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Standard and limitation of intraoperative monitoring of the visual evoked potential

Standard and limitation of intraoperative monitoring of the visual evoked potential,10.1007/s00701-010-0600-2,Acta Neurochirurgica,Kunihiko Kodama,Tet

Standard and limitation of intraoperative monitoring of the visual evoked potential   (Citations: 4)
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Background  Visual evoked potential (VEP) has been installed as one of the intraoperative visual function monitoring. It remains unclear, however, whether intraoperative VEP monitoring facilitates as a real time visual function monitoring with satisfactory effectiveness and sensitivity. To evaluate this, relationships between VEP waveform changes and postoperative visual function were analysed retrospectively. Methods  Intraoperative VEP monitoring was carried out for 106 sides (eyes) in 53 surgeries, including two intraorbital, 36 parasellar and 15 cortical lesions in Shinshu University Hospital under total intravenous anaesthesia. Red light flash stimulation was provided to each eye independently. VEP recording and postoperative visual function were analysed. Results  In 103 out of 106 sides (97%), steady VEP monitoring was recorded. Stable VEP was acquired from eyes having corrected visual acuity greater than 0.4. VEP was not recorded in one side with corrected visual acuity of 0.3 and two sides in whom sevoflurane was used incidentally for anaesthesia. Transient VEP decrease was observed in three sides, but visual function was preserved. Permanent VEP decrease was seen in seven sides, which presented visual impairment postoperatively. In one side, visual acuity improved but minor visual field defect was encountered postoperatively, though VEP unchanged throughout the surgery. Conclusions  Intraoperative monitoring of VEP predicts postoperative visual function: reversible change in VEP means visual function to be preserved. Visual field defect without decrease in the visual acuity may not be predicted by VEP monitoring. Intraoperative VEP monitoring will be mandatory for surgeries harbouring a risk of visual impairment.
Journal: Acta Neurochirurgica - ACTA NEUROCHIR , vol. 152, no. 4, pp. 643-648, 2010
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    • ...Other factors, such as thermal damage resulting from using the high-speed drill during orbitotomy, removal of the sphenoid wing and anterior clinoidectomy and manipulation-induced vasospasm of the nutritive microvasculature, could also be implicated [21, 29]...
    • ...Recently, however, several authors have successfully recorded stable scalp VEP or cortical responses after flash stimulation and correlated them with postoperative visual outcome [21, 30, 36]...
    • ...In 2010, papers by Kodama et al. and Sasaki et al. have reported much more stable and reproducible scalp flash VEP recorded during neurosurgery in comparison to earlier studies [21, 36]...
    • ...There were three cases of reversible VEP amplitude decrease with unchanged postoperative visual outcome and seven cases with more than 50% reduction of VEP amplitude, which has not returned to the baseline level; severe postoperative visual disturbances were present in all seven cases [21]...
    • ...Therefore, recently published studies have shown a correlation between stable intraoperative VEP or cortical responses and stable or improved postoperative visual function, and between irreversible intraoperative VEP amplitude decrease or irreversible changes in cortical response morphology and postoperative deterioration of visual function [21, 30, 36]...
    • ...This is in contrast with the recently published articles about flash VEP or cortical responses recorded during neurosurgery, where the authors mostly reported minimal intraoperative amplitude fluctuations, which were associated with unchanged postoperative visual function [21, 30, 36]...
    • ...This is in accordance with the findings of Kodama et al., who were able to record stable intraoperative flash VEP from eyes with corrected visual acuity greater than 0.4 [21]...

    Mitja Benedičičet al. Intraoperative monitoring of the visual function using cortical potent...

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