Protecting the Visual Pathways During Optic Nerve Surgery Using Intraoperative Visual Evoked Potentials (VEP)
By Admin | February 15, 2020
Protecting the Visual Pathways During Optic Nerve Surgery Using Intraoperative Visual Evoked Potentials (VEP)
Faisal R. Jahangiri, M.D., CNIM, D.ABNM, FASNM, FASET1,
Sidra Ilyas, MD2, Rabehah Asdi3, Esther Escobedo, CNIM1, Michael Seals, MD4
1Axis Neuromonitoring LLC, Richardson, TX;
2Dept. of Anatomy, School of Medicine, University of California, San Francisco, CA,
3School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX;
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.
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.
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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.
