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

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.

Quantifying the Speed of Chromatophore Activity at the Single-Organ Level in Response to a Visual Startle Stimulus in Living, Intact Squid

The speed of adaptive body patterning in coleoid cephalopods is unmatched in the natural world. While the literature frequently reports their remarkable ability to change coloration significantly faster than other species, there is limited research on the temporal dynamics of rapid chromatophore coordination underlying body patterning in living, intact animals. In this exploratory pilot study, we aimed to measure chromatophore activity in response to a light flash stimulus in seven squid, Doryteuthis pealeii. We video-recorded the head/arms, mantle, and fin when squid were presented with a light flash startle stimulus. Individual chromatophores were detected and tracked over time using image analysis. We assessed baseline and response chromatophore surface area parameters before and after flash stimulation, respectively. Using change-point analysis, we identified 4,065 chromatophores from 185 trials with significant surface area changes elicited by the flash stimulus. We defined the temporal dynamics of chromatophore activity to flash stimulation as the latency, duration, and magnitude of surface area changes (expansion or retraction) following the flash presentation. Post stimulation, the response’s mean latency was at 50 ms (± 16.67 ms), for expansion and retraction, across all body regions. The response duration ranged from 217 ms (fin, retraction) to 384 ms (heads/arms, expansion). While chromatophore expansions had a mean surface area increase of 155.06%, the retractions only caused a mean reduction of 40.46%. Collectively, the methods and results described contribute to our understanding of how cephalopods can employ thousands of chromatophore organs in milliseconds to achieve rapid, dynamic body patterning.

Contactless recordings of retinal activity using optically pumped magnetometers

Optically pumped magnetometers (OPMs) have been adopted for the recording of brain activity. Without the need to be cooled to cryogenic temperatures, an array of these sensors can be placed more flexibly, which allows for the recording of neuronal structures other than neocortex. Here we use eight OPM sensors to record human retinal activity following flash stimulation. We compare this magnetoretinographic (MRG) activity to the simultaneously recorded electroretinogram of the eight participants. The MRG shows the familiar flash-evoked potentials (a-wave and b-wave) and shares a highly significant amount of information with the electroretinogram recording (both in a simultaneous and separate recording). We conclude that OPM sensors have the potential to become a contactless alternative to fiber electrodes for the recording of retinal activity. Such a contactless solution can benefit both clinical and neuroscientific settings.

Seizure triggered by flicker electroretinogram in a patient with no history of epilepsy

Purpose It is well known that repetitive flash stimulation may trigger seizures in susceptible individuals. Nevertheless, reports of such incidents occurring during recording of a flash electroretinogram (ERG) are extremely rare. Here, we describe the case of a photic-induced seizure triggered during an ERG recording in the absence of a history of epilepsy or other paroxysmal events. Methods A 14-year-old male patient presented with reduced visual acuity and impaired mesopic vision. Ophthalmological exams confirmed the patient’s complaints but were inconclusive as to the underlying pathophysiology. An ERG recording was performed, during which the 30-Hz flicker stimulus triggered a seizure. Results The ERG was essentially normal, with the exception of a 7-Hz rhythm superimposed onto the flicker ERG response that was recorded when the seizure developed. Conclusions The present case highlights the possibility that the 30-Hz ERG flash stimulus triggers a seizure in patients with no previous paroxysmal events. Literature evidence suggests that the likelihood of such an incident could be reduced by stimulating monocularly.

Source localization of S-cone and L/M-cone driven signals using silent substitution flash stimulation

This study aimed to analyze the neuronal sources of the visual evoked potentials after flash stimulation of the S- and the L/M-cone driven channels of the visual system. For 11 volunteers a 64-channel electroencephalography (EEG) was recorded during selective excitation of both color opponent channels. Individual and grand average data were analyzed topographically. Source localization was carried out using a realistically shaped three compartment boundary element model (BEM) and a mirrored moving dipole model. We found two main components (N1, P1) in all subjects, as well as a third late component in most subjects. For these components significant latency differences (N1=33 ms, P1=22 ms; p<0.05) between both color opponent channels were found. The results showed no differences in the topography and no differences in dipole localization between both color channels. Talairach coordinates of grand averages indicated activation in area 18. Comparison of results of separately stimulated eyes revealed no differences. Our findings showed that neural processing occurs in the same areas of the visual cortex for stimuli with different spectral properties. The signals of S- and L/M-cone driven channels are transmitted in distinct pathways to the cortex. Thus, the observed latency differences might be caused by different anatomical and functional properties of these pathways.

Critical Changes in Cortical Neuronal Interactions in Anesthetized and Awake Rats

Background: Neuronal interactions are fundamental for information processing, cognition, and consciousness. Anesthetics reduce spontaneous cortical activity; however, neuronal reactivity to sensory stimuli is often preserved or augmented. How sensory stimulus–related neuronal interactions change under anesthesia has not been elucidated. In this study, the authors investigated the visual stimulus–related cortical neuronal interactions during stepwise emergence from desflurane anesthesia. Methods: Parallel spike trains were recorded with 64-contact extracellular microelectrode arrays from the primary visual cortex of chronically instrumented, unrestrained rats (N = 6) at 8, 6, 4, and 2% desflurane anesthesia and wakefulness. Light flashes were delivered to the retina by transcranial illumination at 5- to 15-s randomized intervals. Information theoretical indices, integration and interaction complexity, were calculated from the probability distribution of coincident spike patterns and used to quantify neuronal interactions before and after flash stimulation. Results: Integration and complexity showed significant negative associations with desflurane concentration (N = 60). Flash stimulation increased integration and complexity at all anesthetic levels (N = 60); the effect on complexity was reduced in wakefulness. During stepwise withdrawal of desflurane, the largest increase in integration (74%) and poststimulus complexity (35%) occurred before reaching 4% desflurane concentration—a level associated with the recovery of consciousness according to the rats’ righting reflex. Conclusions: Neuronal interactions in the cerebral cortex are augmented during emergence from anesthesia. Visual flash stimuli enhance neuronal interactions in both wakefulness and anesthesia; the increase in interaction complexity is attenuated as poststimulus complexity reaches plateau. The critical changes in cortical neuronal interactions occur during transition to consciousness.