The predictive value of intraoperative visual evoked potential for visual outcome after extended endoscopic endonasal surgery for adult craniopharyngioma

2021 ◽  
pp. 1-11
Author(s):  
Ning Qiao ◽  
Xiaocui Yang ◽  
Chuzhong Li ◽  
Guofo Ma ◽  
Jie Kang ◽  
...  
Keyword(s):  
Visual Impairment ◽  
Real Time ◽  
Visual Evoked Potential ◽  
Evoked Potential ◽  
Tumor Volume ◽  
Visual Outcome ◽  
Adult Patients ◽  
Endoscopic Endonasal Surgery ◽  
Clinical Value ◽  
Endoscopic Endonasal

OBJECTIVE Due to the proximity of craniopharyngioma to the optic apparatus, one of the most common complications after surgery is visual deterioration. Intraoperative visual evoked potential (VEP), as a means of real-time visual function monitoring, has been integrated into transsphenoidal surgery for pituitary adenoma to predict postoperative visual outcome. Compared with pituitary tumor, craniopharyngioma often adheres to optic nerves, with increased risk of postoperative visual impairment. Furthermore, extended endoscopic endonasal surgery (EEES) can provide direct visualization of the surgical plane between the craniopharyngioma and the optic nerves, which contributes to analysis of the mechanism of real-time VEP changes during surgery. Therefore, VEP monitoring applied during EEES for craniopharyngioma may have more clinical value. However, only 9 patients who underwent EEES with VEP monitoring for craniopharyngioma have been sporadically reported to date. In this paper, the authors present the largest series to date analyzing the clinical value of VEP to predict postoperative visual outcome in adult patients with craniopharyngioma. METHODS Sixty-five adult patients who underwent EEES with intraoperative VEP monitoring for primary craniopharyngioma were retrospectively reviewed. The association between changes in VEP amplitude and postoperative visual outcome was determined. In addition, other potential prognostic factors with regard to postoperative visual outcomes were included in the analysis. RESULTS Gross-total resection was achieved in 59 patients (90.8%). Reproducible and stable VEP was recorded in 128 of 130 eyes (98.5%). During surgery, VEP remained stable in 108 eyes, 10 (9.3%) of which had new visual acuity (VA) and/or visual field (VF) defects after surgery. Transient VEP decrease was recorded in 15 eyes, 4 (26.7%) of which had visual deterioration. Of the 5 eyes with permanent VEP decrease, 3 (60%) experienced postoperative visual impairment. Permanent VEP decrease (OR 19.868, p = 0.007) and tight adhesion (OR 6.104, p = 0.040) were independent adverse factors for postoperative VA deterioration. Tight adhesion (OR 7.150, p = 0.002) and larger tumor volume (OR 1.066, p = 0.001) were significant risk factors for postoperative VF defects. CONCLUSIONS Intraoperative VEP monitoring can serve as a real-time warning to guide surgeons to avoid postoperative visual impairment. It effectively predicted VA changes in adult patients with craniopharyngioma after EEES. Tight adhesion and larger tumor volume were also strong predictors of postoperative visual impairment.

scholarly journals Prognostic Utility of Optical Coherence Tomography for Visual Outcome After Extended Endoscopic Endonasal Surgery for Adult Craniopharyngiomas

2022 ◽  
Vol 11 ◽  
Author(s):  
Ning Qiao ◽  
Chuzhong Li ◽  
Jing Xu ◽  
Guofo Ma ◽  
Jie Kang ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Field ◽  
Visual Outcome ◽  
Adult Patients ◽  
Optical Coherence ◽  
Patient Counseling ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Prognostic Utility

IntroductionOwing to the close vicinity of the optic chiasma, visual dysfunction is known as one of the most common surgical indications and postoperative complications in adult patients with craniopharyngiomas, probably leading to poor quality of life. Historically, very few consistent predictive factors associated with the visual outcome are identified, which may not be helpful for patient counseling and preoperative decision making. Recently, optical coherence tomography (OCT) serving as a novel high-resolution imaging technique can assess the retinal morphology by measuring the circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell complex thickness. However, few studies have examined the prognostic utility of OCT parameters for visual outcome after surgery for craniopharyngiomas. This study aims to use the largest series to evaluate the association between OCT parameters and visual outcome after extended endoscopic endonasal surgery (EEES) for primary craniopharyngiomas in adults.Material and MethodsFrom October 2018 to October 2020, one hundred and seventy eyes in 88 adult patients with newly confirmed craniopharyngiomas were retrospectively reviewed and pertinent prognostic factors were analyzed.ResultsGross total resection was performed in 82 (93.2%) patients. The median postoperative follow-up time was 10.9 months. Multiple logistic regression analysis showed that increased temporal cpRNFL thickness was associated with higher odds of visual acuity (VA) improvement and maintenance (OR = 1.070; 95% CI, 1.005–1.140; p = 0.035), and greater inferior cpRNFL thickness was significantly associated with visual field (VF) improvement and maintenance (OR = 1.034; 95% CI, 1.001–1.068; p = 0.046). Furthermore, tight adhesion between optic nerves and craniopharyngiomas was demonstrated as an independent adverse factor for either postoperative VA or VF (p = 0.048, p = 0.030, respectively). The ROC results further verified the robustness of the prediction model either in VA (AUC = 0.843; 95% CI, 0.734–0.952; p < 0.001) or VF (AUC = 0.849; 95% CI, 0.741–0.958; p < 0.001).ConclusionPreoperative OCT can effectively predict visual outcome after EEES for adult craniopharyngiomas. It can also serve as a reliable alternative to evaluate preoperative visual field defects, especially for patients with lower compliance. Tight adhesion was confirmed as an independent risk factor for postoperative visual outcome. The OCT-based multivariable prediction models developed in the present study may contribute to patient counseling on visual prognosis.

Efficacy of the visual evoked potential monitoring in endoscopic transnasal transsphenoidal surgery as a real-time visual function

2018 ◽  
Vol 66 (4) ◽  
pp. 1075 ◽  
Author(s):  
Daisuke Wajima ◽  
Fumihiko Nishimura ◽  
Young-Soo Park ◽  
Yasushi Motoyama ◽  
Ichiro Nakagawa ◽  
...  
Keyword(s):  
Real Time ◽  
Visual Function ◽  
Transsphenoidal Surgery ◽  
Visual Evoked Potential ◽  
Evoked Potential ◽  
Evoked Potential Monitoring ◽  
Visual Evoked ◽  
Potential Monitoring

Multifocal visual evoked potential evaluation for diagnosis of acute optic neuritis and for prediction of visual outcome and ganglion cell layer thinning following optic neuritis

2020 ◽  
pp. 135245852097573
Author(s):  
Gorm Pihl-Jensen ◽  
Benedikte Wanscher ◽  
Jette Lautrup Frederiksen
Keyword(s):  
Optic Neuritis ◽  
Ganglion Cell ◽  
Visual Function ◽  
Visual Evoked Potential ◽  
Evoked Potential ◽  
Conduction Block ◽  
Visual Outcome ◽  
Multifocal Visual Evoked Potential ◽  
Visual Evoked

Background:: While damage to the optic nerve following optic neuritis (ON) is readily quantifiable, the evaluation of prognosis for visual function and neuroaxonal loss in the acute ON is challenging. Objective:: The objective of this study is to investigate the value of multifocal visual evoked potential (mfVEP) in acute ON, diagnostically for acute ON and prognostically for visual outcome and subsequent ganglion cell/inner plexiform layer thickness (GCLIPLt). Methods:: A prospective cohort study of mfVEP and full-field visual evoked potential (ffVEP) in acute, unilateral ON (onset < 31 days) was conducted. Comparisons with healthy controls ( n = 30) and association analysis with follow-up optical coherence tomography (OCT) measurements (of the GCLIPLt) and visual function (Sloan low-contrast visual acuity (LCVA)) were conducted. Results:: Seventy-nine ON patients were included (mean: 17 days from onset). Excluding measurements with conduction block, ffVEP ( n = 54) and mfVEP ( n = 44) showed sensitivities of 89% and 84% to a specificity of 97%. 65/79 patients were re-examined (mean: 200 days follow-up). mfVEP amplitude and latency inter-eye asymmetry in acute ON correlated with GCLIPLt ( r = 0.587 and Spearman’s ρ = 0.597, for both, p < 0.001). mfVEP amplitude correlated with LCVA inter-eye asymmetry at follow-up ( r = 0.421, p < 0.001), mfVEP latency did not. Conclusion: mfVEP may support the prognostic evaluation of acute ON patients and prove valuable in future neuroprotective and remyelinating trials. In acute ON, the increase in diagnostic value of mfVEP to ffVEP may be limited due to widespread conduction block.

Surgical Outcomes of Endoscopic Endonasal Surgery in 29 Patients with Craniopharyngioma

2020 ◽  
Author(s):  
Arad Iranmehr ◽  
Mostafa Esmaeilnia ◽  
Khashayar Afshari ◽  
Seyed Mousa Sadrehosseini ◽  
Azin Tabari ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Visual Outcome ◽  
Extent Of Resection ◽  
Csf Leak ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Pituitary Dysfunction ◽  
Before And After

Abstract Background Recently the endoscopic endonasal surgery (EES) has been introduced as a modality for the treatment of patients with craniopharyngiomas. In this study, we describe our initial experience in treatment of 29 patients with craniopharyngiomas using this approach. Methods Twenty-nine consecutive patients with craniopharyngiomas who had undergone EES in a 5-year period were studied retrospectively. Patients underwent preoperative and postoperative endocrinologic and ophthalmologic evaluations. Radiologic characteristics of tumors and extent of resection were determined. The recurrence and complications were evaluated. Results Pituitary and visual dysfunction were observed preoperatively in 89.7 and 86% of patients, respectively. After EES, visual outcome either showed an improvement or else remained unchanged in 92.3% of the cases; however, pituitary function remained unchanged and even got worsened in 34.6% of the cases. Prevalence of diabetes insipidus before and after surgery was 58.6 and 69.2%. The rate of gross total resection was 62%. Moreover, 86.2% of the tumors were almost totally resected (more than 95% of the tumor size resected). After surgery, cerebrospinal fluid (CSF) leak and meningitis occurred in four (13.8%) and two (6.9%) patients, respectively. Perioperative mortality was seen in two of the cases (6.9%). The mean follow-up was 25 months and tumor recurrence was discovered in four patients (15.3%). Conclusion The EES with the goal of maximal and safe tumor resection could be used for the treatment of most craniopharyngiomas. Although the rates of visual improvement and gross tumor resection are high, CSF leak, pituitary dysfunction, and meningitis are serious concerns.

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

2021 ◽  
Author(s):  
Ridzky Firmansyah Hardian ◽  
Toshihiro Ogiwara ◽  
Atsushi Sato ◽  
Yu Fujii ◽  
Yota Suzuki ◽  
...  
Keyword(s):  
Visual Function ◽  
Predictive Value ◽  
Visual Evoked Potential ◽  
Evoked Potential ◽  
Light Stimulus ◽  
Warning Signal ◽  
Endoscopic Endonasal ◽  
Evoked Potential Monitoring ◽  
Flash Stimulation ◽  
Visual Evoked

Abstract 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.

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

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiaorong Tao ◽  
Xiaocui Yang ◽  
Xing Fan ◽  
Hao You ◽  
Yanwen Jin ◽  
...  
Keyword(s):  
Visual Evoked Potential ◽  
Evoked Potential ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Threshold Value ◽  
Endoscopic Endonasal ◽  
P100 Latency ◽  
Visual Deterioration ◽  
Vep Latency ◽  
Visual Evoked

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 &lt; 0.001). An extension over 8.61% in VEP latency was identified as a predictor of post-operative visual deterioration (p &lt; 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.

scholarly journals Cortical visual impairment in children with acute encephalitis syndrome

2016 ◽  
Vol 15 (2) ◽  
pp. 249-251
Author(s):  
Prastiya Indra Gunawan ◽  
Desi Primayani ◽  
Darto Saharso
Keyword(s):  
Visual Impairment ◽  
Visual Evoked Potential ◽  
Evoked Potential ◽  
Vision Loss ◽  
Medical Science ◽  
Central Nervous System Damage ◽  
Acute Encephalitis Syndrome ◽  
Acute Encephalitis ◽  
Cortical Visual Impairment ◽  
Visual Evoked

Background: Acute encephalitis syndrome (AES) is one of cortical visual impairment (CVI) causes. There were only few studies about cortical visual involvement in children with AES. Objective: To describe CVI in children with AES. Methods: This study included all children with AES during January to March 2014, were examined for visual evoked potential (VEP) to evaluate cortical visual pathway. AES was defined as clinical condition characterized by acute onset of fever, a change in mental status, and/or new onset of seizures. CVI was defined as vision loss caused by central nervous system damage confirmed by VEP. Results: There were 9 children with AES and all showed bilateral CVI. The age range between 6 to 48 months old, with 7 males and 2 females. Visual evoked potential result showed 8 children with demyelinating type and 1 with axonal type. Conclusion: Type of CVI caused by AES can be demyelinating type or axonal type.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.249-251

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