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Pediatric craniopharyngioma with significantly increased intraoperative visual evoked potential amplitude and
Yuichi Oda1, Kosaku Amano2, Kentaro Chiba1
1Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan.
Insights
Visual evoked potential (VEP) monitoring during surgery for pediatric craniopharyngioma showed improved VEP amplitude after tumor removal. This correlated with significant postoperative visual acuity recovery.
Area of Science:
- Neuroscience
- Ophthalmology
- Neurosurgery
Background:
- Visual evoked potential (VEP) is crucial for preserving visual function during brain tumor resection.
- Craniopharyngiomas, particularly in pediatric cases, can cause significant visual disturbances due to their location.
Observation:
- A 13-year-old boy with worsening vision underwent endoscopic transsphenoidal surgery for a suprasellar craniopharyngioma.
- Intraoperative VEP monitoring revealed unstable signals pre-resection, with significant wave detection post-tumor debulking.
Findings:
- Gross total tumor resection was achieved with preservation of critical vasculature.
- A marked increase in VEP amplitude was observed intraoperatively, coinciding with optic nerve decompression.
- Postoperative visual acuity showed remarkable improvement.
Implications:
- Intraoperative VEP monitoring can guide safe resection of suprasellar tumors affecting vision.
- VEP amplitude changes may reflect optic pathway compression and decompression.
- This case highlights the efficacy of VEP in managing pediatric craniopharyngioma and visual deficits.
Abstract:
Visual evoked potential (VEP) is an established modality that allows safe brain tumor resection and preservation of optical function. We herein present a case of a pediatric craniopharyngioma with significant improvement in the VEP amplitude detected during endoscopic transsphenoidal surgery (ETS) and obvious postoperative improvement in visual acuity. A 13-year-old boy presented with visual acuity disturbance in his right eye and was followed up for 5 months by an ophthalmologist. His visual acuity rapidly worsened, and a suprasellar lesion with calcification was found on brain computed tomography. The patient underwent tumor resection during ETS with intraoperative transcranial VEP monitoring. Gross total tumor resection was achieved without injury to the perforators, including the superior hypophyseal arteries. The VEP amplitude was unstable, and significant waves were not detectable before tumor resection; however, a positive wave was detected after removing most of the tumor and exposing the bilateral optic nerves and optic chiasm. Subsequently, negative and positive VEP waves were continuously detected. Visual acuity improved remarkably on postoperative day 10. This case demonstrated both a significant increase in the intraoperative VEP amplitude and rapid postoperative improvement in visual acuity. We surmised that the preoperative rapid worsening of visual dysfunction, intraoperative increase in the VEP amplitude, and significant postoperative improvement in visual acuity were associated with the compression of the optic nerves by the internal carotid artery, anterior cerebral artery, and tumor.
