Acta Scientific Clinical Case Reports (ASCR)

Case Report Volume 1 Issue 2

Protecting the Visual Pathways During Optic Nerve Surgery Using Intraoperative Visual Evoked Potentials (VEP)

Faisal R Jahangiri1*, Sidra Ilyas2, Rabehah Asdi3, Esther Escobedo1 and Michael Seals4

1Axis Neuromonitoring LLC, Richardson, TX, USA
2Department of Anatomy, School of Medicine, University of California, San Francisco, CA, USA
3School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
4Atlas Neuromonitoring LLC, Richardson, TX, USA

*Corresponding Author:Faisal R Jahangiri, Axis Neuromonitoring LLC, Richardson, TX, USA.

Received: January 30, 2020; Published: February 10, 2020

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Abstract

  This case report illustrates the benefit of utilizing Intraoperative Neurophysiological Monitoring (IONM) during the resection of an optic nerve lesion. A multimodality IONM utilized Electroretinogram (ERG), Visual Evoked Potentials (VEP) and Electroencephalography (EEG).

  A 47-year-old female presented with left intracranial meningioma and decreased vision in the right eye. An MRI showed tumor attached to the left optic nerve and posteriorly displacing optic nerve and chiasm to the right. After induction and patient positioning, LED goggles were placed and secured on both eyes for performing VEP. The VEP responses were absent at baseline due to the inhalational agent. After switching to Total Intravenous Anesthesia (TIVA), ERG responses were recorded bilaterally. Baseline VEP and EEG recordings were obtained with good left VEP and absent right VEP responses. During tumor resection there was sudden decrease in left VEP responses. Retractors were removed immediately and the responses came back to baseline within few minutes. The tumor was resected without any loss of vision intraoperatively.

  The patient noticed an improvement in her right eye four days post-operatively. One month post-operatively she continued to feel improvement. In this patient, the VEP was used effectively for the prevention of any loss of vision intra-operatively. The neurophysiological monitoring utilizing ERG and VEP helped prevent any further loss of vision and directing the surgeon intra-operatively.

Keywords: Electroretinogram (ERG); Visual Evoked Potentials (VEP); Electroencephalography (EEG); Intraoperative Neurophysiological Monitoring (IONM); Tumor

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References

  1. American Clinical Neurophysiology Society. "Guideline 9B: guidelines on visual evoked potentials”. American Journal of Electroneurodiagnostic Technology 46.3 (2006): 254-274.
  2. Jahangiri, FR. “Surgical Neurophysiology: An Introduction to Intraoperative Neurophysiological Monitoring (IONM)”. Second Edition. 193-95, April (2012).
  3. Abulaban A and Jahangiri FR. “Establishment of Normal Visual Evoked Potentials (VEPs) Values in Adult Saudi Males”. Abstracts published in the proceeding of King Saud Bin Abdulaziz University for Health Sciences 15th Resident’s Day. Riyadh, Saudi Arabia: King Abdulaziz Medical City (2012): 36.
  4. ABRET Neurodiagnostic Credentialing and Accreditation. ABRET (2019).
  5. ABNM: American Board of Neurophysiologic Monitoring. ABNM: American Board of Neurophysiologic Monitoring (2019).
  6. Gertsch JH., et al. “Practice guidelines for the supervising professional: intraoperative neurophysiological monitoring”. Journal of Clinical Monitoring and Computing 33 (2019): 175-183.
  7. Hayashi H and Kawaguchi M. “Intraoperative monitoring of flash visual evoked potential under general anesthesia”. Korean Journal of Anesthesiology 70 (2017): 127-135. 
  8. Cedzich C., et al. “Are flash-evoked visual potentials useful for intraoperative monitoring of visual pathway function?” Neurosurgery 21 (1987): 709-715.
  9. Jahangiri FR., et al. “Protecting the Visual Pathways during Optic Nerve Surgery Using Neurophysiological Monitoring”. Abstracts published in the proceeding of the Department of Medicine: 13th Research Day. Riyadh, Saudi Arabia: King Abdulaziz Medical City 32 (2012).
  10. Thirumala PD., et al. “Neurophysiologic Intraoperative Monitoring of Olfactory and Optic Nerves”. Journal of Clinical and Neurophysiology (2011). 
  11. Harding GF., et al. “Visual evoked potential monitoring of optic nerve function during surgery”. Journal of Neurology, Neurosurgery, and Psychiatry 53.10 (1990): 890-895. 
  12. Nishimura F., et al. “Efficacy of the visual evoked potential monitoring in endoscopic transnasal transsphenoidal surgery as a real-time visual function”. Neurology India 66 (2018): 1075-1080.
  13. Gutzwiller EM., et al. “Intraoperative monitoring with visual evoked potentials for brain surgeries”. Journal of Neurosurgery 130 (2018): 654-660.
  14. Chung SB., et al. “Intraoperative visual evoked potential has no association with postoperative visual outcomes in transsphenoidal surgery”. Acta Neurochirurgica (Wien). 154.8 (2012): 1505-1510.
  15. Kamio Y., et al. “Usefulness of intraoperative monitoring of visual evoked potentials in transsphenoidal surgery”. Neurologia medico-chirurgica (Tokyo) 54 (2014): 606-611.
  16. Luo Y., et al. “Clinical utility and limitations of intraoperative monitoring of visual evoked potentials. PLoS One 10.3 (2015): e0120525.
  17. Ezzat S., et al. “The prevalence of pituitary adenomas: a systematic review". Cancer 101 (2004): 613-619. 
  18. Asa SL. "Practical pituitary pathology: what does the pathologist need to know?". Archives of Pathology and Laboratory Medicine 132 (2008): 1231-1240.
  19. Halliday AM. Evoked potentials in clinical testing, 2nd ed. London: Churchill Livingstone (1993).
  20. McDonald WI., et al. “Recommended diagnostic criteria for multiple sclerosis: Guidelines from the international panel on the diagnosis of multiple sclerosis”. Annals of Neurology 50 (2001): 121-127.
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Citation

Citation: Faisal R Jahangiri., et al. “Protecting the Visual Pathways During Optic Nerve Surgery Using Intraoperative Visual Evoked Potentials (VEP)”. Acta Scientific Clinical Case Reports 1.2 (2020): 01-06.



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