Comparison Between Conventional Flash and Off-Response Intraoperative Visual Evoked Potential Monitoring for Endoscopic Endonasal Surgery.
Comparison Between Conventional Flash and Off-Response Intraoperative Visual Evoked Potential Monitoring for Endoscopic Endonasal Surgery.
复制标题
内窥镜鼻内手术中传统闪光和失反应术中视觉诱发电位监测的比较。
DOI：
10.1093/ons/opab329
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Horiuchi T
中科院分区：
文献类型：
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作者：
Hardian RF;Ogiwara T;Sato A;Fujii Y;Suzuki Y;Hanaoka Y;Miyata M;Kamiya K;Sasaki T;Goto T;Hongo K;Horiuchi T
术中闪光刺激视觉诱发电位(VEP)监测已用于鼻内窥镜手术(EEA)。为评价无反应性VEP监测与常规闪光刺激VEP监测的异同。方法自2015年3月至2020年3月，对70例(140眼)EEA手术患者进行术中VEP监测，并与常规的闪光刺激VEP监测进行比较。光刺激由一对护目镜电极传递。记录电极放置在头皮枕区上方。警告信号是由于VEP的峰间波幅与初始波幅相比降低了50%以上。术前、术后分别进行视功能评定。比较闪光和非反应VEP监测结果。结果134只眼记录到VEP。23只眼出现警告信号(暂时性17只眼，永久性6只眼)。2眼闪光VEP监测显示永久性VEP衰减，其中1例术后视功能恶化。4只眼非反应性VEP监测显示永久性VEP衰减，其中2例术后视功能恶化。闪光刺激VEP的敏感度、特异度、阳性预测值和阴性预测值分别为100%、98.9%、50%和100%，而非反应性VEP的敏感度、特异度、阳性预测值和阴性预测值分别为100%、97.8%、50%和100%。无反应VEP监测不逊于常规闪光刺激VEP监测。
BACKGROUNDIntraoperative 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.OBJECTIVETo evaluate off-response VEP monitoring in comparison with the conventional flash stimulation VEP monitoring for EEA.METHODSFrom 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.RESULTSVEP 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.CONCLUSIONVEP monitoring was useful to monitor visual function in EEA surgery. Off-response VEP monitoring was not inferior to conventional flash stimulation VEP monitoring.