Cochard Eva, Bérard Nadia, Schaller Karl, Boëx Colette
Department of Neurosurgery, "Hôpitaux Universitaires de Genève", Genève, Switzerland.
Faculty of Medicine, "Université de Genève", Genève, Switzerland.
J Clin Neurophysiol. 2024 Nov 7;42(5):444-450. doi: 10.1097/WNP.0000000000001129.
The objectives of the study were to evaluate the validity of intraoperative flash visual evoked potentials (VEPs) when electroretinograms (ERGs) were unstable, to compare white versus red light-emitting diodes, and to assess the impact of luminance on ERG variability.
Thirty patients were included (Inomed system; pre- and postoperative visual fields). Possible changes in visual fields were assessed with mean defects in perimetry. The receiver operating characteristic (ROC) curves of normalized VEPs and of normalized and corrected VEPs with ERGs were compared.
Thirty-two eyes could be analyzed in 20 patients (mainly gliomas and meningiomas): 2 had a severe defect in their visual field, and 6 had a mild defect. The receiver operating characteristic curve indicated (1) normalized and corrected VEPs with ERGs were more reliable than normalized VEPs only ( P < 0.03) and (2) an alarm threshold of 80% of normalized and corrected VEPs. No significant difference in variability of ERGs was found with white or red light-emitting diodes with this system. Increased luminance improved stability of ERGs ( P < 0.05).
Normalization and correction of VEPs with ERGs improved the validity of VEPs and indicated a 20% decrease as alarm criterion. This normalization and correction with peripheral excitation could be generalized to improve the reliability of neuromonitoring.
本研究的目的是评估在视网膜电图（ERG）不稳定时术中闪光视觉诱发电位（VEP）的有效性，比较白色与红色发光二极管，并评估亮度对ERG变异性的影响。
纳入30例患者（Inomed系统；术前和术后视野）。用视野检查中的平均缺损评估视野可能的变化。比较了标准化VEP以及与ERG相关的标准化和校正后VEP的受试者操作特征（ROC）曲线。
20例患者（主要为胶质瘤和脑膜瘤）的32只眼可进行分析：2只眼视野有严重缺损，6只眼视野有轻度缺损。受试者操作特征曲线表明：（1）与ERG相关联的标准化和校正后VEP比仅标准化VEP更可靠（P < 0.03）；（2）标准化和校正后VEP的警报阈值为80%。使用该系统时，白色或红色发光二极管在ERG变异性方面未发现显著差异。亮度增加可提高ERG的稳定性（P < 0.05）。
用ERG对VEP进行标准化和校正可提高VEP的有效性，并表明以降低20%作为警报标准可行。这种外周刺激下的标准化和校正可推广应用以提高神经监测的可靠性。
