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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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Baş G, Taşkıran E, Arslan S, Kemerdere R, Tanrıöver N. Intraoperative visual evoked potential and subcortico-cortical evoked potential monitoring in diffuse low-grade glioma surgery: a case report. Acta Neurol Belg 2023; 123:2365-2370. [PMID: 36648703 DOI: 10.1007/s13760-023-02186-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Affiliation(s)
- Gülçin Baş
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey.
| | - Emine Taşkıran
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Serdar Arslan
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
- Department of Radiology, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Rahşan Kemerdere
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Necmettin Tanrıöver
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
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Olmsted ZT, Silverstein JW, Einstein EH, Sowulewski J, Nelson P, Boockvar JA, D'Amico RS. Evolution of flash visual evoked potentials to monitor visual pathway integrity during tumor resection: illustrative cases and literature review. Neurosurg Rev 2023; 46:46. [PMID: 36715828 DOI: 10.1007/s10143-023-01955-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 12/21/2022] [Accepted: 01/23/2023] [Indexed: 01/31/2023]
Abstract
Flash visual evoked potentials (fVEPs) provide a means to interrogate visual system functioning intraoperatively during tumor resection in which the optic pathway is at risk for injury. Due to technical limitations, fVEPs have remained underutilized in the armamentarium of intraoperative neurophysiological monitoring (IONM) techniques. Here we review the evolution of fVEPs as an IONM technique with emphasis on the enabling technological and intraoperative improvements. A combined approach with electroretinography (ERG) has enhanced feasibility of fVEP neuromonitoring as a practical application to increase safety and reduce error during tumor resection near the prechiasmal optic pathway. The major advance has been towards differentiating true cases of damage from false findings. We use two illustrative neurosurgical cases in which fVEPs were monitored with and without ERG to discuss limitations and demonstrate how ERG data can clarify false-positive findings in the operating room. Standardization measures have focused on uniformity of photostimulation parameters for fVEP recordings between neurosurgical groups.
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Affiliation(s)
- Zachary T Olmsted
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, New York, NY, USA.
| | - Justin W Silverstein
- Department of Neurology, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, New York, NY, USA
- Neuro Protective Solutions, New York, NY, USA
| | - Evan H Einstein
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, New York, NY, USA
| | | | - Priscilla Nelson
- Department of Anesthesiology, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, New York, NY, USA
| | - John A Boockvar
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, New York, NY, USA
| | - Randy S D'Amico
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, New York, NY, USA
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Maryashev SA, Dombaanai BS, Eliseeva NM, Ogurtsova AA, Baev AA, Pitskhelauri DI, Pronin IN. [Intraoperative visual evoked potential recording in occipital tumor surgery]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:35-45. [PMID: 37650275 DOI: 10.17116/neiro20238704135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Currently, visual field defects are considered as an inevitable consequence of occipital lobe surgery. However, recent advances in neuroimaging techniques, such as diffusion tensor tractography allowing better visualization of optic radiation and its relationship with occipital lobe tumors, as well as intraoperative monitoring of cortical visual evoked potentials (cVEPs) can contribute to correct planning of surgery and minimizing the risk of visual field defects after surgery. OBJECTIVE To evaluate the effectiveness of intraoperative monitoring of cVEP in patients with occipital lobe tumors. MATERIAL AND METHODS Ten patients with occipital lobe tumors have undergone surgery with neurophysiological monitoring since 2020. Mean age of patients was 57 years. There were 6 women and 4 men. In 7 patients, neoplasms were located in the right hemisphere, in 3 patients - in the left hemisphere. According to preoperative automatic perimetry data, 7 patients had various visual field defects, and other ones had intact visual fields. All patients underwent pre- and postoperative MRI for visualization of optic radiation, its relationship with tumor and control of resection quality. Intraoperative monitoring of cVEPs was performed in all patients. RESULTS Biopsy verified glioblastoma in 5 cases, metastasis of adenocarcinoma - 2 cases, diffuse glioma - 1 case, ganglioglioma - 1 case, CNS lymphoma - 1 case. Postoperative MRI confirmed total or subtotal resection of tumor in all cases. Enlargement of visual fields occurred in 3 patients after surgery. Two ones had deterioration and/or new homonymous defect. No changes of visual fields was observed in other cases. Analysis of visual field defects after surgery found no correlation with functional state of visual tract according to fractional anisotropy before and after surgery. CONCLUSION MR tractography of optic radiation and intraoperative monitoring of cVEP allow choosing the safest approach for resection of occipital tumor and minimizing the risk of damage to visual cortex and optic radiation fibers. In most cases, postoperative visual functions do not worsen after intraoperative mapping of visual cortex and determining the safest trajectory for resection of occipital lobe tumors. Moreover, improvement is observed in some cases.
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Affiliation(s)
| | | | | | | | - A A Baev
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
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Yoo J, Park HH, Kang SG, Chang JH. Recent Update on Neurosurgical Management of Brain Metastasis. Brain Tumor Res Treat 2022; 10:164-171. [PMID: 35929114 PMCID: PMC9353165 DOI: 10.14791/btrt.2022.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 11/20/2022] Open
Abstract
Brain metastasis (BM), classified as a secondary brain tumor, is the most common malignant central nervous system tumor whose median overall survival is approximately 6 months. However, the survival rate of patients with BMs has increased with recent advancements in immunotherapy and targeted therapy. This means that clinicians should take a more active position in the treatment paradigm that passively treats BMs. Because patients with BM are treated in a variety of clinical settings, treatment planning requires a more sophisticated decision-making process than that for other primary malignancies. Therefore, an accurate prognostic prediction is essential, for which a graded prognostic assessment that reflects next-generation sequencing can be helpful. It is also essential to understand the indications for various treatment modalities, such as surgical resection, stereotactic radiosurgery, and whole-brain radiotherapy and consider their advantages and disadvantages when choosing a treatment plan. Surgical resection serves a limited auxiliary function in BM, but it can be an essential therapeutic approach for increasing the survival rate of specific patients; therefore, this must be thoroughly recognized during the treatment process. The ultimate goal of surgical resection is maximal safe resection; to this end, neuronavigation, intraoperative neuro-electrophysiologic assessment including evoked potential, and the use of fluorescent materials could be helpful. In this review, we summarize the considerations for neurosurgical treatment in a rapidly changing treatment environment.
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Affiliation(s)
- Jihwan Yoo
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Gu Kang
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Lanteri P, Garbarino S, Sannita WG. Corrigendum to "Visual electrophysiological testing: On a path to obsolescence?' [Clin. Neurophysiol. 138 (2022) 122]. Clin Neurophysiol 2022; 139:133-134. [PMID: 35550728 DOI: 10.1016/j.clinph.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Paola Lanteri
- Neurophysiopathology Center, Foundation IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/child Sciences (DINOGMI), University of Genova, Italy
| | - Walter G Sannita
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/child Sciences (DINOGMI), University of Genova, Italy.
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Nakagawa I, Park H, Kotsugi M, Yokoyama S, Omoto K, Myochin K, Takeshima Y, Matsuda R, Nishimura F, Yamada S, Takatani T, Nakase H. Diagnostic Impact of Monitoring Visual Evoked Potentials to Prevent Visual Complications During Endovascular Treatment for Intracranial Aneurysm. Front Neurol 2022; 13:761263. [PMID: 35280302 PMCID: PMC8904750 DOI: 10.3389/fneur.2022.761263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The present study aimed to determine the incidence of intraprocedural visual-evoked potential (VEP) changes and to identify correlations with intraprocedural ischemic complications during endovascular treatment in patients with intracranial aneurysm related to visual function. Methods This study analyzed data from 104 consecutive patients who underwent endovascular coil embolization to treat intracranial aneurysms related to visual function under VEP and transcranial motor evoked potential (MEP) monitoring. We analyzed associations between significant changes in MEP and VEP, defined as a >50% decrease in amplitude, and both intraprocedural complications and postoperative neurological deficits. Factors associated with postoperative neurological deficits were also assessed. Results Treated aneurysms were predominantly located in the internal carotid artery (95%). Five (5%) were located in the posterior cerebral artery (PCA). Significant decreases in intraprocedural VEP occurred in four patients (4%), although one of those four patients did not show concomitant MEP decreases during procedures. Immediate salvage procedures avoided postoperative visual disturbances. All VEP decreases were transient and not associated with postoperative visual impairment. One of three cases who underwent intraoperative balloon occlusion test showed tolerance to balloon occlusion of the proximal PCA under VEP assessment; parent artery occlusion was performed without postoperative visual disturbance in that case. Conclusion Although significant VEP decreases occurred 4% during neuro-endovascular aneurysm treatment related to visual function, intraprocedural VEP monitoring identifies ischemic changes associated with visual pathways and facilitates prompt initiation of salvage procedures.
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Affiliation(s)
- Ichiro Nakagawa
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
- *Correspondence: Ichiro Nakagawa
| | - HunSoo Park
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Masashi Kotsugi
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Shohei Yokoyama
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Kouji Omoto
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Kaoru Myochin
- Departments of Radiology, Nara Medical University, Kashihara, Japan
| | | | - Ryosuke Matsuda
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | | | - Shuichi Yamada
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Tsunenori Takatani
- Division of Central Clinical Laboratory, Nara Medical University, Kashihara, Japan
| | - Hiroyuki Nakase
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
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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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Seidel K, Szelényi A, Bello L. Intraoperative mapping and monitoring during brain tumor surgeries. HANDBOOK OF CLINICAL NEUROLOGY 2022; 186:133-149. [PMID: 35772883 DOI: 10.1016/b978-0-12-819826-1.00013-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Many different methodologies and paradigms are available to guide surgery of supratentorial tumors with the aim to preserve quality of life of the patients and to increase the extent of tumor resection. Neurophysiologic monitoring techniques (such as different evoked potentials) may help to continuously assess functional integrity of the observed systems and warn about vascular injury. For neurophysiologic mapping methods, the focus is not only to preserve cortical sites, but also to prevent injury to subcortical pathways. Therefore, cortical mapping is not enough but should be combined with subcortical mapping to identify tracts. This may be done by alternating resection and stimulation, or by continuous mapping via an electrified surgical tool such as a stimulating suction tip. Increasingly refined techniques are evolving to improve mapping of complex motor networks as well as language and higher cortical functions. Finally, in deciding between an awake vs asleep intraoperative setting, various factors need to be considered, such as the surgical goal, patient expectation and cooperation, treating team expertise, and neurooncologic aspects including histopathology. Therefore, the choice of protocol depends on the clinical context and the experience of the interdisciplinary team treating the patients.
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Affiliation(s)
- Kathleen Seidel
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Andrea Szelényi
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Lorenzo Bello
- Department of Oncology and Hemato-Oncology, Neurosurgical Oncology Unit, Università degli Studi di Milano, Milan, Italy
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Tao X, Yang X, Fan X, You H, Jin Y, Liu J, Guo D, Li C, Qiao H. Prediction of Post-operative Visual Deterioration Using Visual-Evoked Potential Latency in Extended Endoscopic Endonasal Resection of Craniopharyngiomas. Front Neurol 2021; 12:753902. [PMID: 34925215 PMCID: PMC8678070 DOI: 10.3389/fneur.2021.753902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The current study aimed to investigate the predictive value of visual-evoked potential (VEP) latency for post-operative visual deterioration in patients undergoing craniopharyngioma resection via extended endoscopic endonasal approach (EEEA). Methods: Data from 90 patients who underwent craniopharyngioma resection via EEEA with intraoperative VEP monitoring were retrospectively reviewed. P100 latency was compared between patients with and without post-operative visual deterioration, and the threshold value of P100 latency for predicting post-operative visual deterioration was calculated by the receiver operating characteristic curve analysis. In addition, other potential prognostic factors regarding post-operative visual outcomes were also analyzed by multivariate analysis. Results: Patients with post-operative visual deterioration showed a significantly longer VEP latency than those without (p < 0.001). An extension over 8.61% in VEP latency was identified as a predictor of post-operative visual deterioration (p < 0.001). By contrast, longer preoperative visual impairment duration and larger tumor volume were not significant predictors for post-operative visual deterioration. Conclusions: The current study revealed that intraoperative VEP monitoring in EEEA is effective for predicting post-operative visual deterioration, and an extension over 8.61% in VEP latency can be used as a critical cut-off value to predict post-operative visual deterioration.
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Affiliation(s)
- Xiaorong Tao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiaocui Yang
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xing Fan
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Hao You
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yanwen Jin
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jiajia Liu
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Dongze Guo
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chuzhong Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hui Qiao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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11
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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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Schaller K, Iannotti GR, Orepic P, Betka S, Haemmerli J, Boex C, Alcoba-Banqueri S, Garin DFA, Herbelin B, Park HD, Michel CM, Blanke O. The perspectives of mapping and monitoring of the sense of self in neurosurgical patients. Acta Neurochir (Wien) 2021; 163:1213-1226. [PMID: 33686522 PMCID: PMC8053654 DOI: 10.1007/s00701-021-04778-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/17/2021] [Indexed: 12/25/2022]
Abstract
Surgical treatment of tumors, epileptic foci or of vascular origin, requires a detailed individual pre-surgical workup and intra-operative surveillance of brain functions to minimize the risk of post-surgical neurological deficits and decline of quality of life. Most attention is attributed to language, motor functions, and perception. However, higher cognitive functions such as social cognition, personality, and the sense of self may be affected by brain surgery. To date, the precise localization and the network patterns of brain regions involved in such functions are not yet fully understood, making the assessment of risks of related post-surgical deficits difficult. It is in the interest of neurosurgeons to understand with which neural systems related to selfhood and personality they are interfering during surgery. Recent neuroscience research using virtual reality and clinical observations suggest that the insular cortex, medial prefrontal cortex, and temporo-parietal junction are important components of a neural system dedicated to self-consciousness based on multisensory bodily processing, including exteroceptive and interoceptive cues (bodily self-consciousness (BSC)). Here, we argue that combined extra- and intra-operative approaches using targeted cognitive testing, functional imaging and EEG, virtual reality, combined with multisensory stimulations, may contribute to the assessment of the BSC and related cognitive aspects. Although the usefulness of particular biomarkers, such as cardiac and respiratory signals linked to virtual reality, and of heartbeat evoked potentials as a surrogate marker for intactness of multisensory integration for intra-operative monitoring has to be proved, systemic and automatized testing of BSC in neurosurgical patients will improve future surgical outcome.
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Affiliation(s)
- Karl Schaller
- Department of Neurosurgery, Geneva University Medical Center & Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Giannina Rita Iannotti
- Department of Neurosurgery, Geneva University Medical Center & Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
- Functional Brain Mapping Laboratory, Department of Fundamental Neurosciences, University Geneva, Geneva, Switzerland
| | - Pavo Orepic
- Laboratory of Neurocognitive Science, Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Sophie Betka
- Department of Neurosurgery, Geneva University Medical Center & Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
- Laboratory of Neurocognitive Science, Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Julien Haemmerli
- Department of Neurosurgery, Geneva University Medical Center & Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Colette Boex
- Department of Neurosurgery, Geneva University Medical Center & Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
- Department of Clinical Neurosciences, Geneva University Medical Center & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sixto Alcoba-Banqueri
- Laboratory of Neurocognitive Science, Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Dorian F A Garin
- Department of Neurosurgery, Geneva University Medical Center & Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Bruno Herbelin
- Laboratory of Neurocognitive Science, Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Hyeong-Dong Park
- Laboratory of Neurocognitive Science, Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Christoph M Michel
- Functional Brain Mapping Laboratory, Department of Fundamental Neurosciences, University Geneva, Geneva, Switzerland
| | - Olaf Blanke
- Laboratory of Neurocognitive Science, Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Geneva University Medical Center & Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Feng AY, Sussman ES, Jin MC, Wong S, Lopez J, Pulli B, Heit JJ, Telischak N. Intraoperative Neuromonitoring for Cerebral Arteriovenous Malformation Embolization: A Propensity-Score Matched Retrospective Database Study. Cureus 2021; 13:e12946. [PMID: 33654622 PMCID: PMC7910512 DOI: 10.7759/cureus.12946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The treatment of cerebral arteriovenous malformations (AVMs) may result in neurologic morbidity, particularly when an AVM is located in or adjacent to eloquent brain regions. Intraoperative neurophysiologic monitoring (IONM) may be utilized to reduce the risk of iatrogenic injury during endovascular AVM embolization; however, IONM for endovascular AVM embolization is not ubiquitously the standard of care. Methods Admissions for AVM embolization were assessed from the IBM MarketScan® Commercial and Medicare Supplemental databases (IBM Watson Health, Somers, NY). Inclusion criterion for patients was continuous enrollment six months before and after the index encounter. The use of IONM and presence of intracranial hemorrhage (ICH) were noted. Propensity-score matched cohorts with and without IONM were generated to minimize bias between treatment groups (adjusting for age, sex, and comorbidities). Results From 2007 to 2016, there were 16,279 patients diagnosed with cerebral AVM in the MarketScan database. Embolized patients were stratified into IONM and non-IONM cohorts; there were 357 patients in the IONM cohort and 1775 patients in the non-IONM cohort. Provider types were significantly different between cohorts (p<0.005). Unruptured AVMs were significantly more likely to be embolized with adjunctive IONM (17.7%) compared to ruptured AVMs (7.9%) (p<0.005). After balancing for baseline comorbidities, there were 266 patients in the IONM cohort, and 1347 patients in the non-IONM cohort. Among unruptured AVM patients, IONM was linked to a significantly shorter length of stay (2.72 versus 4.92 days; p<0.005), significantly lower rates of complications within 30 days of discharge (0.00% versus 1.88%; p=0.038), and significantly lower total payment ($40,179 versus $50,844; p<0.0001). Conclusion Endovascular embolization for unruptured AVMs performed with adjunctive IONM was associated with shorter length of stay, lower complication rates, and hospitalization costs.
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Affiliation(s)
- Austin Y Feng
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | - Eric S Sussman
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | - Michael C Jin
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | - Sandy Wong
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | - Jaime Lopez
- Neurology, Stanford University School of Medicine, Stanford, USA
| | - Benjamin Pulli
- Radiology, Stanford University School of Medicine, Stanford, USA
| | - Jeremy J Heit
- Radiology, Stanford University School of Medicine, Stanford, USA
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14
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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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15
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Dlamini M. Neuromonitoring. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2020. [DOI: 10.36303/sajaa.2020.26.6.s3.2534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neuromonitoring is used during surgery to assess the functional integrity of the brain, brain stem, spinal cord, or peripheral nerves. The aim of monitoring is to prevent permanent damage by early intervention when changes are detected in the monitor. Neuromonitoring is also used to map areas of the nervous system in order to guide management in some cases.
The best neuromonitor remains the awake patient. In the conscious state, the function of individual parts of the nervous system and the complex interactions of its different parts can be assessed more accurately. However, most surgical procedures involving the nervous system require general anaesthesia.
Procedures that require neuromonitoring can have changes in their monitored parameters corrected by modifying the surgical approach or by having the anaesthesiologist manipulate the parameters under their control. An ideal neuromonitor would be one that is specific for the parameter of interest, and gives reliable, reproducible, or continuous results.
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16
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Momjian S, Tyrand R, Landis BN, Boëx C. Intraoperative monitoring of olfactory function: a feasibility study. J Neurosurg 2020; 132:1659-1664. [PMID: 31003213 DOI: 10.3171/2019.1.jns182731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/21/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intraoperative neuromonitoring of the chemical senses (smell and taste) has never been performed. The objective of this study was to determine if olfactory-evoked potentials could be obtained intraoperatively under general anesthesia. METHODS A standard olfactometer was used in the surgical theater with hydrogen sulfide (4 ppm, 200 msec). Olfactory-evoked potentials were recorded in 8 patients who underwent neurosurgery for resection of cerebral lesions. These patients underwent routine target-controlled propofol and sufentanil general anesthesia. Frontal, temporal, and parietal scalp subdermal electrodes were recorded ipsilaterally and contralaterally at the site of the surgery. Evoked potentials were computed if at least 70 epochs (0.5-100 Hz) satisfying the artifact rejection criterion (threshold 45 μV) could be extracted from signals of electrodes. RESULTS Contributive recordings were obtained for 5 of 8 patients (3 patients had fewer than 70 epochs with an amplitude < 45 μV). Olfactory-evoked potentials showed N1 responses (mean 442.8 ± 40.0 msec), most readily observed in the patient who underwent midline anterior fossa neurosurgery. No component of later latencies could be recorded consistently. CONCLUSIONS The study confirms that olfactory-evoked potentials can be measured in response to olfactory stimuli under general anesthesia. This demonstrates the feasibility of recording olfactory function intraoperatively and opens the potential for neuromonitoring of olfactory function during neurosurgery.
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Affiliation(s)
- Shahan Momjian
- 1Department of Neurosurgery
- 2Faculty of Medicine, University of Geneva, Switzerland
| | - Rémi Tyrand
- 2Faculty of Medicine, University of Geneva, Switzerland
- 3Department of Neurology
| | - Basile N Landis
- 2Faculty of Medicine, University of Geneva, Switzerland
- 4Rhinology-Olfactory Unit, Department of Otorhinolaryngology Head & Neck Surgery, Geneva University Hospitals; and
| | - Colette Boëx
- 2Faculty of Medicine, University of Geneva, Switzerland
- 3Department of Neurology
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Kutty RK, Kumar A, Yamada Y, Kawase T, Tanaka R, Miyatani K, Higashiguchi S, Ravishankar V, Takizawa K, Kato Y. Visual Outcomes after Surgery for Paraclinoid Aneurysms: A Fujita Experience. Asian J Neurosurg 2020; 15:363-369. [PMID: 32656133 PMCID: PMC7335145 DOI: 10.4103/ajns.ajns_39_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/06/2020] [Accepted: 02/25/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The surgical strategies for clipping of paraclinoid aneurysms are diverse. These aneurysms are unique in their location, as they closely abut the anterior clinoid process (ACP) and the optic nerve. The ultimate goal of clipping encompasses the exposure of neck of the aneurysm which is seldom complete without the manipulation of optic nerve and the ACP. This manipulation may result in disturbances of vision postoperatively. We analyze our results of visual outcomes in the surgery for paraclinoid aneurysms in this retrospective study. MATERIALS AND METHODS All patients with paraclinoid aneurysms who underwent surgery from June 2014 to June 2019 were included in the study. Surgical procedure was uniform in all patients which included anterior clinoidectomy and clipping of aneurysms as per the Bantane protocol. Glasgow Outcome Scale as well as vision was assessed at discharge and at 1 month and 6 months. RESULTS There were 77 cases of paraclinoid aneurysms operated during the abovementioned period. All patients had no symptoms related to vision preoperatively. Visual deterioration was noted in two patients. All patients were discharged with a good outcome on the Glasgow Outcome Scale. CONCLUSION Paraclinoid aneurysm has a good outcome when treated with surgery. The visual deterioration following surgery can be minimized with extradural anterior clinoidectomy and careful handling of the vessels and nerve.
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Affiliation(s)
- Raja K. Kutty
- Department of Neurosurgery, Government Medical College, Trivandrum, Kerala, India
| | - Ambuj Kumar
- Department of Neurosurgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Yasuhiro Yamada
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Otobashi, Nagoya, Japan
| | - Tsukosa Kawase
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Otobashi, Nagoya, Japan
| | - Riki Tanaka
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Otobashi, Nagoya, Japan
| | - Kyosuke Miyatani
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Otobashi, Nagoya, Japan
| | - Saeko Higashiguchi
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Otobashi, Nagoya, Japan
| | - Vigneswar Ravishankar
- Department of Neurosurgery, Institute of Neurosciences and Spinal Disorders, MGM Healthcare, Chennai, Tamil Nadu, India
| | - Katsumi Takizawa
- Department of Neurosurgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Hokkaido, Japan
| | - Yoko Kato
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Otobashi, Nagoya, Japan
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18
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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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19
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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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20
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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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21
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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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22
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Ishida W, Casaos J, Chandra A, D'Sa A, Ramhmdani S, Perdomo-Pantoja A, Theodore N, Jallo G, Gokaslan ZL, Wolinsky JP, Sciubba DM, Bydon A, Witham TF, Lo SFL. Diagnostic and therapeutic values of intraoperative electrophysiological neuromonitoring during resection of intradural extramedullary spinal tumors: a single-center retrospective cohort and meta-analysis. J Neurosurg Spine 2019; 30:839-849. [PMID: 30835707 DOI: 10.3171/2018.11.spine181095] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/09/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE With the advent of intraoperative electrophysiological neuromonitoring (IONM), surgical outcomes of various neurosurgical pathologies, such as brain tumors and spinal deformities, have improved. However, its diagnostic and therapeutic value in resecting intradural extramedullary (ID-EM) spinal tumors has not been well documented in the literature. The objective of this study was to summarize the clinical results of IONM in patients with ID-EM spinal tumors. METHODS A retrospective patient database review identified 103 patients with ID-EM spinal tumors who underwent tumor resection with IONM (motor evoked potentials, somatosensory evoked potentials, and free-running electromyography) from January 2010 to December 2015. Patients were classified as those without any new neurological deficits at the 6-month follow-up (group A; n = 86) and those with new deficits (group B; n = 17). Baseline characteristics, clinical outcomes, and IONM findings were collected and statistically analyzed. In addition, a meta-analysis in compliance with the PRISMA guidelines was performed to estimate the overall pooled diagnostic accuracy of IONM in ID-EM spinal tumor resection. RESULTS No intergroup differences were discovered between the groups regarding baseline characteristics and operative data. In multivariate analysis, significant IONM changes (p < 0.001) and tumor location (thoracic vs others, p = 0.018) were associated with new neurological deficits at the 6-month follow-up. In predicting these changes, IONM yielded a sensitivity of 82.4% (14/17), specificity of 90.7% (78/86), positive predictive value (PPV) of 63.6% (14/22), negative predictive value (NPV) of 96.3% (78/81), and area under the curve (AUC) of 0.893. The diagnostic value slightly decreased in patients with schwannomas (AUC = 0.875) and thoracic tumors (AUC = 0.842). Among 81 patients who did not demonstrate significant IONM changes at the end of surgery, 19 patients (23.5%) exhibited temporary intraoperative exacerbation of IONM signals, which were recovered by interruption of surgical maneuvers; none of these patients developed new neurological deficits postoperatively. Including the present study, 5 articles encompassing 323 patients were eligible for this meta-analysis, and the overall pooled diagnostic value of IONM was a sensitivity of 77.9%, a specificity of 91.1%, PPV of 56.7%, and NPV of 95.7%. CONCLUSIONS IONM for the resection of ID-EM spinal tumors is a reasonable modality to predict new postoperative neurological deficits at the 6-month follow-up. Future prospective studies are warranted to further elucidate its diagnostic and therapeutic utility.
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Affiliation(s)
- Wataru Ishida
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joshua Casaos
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arun Chandra
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adam D'Sa
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Seba Ramhmdani
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Nicholas Theodore
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - George Jallo
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- 4Department of Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Ziya L Gokaslan
- 2Department of Neurosurgery, Brown University School of Medicine, Providence, Rhode Island
| | - Jean-Paul Wolinsky
- 3Department of Neurological Surgery, Northwestern University, Chicago, Illinois; and
| | - Daniel M Sciubba
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ali Bydon
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy F Witham
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sheng-Fu L Lo
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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