32:889-895. [DOI: 10.1007/s10877-017-0092-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 12/13/2017] [Indexed: 11/29/2022]
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Uribe AA, Mendel E, Peters ZA, Shneker BF, Abdel-Rasoul M, Bergese SD. Comparison of visual evoked potential monitoring during spine surgeries under total intravenous anesthesia versus balanced general anesthesia. Clin Neurophysiol 2017; 128:2006-2013. [DOI: 10.1016/j.clinph.2017.07.420] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 07/21/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
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Coppola A, Tramontano V, Basaldella F, Arcaro C, Squintani G, Sala F. Intra-operative neurophysiological mapping and monitoring during brain tumour surgery in children: an update. Childs Nerv Syst 2016; 32:1849-59. [PMID: 27659828 DOI: 10.1007/s00381-016-3180-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 07/05/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Over the past decade, the reluctance to operate in eloquent brain areas has been reconsidered in the light of the advent of new peri-operative functional neuroimaging techniques and new evidence from neuro-oncology. To maximise tumour resection while minimising morbidity should be the goal of brain surgery in children as much as it is in adults, and preservation of brain functions is critical in the light of the increased survival and the expectations in terms of quality of life. DISCUSSION Intra-operative neurophysiology is the gold standard to localise and preserve brain functions during surgery and is increasingly used in paediatric neurosurgery. Yet, the developing nervous system has peculiar characteristics in terms of anatomical and physiological maturation, and some technical aspects need to be tailored for its use in children, especially in infants. This paper will review the most recent advances in the field of intra-operative neurophysiology (ION) techniques during brain surgery, focussing on those aspects that are relevant to the paediatric neurosurgery practice.
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Affiliation(s)
- Angela Coppola
- Pediatric Neurosurgery, Institute of Neurosurgery, University Hospital, Verona, Italy
| | | | | | - Chiara Arcaro
- Division of Neurology, University Hospital, Verona, Italy
| | | | - Francesco Sala
- Pediatric Neurosurgery, Institute of Neurosurgery, University Hospital, Verona, Italy. .,Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Sato A. Interpretation of the causes of instability of flash visual evoked potentials in intraoperative monitoring and proposal of a recording method for reliable functional monitoring of visual evoked potentials using a light-emitting device. J Neurosurg 2016; 125:888-897. [PMID: 26894463 DOI: 10.3171/2015.10.jns151228] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Effective monitoring and application of visual evoked potentials (VEPs) during neurosurgery is a major challenge. While many monitoring methods have been effectively used, the use of VEPs as an objective determination method has not been established. The purpose of this report was to present a method for overcoming this limitation according to the use of a specific stimulus. METHODS Data analysis was performed in 26 cases of brain surgery. Observation was carried out for 2 groups of responses: the response derived from the start of light emission, described as the on response, and the response derived from the end of light emission, described as the off response. These reactions were separated by extending the light emission time. The waves from the visual cortex were selected from each reaction following the start and the end of light emission with consideration for the characteristics of the potential distribution. The waves were observed to characterize changes resulting from variations in duration and quantity of light emission. The results of the analysis were used to determine the optimal emission time and amount of light for effective use of wave components during VEP monitoring. RESULTS Stable and recordable waves were observed by monitoring the off response, consisting of the P1-N1-P2 component, with a wave latency of approximately 100 msec. Since the off response was correlated with the input, the stable wave derived from the off response could be adjusted by changing the light emission time and intensity. Individual differences in the latency of the off response were decreased by extending the light emission time and reducing the quantity of light. However, it was difficult to achieve stability by adjusting the light intensity and emission time using the on response. The off response was confirmed to be sufficiently stable for intraoperative monitoring. Moreover, during 1 case in which manipulation of the optic nerve was necessary, reduction in the off response was found to occur when the nerve was manipulated and to reverse when the manipulation stopped. CONCLUSIONS The off response was shown to have the capacity to function as a monitoring tool, providing more stable wave forms than the on response. Recording conditions could be adjusted to achieve a light-emitting time of 500 msec and a light quantity of 8000 Lx. Stable monitoring of VEPs using light-emitting stimuli can contribute toward improving surgical outcomes.
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Affiliation(s)
- Atsushi Sato
- Division of Neurosurgery, Ina Central Hospital, Ina, Japan
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Demartini Z, Matos LAD, Dos Santos MLT, Cardoso-Demartini ADA. Endovascular Therapeutic Occlusion of the Posterior Cerebral Artery: An Option for Ruptured Giant Aneurysm in a Child. Pediatr Neurosurg 2016; 51:199-203. [PMID: 26974558 DOI: 10.1159/000444193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/21/2016] [Indexed: 11/19/2022]
Abstract
The incidence of intracranial aneurysms in the pediatric population is low, and surgical clipping remains a good long-term treatment option. However, posterior circulation aneurysms are even more complex to manage in children than in adults. We report a case of a giant aneurysm of the posterior cerebral artery in a 10-year-old boy presenting with subarachnoid hemorrhage. Endovascular treatment with platinum coils was performed with total occlusion of the aneurysm and the affected arterial segment without complications. The patient achieved good recovery, and a late control angiogram confirmed exclusion of the aneurysm. Occurrence of special features of cerebral aneurysm in children, in comparison to adults, is also described. Parent artery sacrifice is an effective therapeutic option, but long-term follow-up is necessary to avoid recurrence and rebleeding.
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Affiliation(s)
- Zeferino Demartini
- Cajuru University Hospital, Department of Neurosurgery, Pontifical University Catholic of Parana, Curitiba, Brazil
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Luo Y, Regli L, Bozinov O, Sarnthein J. Correction: Clinical Utility and Limitations of Intraoperative Monitoring of Visual Evoked Potentials. PLoS One 2015; 10:e0133819. [PMID: 26193358 PMCID: PMC4508100 DOI: 10.1371/journal.pone.0133819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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