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  • Direct epidural electrical stimulation of the optic nerve : a new method for intraoperative assessment of function
    Bošnjak, Roman ; Benedičič, Mitja
    Intraoperative visual system monitoring of lesions with a close relationship to the optic apparatus by using light flashes reportedly is difficult to perform, and the results are too unreliable to ... interpret. The authors used direct epidural electrical stimulation of the optic nerve (ON) during surgery instead of light flashes. Four patients were included in this feasibility study. In 3 patients-1 each harboring a planum sphenoidale meningioma, a tuberculum sellae meningioma, and an intraorbital ON sheath meningioma-2 stimulating needle electrodes were placed on each side of the ON just anteriorto the optic canal, before unroofing the optic canal and an extradural anterior clinoidectomy. In the fourth patient, who harbored a frontotemporal astrocytoma, stimulation was applied at the exit of the ON fromthe canal. The electrically induced visual evoked potentials (eVEPs) wererecorded from the scalp before, during, and after tumor removal. A typicaleVEP consisted of N20 and N40 waves. The amplitude of the N40 wave varied up to 25% prior to tumor removal. In the patient with a symptomatic tuberculum sellae meningioma, the decompressive effect of opening the optic canal and the impact of manipulation during piecemeal tumor removal were detected by the eVEPs. In the patient with an ON sheath meningioma and light sensation, only the N20 wave was observed. Epidural electrical stimulation of the ON is a safe means of providing a stable signal and real-time informationon nerve conduction during surgery. It may be a useful adjunct in improving visual outcomes postoperatively. Further clinical studies are necessary.
    Source: Journal of neurosurgery. - ISSN 0022-3085 (Letn. 109, št. 4, 2008, str. 647-653)
    Type of material - article, component part
    Publish date - 2008
    Language - english
    COBISS.SI-ID - 27566553
    DOI

source: Journal of neurosurgery. - ISSN 0022-3085 (Letn. 109, št. 4, 2008, str. 647-653)
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