Extended endoscopic endonasal resection of craniopharyngioma using intraoperative visual evoked potential monitoring: technical note

Miyagishima, Takaaki; Tosaka, Masahiko; Yamaguchi, Rei; Nagaki, Tomohito; Ishii, Naomi; Kojima, Takeo; Yoshimoto, Yuhei

doi:10.1007/s00701-019-04028-7

Cited by 13 publications

(4 citation statements)

References 26 publications

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“…Previous studies showed mixed results between stable VEP findings and postoperative visual function. 2,[4][5][6][7][8] Regarding VEP with transient attenuation, previous studies reported postoperative visual function deterioration in 0% to 50% of cases. 4,5,8 With regard to permanent VEP attenuation, 50% of the patients had postoperative visual function deterioration in our study.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] While some studies reported that intraoperative VEP monitoring is useful for preserving visual function during surgery and predicting the postoperative visual outcome, others showed that intraoperative VEP waveform changes had no association with postoperative visual function. 2,[4][5][6][7][8] These discrepancies may have been caused by the difficulty of obtaining a stable and reproducible VEP waveform.…”

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confidence: 99%

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Comparison Between Conventional Flash and Off-Response Intraoperative Visual Evoked Potential Monitoring for Endoscopic Endonasal Surgery

Hardian¹,

Ogiwara²,

Sato³

et al. 2021

ONSURG

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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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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Comparison Between Conventional Flash and Off-Response Intraoperative Visual Evoked Potential Monitoring for Endoscopic Endonasal Surgery

Hardian¹,

Ogiwara²,

Sato³

et al. 2021

ONSURG

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“…Improved VEPs during ETS for adult craniopharyngiomas have not been reported [12][13][14]. Kawaguchi et al reported a signi cant increase in the intraoperative VEP amplitude during ETS for adult craniopharyngiomas; however, the postoperative visual function was not evaluated because of cognitive dysfunction [15].…”

Section: Discussionmentioning

confidence: 99%

Pediatric craniopharyngioma with significantly increased intraoperative visual evoked potential amplitude and postoperative visual acuity improvement: a case report

Oda,

Amano,

Chiba

et al. 2024

Preprint

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Visual evoked potential (VEP) is an established modality that allows safe brain tumor resection and preservation of optical function. We herein present a case of a pediatric craniopharyngioma with significant improvement in the VEP amplitude detected during endoscopic transsphenoidal surgery (ETS) and obvious postoperative improvement in visual acuity. A 13-year-old boy presented with visual acuity disturbance in his right eye and was followed-up for 5 months by an ophthalmologist. His visual acuity rapidly worsened, and a suprasellar lesion with calcification was found on brain computed tomography. The patient underwent tumor resection during ETS with intraoperative transcranial VEP monitoring. Gross total tumor resection was achieved without injury to the perforators, including the superior hypophyseal arteries. The VEP amplitude was unstable, and significant waves were not detectable before tumor resection; however, a positive wave was detected after removing most of the tumor and exposing the bilateral optic nerves and optic chiasm. Subsequently, negative and positive VEP waves were continuously detected. Visual acuity improved remarkably on postoperative day 10. This case demonstrated both a significant increase in the intraoperative VEP amplitude and rapid postoperative improvement in visual acuity. We surmised that the preoperative rapid worsening of visual dysfunction, intraoperative increase in the VEP amplitude, and significant postoperative improvement in visual acuity were associated with the compression of the optic nerves by the internal carotid artery, anterior cerebral artery, and tumor.

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“…Over the past decades, intraoperative neurophysiological monitoring (IONM) has become a crucial component for modern neurosurgery. Specific to visual function protection, visual-evoked potential (VEP) is proved to be an effective modality for reflecting the integrity of visual pathway from retina to pulvinar cortex, and has been applied to surgeries with the risk of visual pathway damage (6)(7)(8)(9). To our knowledge, in the research field of VEP monitoring, most studies have focused on the predictive value of VEP amplitude for postoperative visual deterioration.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Post-operative Visual Deterioration Using Visual-Evoked Potential Latency in Extended Endoscopic Endonasal Resection of Craniopharyngiomas

et al. 2021

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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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Extended endoscopic endonasal resection of craniopharyngioma using intraoperative visual evoked potential monitoring: technical note

Cited by 13 publications

References 26 publications

Comparison Between Conventional Flash and Off-Response Intraoperative Visual Evoked Potential Monitoring for Endoscopic Endonasal Surgery

Comparison Between Conventional Flash and Off-Response Intraoperative Visual Evoked Potential Monitoring for Endoscopic Endonasal Surgery

Pediatric craniopharyngioma with significantly increased intraoperative visual evoked potential amplitude and postoperative visual acuity improvement: a case report

Prediction of Post-operative Visual Deterioration Using Visual-Evoked Potential Latency in Extended Endoscopic Endonasal Resection of Craniopharyngiomas

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