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Monitoring of visual-evoked potentials during fat packing in endoscopic resection of a giant pituitary adenoma

  • 0Department of Neurosurgery, Brigham and Women's Hospital, Boston, United States.
Surgical Neurology International +

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November 11, 2024

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November 11, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Visual-evoked potentials (VEPs) may not reliably monitor optic nerve integrity during endoscopic transsphenoidal surgery. Careful VEP assessment and anesthetic choice are crucial, especially for patients with pre-existing visual deficits.

Area Of Science

  • Neurosurgery
  • Ophthalmology
  • Neurophysiology

Background

  • Endoscopic transsphenoidal surgery is a primary approach for sellar pathologies, aiming to decompress optic nerves.
  • Visual-evoked potentials (VEPs) are used intraoperatively to monitor optic pathway integrity during these surgeries.
  • The reliability and efficacy of VEPs in this context are subject to ongoing research and present heterogeneous data.

Observation

  • A case involved an 80-year-old male with a pituitary macroadenoma causing visual deficits.
  • During surgery, VEPs decreased, then appeared to improve after partial fat removal, despite paradoxical latency changes.
  • Postoperatively, the patient experienced a visual field deficit, necessitating further surgical intervention.

Findings

  • The observed VEP improvement was likely an artifact due to noise contamination, creating a false impression of signal enhancement.
  • Shortened VEP latencies can be misleading and do not necessarily indicate improved optic nerve function.
  • Baseline VEP reproducibility is critical, especially in patients with compromised pre-existing visual fields.

Implications

  • Careful interpretation of VEP data, considering baseline reproducibility and potential noise interference, is essential.
  • Anesthetic selection plays a role in minimizing electroencephalogram noise that can affect VEP accuracy.
  • This case highlights potential pitfalls in using VEPs for intraoperative neuromonitoring during transsphenoidal surgeries for sellar pathologies.

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