Usefulness of Intraoperative Monitoring of Visual Evoked Potentials in Transsphenoidal Surgery
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概要
- 論文の詳細を見る
Postoperative visual outcome is a major concern in transsphenoidal surgery (TSS). Intraoperative visual evoked potential (VEP) monitoring has been reported to have little usefulness in predicting postoperative visual outcome. To re-evaluate its usefulness, we adapted a high-power light-stimulating device with electroretinography (ERG) to ascertain retinal light stimulation. Intraoperative VEP monitoring was conducted in TSSs in 33 consecutive patients with sellar and parasellar tumors under total venous anesthesia. The detectability rates of N75, P100, and N135 were 94.0%, 85.0%, and 79.0%, respectively. The mean latencies and amplitudes of N75, P100, and N135 were 76.8 ± 6.4 msec and 4.6 ± 1.8 μV, 98.0 ± 8.6 msec and 5.0 ± 3.4 μV, and 122.1 ± 16.3 msec and 5.7 ± 2.8 μV, respectively. The amplitude was defined as the voltage difference from N75 to P100 or P100 to N135. The criterion for amplitude changes was defined as a > 50% increase or 50% decrease in amplitude compared to the control level. The surgeon was immediately alerted when the VEP changed beyond these thresholds, and the surgical manipulations were stopped until the VEP recovered. Among the 28 cases with evaluable VEP recordings, the VEP amplitudes were stable in 23 cases and transiently decreased in 4 cases. In these 4 cases, no postoperative vision deterioration was observed. One patient, whose VEP amplitude decreased without subsequent recovery, developed vision deterioration. Intraoperative VEP monitoring with ERG to ascertain retinal light stimulation by the new stimulus device was reliable and feasible in preserving visual function in patients undergoing TSS.
著者
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Namba Hiroki
Department Of Neurological Surgery School Of Medicine Chiba University
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Takahashi Goro
Department Of Cardiovascular Surgery Graduate School Of Medicine Tohoku University
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Sameshima Tetsuro
Department Of Neurosurgery Miyazaki Prefectural Nichinan Hospital
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Sugiyama Kenji
Department Of Applied Pharmacology Graduate School Of Medicine And Pharmaceutical Sciences Universit
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Koizumi Shinichiro
Department Of Neurosurgery Hamamatsu University School Of Medicine
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SAKAI NAOTO
Department of Chemical Engineering, Faculty of Engineering Science, Osaka University
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SAMESHIMA Tetsuro
Department of Neurosurgery, Head and Neck Surgery, Hamamatsu University School of Medicine
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KAMIO Yoshinobu
Department of Neurosurgery, Head and Neck Surgery, Hamamatsu University School of Medicine
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