Document Detail

Standard and limitation of intraoperative monitoring of the visual evoked potential.
MedLine Citation:
PMID:  20127123     Owner:  NLM     Status:  MEDLINE    
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.
Kunihiko Kodama; Tetsuya Goto; Atsushi Sato; Keiichi Sakai; Yuichiro Tanaka; Kazuhiro Hongo
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2010-02-02
Journal Detail:
Title:  Acta neurochirurgica     Volume:  152     ISSN:  0942-0940     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-24     Completed Date:  2010-06-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  643-8     Citation Subset:  IM    
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto 390-8621, Japan.
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MeSH Terms
Blindness / diagnosis,  physiopathology
Brain Diseases / physiopathology,  surgery*
Cerebral Cortex / physiopathology,  surgery*
Dominance, Cerebral / physiology
Evoked Potentials, Visual / physiology*
Intracranial Aneurysm / physiopathology,  surgery
Middle Aged
Monitoring, Intraoperative*
Nerve Compression Syndromes / physiopathology,  surgery
Optic Nerve Diseases / physiopathology,  surgery
Orbital Diseases / physiopathology,  surgery*
Photic Stimulation
Pituitary ACTH Hypersecretion / physiopathology,  surgery
Pituitary Diseases / physiopathology,  surgery*
Postoperative Complications / diagnosis,  physiopathology*
Risk Factors
Sensitivity and Specificity
Vision Disorders / diagnosis,  physiopathology*
Visual Acuity / physiology
Visual Fields / physiology

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