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  • Usefulness of Intraoperative Visual Function Monitoring During Neurosurgical Procedures

    Final Number:

    Roser Garcia-Armengol MD; Alicia Martinez-Piñeiro MD; Belen Menendez; Kaoutar Mekkaoui MD; Cristina Hostalot MD; Jordi Manuel de Rimbau MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Intraoperative visual evoked potentials (VEP) feasibility and reproducibility under general anesthesia were not clear for years (1,. The aim of this study is to evaluate intraoperative VEPs reproducibility and its value to predict the visual function postoperative status.

    Methods: Intraoperative monitoring of ERG (electroretinogram) and transcranial VEPs (tcVEP) was attempted in 30 patients (60 eyes) who underwent surgical procedures including 11 parasellar and 16 cortical lesions and 3 mesial sclerosis. Cortical VEPs (CVEP) was recorded simultaneously in 6 patients (12 eyes). White-light fla<sh stimulation was provided by 18 diodes embedded in a silicone disk. We defined warning criterion as a 50% decrease in amplitude compared with the baseline level. We evaluated VEP reproducibility and the correlation between intraoperative VEP events and the postoperative visual function prognosis.

    Results: Stable ERG was obtained in all less 2 eyes. Reproducible tcVEPs and cVEP were recorded in 96.6%(29/30) and 83,3% (5/6) of patients, respectively. We detected pathologically significant events in 6 patients. Four of them recovered intraoperatively, without developing any postsurgical new visual deficit. Two patients presented with persistent cVEP and tcVEP deterioration, respectively, with a worsening of preoperative visual function. In 24 patients without any significant amplitude changes in tcVEP, 22 showed no change, 1 developed a new visual deficit (homonymous quandrantanopia) and 1 manifested improved visual function postoperatively.

    Conclusions: Intraoperative transcranial and cortical VEP monitoring is feasible and reproducible. It should be considered to prevent visual function deterioration during neurosurgical procedures where optic pathways were in risk. cVEP recording is specially recommended in case of retrochiasmatic lesions

    Patient Care: With this study we can avoid visual deficits in some neurosurgical procedures

    Learning Objectives: To Know intraoperative VEPs reproducibility and correlation of visual function postoperative status

    References: 1. Luo Y, Regli L, Bozinov O, Sarnthein J. Clinical utility and limitations of intraoperative monitoring of visual evoked potentials. . Plos one, 2015 2. Ota T1, Kawai K, Kamada K, Kin T, Saito N. Intraoperative monitoring of cortically recorded visual response for posterior visual pathway. J Neurosurg. 2010 Feb;112(2):285-94.

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