From the Department of Medical Imaging,The Ottawa Hospital,Ottawa, ON,Canada.
Department of Surgery, Division of Neurosurgery,The Ottawa Hospital,Ottawa, ON,Canada.
Can J Neurol Sci. 2019 May;46(3):295-302. doi: 10.1017/cjn.2019.4. Epub 2019 Mar 14.
To determine the relationship between intraoperative flash visual evoked potential (FVEP) monitoring and visual function.
Intraoperative FVEPs were recorded from electrodes placed in the scalp overlying the visual cortex (Oz) after flashing red light stimulation delivered by Cadwell LED stimulating goggles in 89 patients. Restrictive filtering (typically 10-100 Hz), optimal reject window settings, mastoid reference site, total intravenous anesthetic (TIVA), and stable retinal stimulation (ensured by concomitant electroretinogram [ERG] recording) were used to enhance FVEP reproducibility.
The relationship between FVEP amplitude change and visual outcome was determined from 179 eyes. One eye had a permanent intraoperative FVEP loss despite stable ERG, and this eye had new, severe postoperative visual dysfunction. Seven eyes had transient significant FVEP change (>50% amplitude decrease that recovered by the end of surgery), but only one of those had a decrease in postoperative visual acuity. FVEP changes in all eight eyes (one permanent FVEP loss plus seven transient FVEP changes) were related to surgical manipulation. In each case the surgeon was promptly informed of the FVEP deterioration and took remedial action. The other eyes did not have FVEP changes, and none of those eyes had new postoperative visual deficits.
Our FVEP findings relate to visual outcome with a sensitivity and specificity of 1.0. New methods for rapidly acquiring reproducible FVEP waveforms allowed for timely reporting of significant FVEP change resulting in prompt surgical action. This may have accounted for the low postoperative visual deficit rate (1%) in this series.
确定术中闪光视觉诱发电位（FVEP）监测与视觉功能之间的关系。
在 89 例患者中，使用 Cadwell LED 刺激护目镜闪烁红光刺激后，在头皮上覆盖视觉皮层（Oz）的电极记录术中 FVEP。采用限制滤波（通常为 10-100 Hz）、最佳拒绝窗口设置、乳突参考部位、全静脉麻醉（TIVA）和稳定的视网膜刺激（通过同时记录视网膜电图 [ERG] 来确保）来增强 FVEP 的可重复性。
从 179 只眼中确定了 FVEP 振幅变化与视觉结果之间的关系。一只眼睛尽管 ERG 稳定，但术中 FVEP 永久性丧失，该眼术后出现新的严重视力障碍。7 只眼睛的 FVEP 出现短暂的显著变化（>振幅降低 50%，在手术结束时恢复），但只有 1 只眼睛的术后视力下降。8 只眼睛（1 只永久性 FVEP 丧失加 7 只暂时性 FVEP 变化）的 FVEP 变化与手术操作有关。在每种情况下，都及时告知外科医生 FVEP 恶化情况，并采取补救措施。其他眼睛没有 FVEP 变化，这些眼睛中没有新的术后视力缺陷。
我们的 FVEP 发现与视觉结果相关，敏感性和特异性均为 1.0。快速获取可重复 FVEP 波形的新方法可及时报告显著的 FVEP 变化，从而及时采取手术措施。这可能是本系列术后视力缺陷率（1%）较低的原因。
