Artikel
Change in operative management leads to an improvement of visually evoked potentials (VEPs) in surgery of brain tumours involving the visual pathway
Änderung des operativen Vorgehens führt zu einer Verbesserung von visuell evozierten Potentialen (VEP) bei Operationen von Tumoren der Sehbahn
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Veröffentlicht: | 25. Mai 2022 |
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Objective: The aim of the study was to investigate whether a change in perioperative visually evoked potentials (VEPs) correlates with the postoperative visual acuity in patients undergoing brain tumor surgery and whether a change in operative strategy/perioperative management can influence outcome.
Methods: Data from 120 patients undergoing surgery for brain tumors involving the visual pathway at our department between 2017 and 2019 in whom intraoperative VEPs were recorded, were analyzed retrospectively. Visual acuity was assessed pre- and postoperatively. Changes in VEP amplitude of <20% were considered to be significant. The reaction of the surgical team to the changes was obtained (including adjustment of surgical strategy, application of intravenous nimodipine, and modification of blood pressure).
Results: Stable and reproducible VEPs could be obtained in 86.7 % of all patients. A deterioration occurred in 12.5% of all cases (15 patients). A VEP deterioration correlated with a post-operative worsening of visual acuity in 5/15 patients. In the remaining 10 patients, a change in surgical strategy or/and rheological parameters resulted in an improvement of the VEP signal. In 8/10 patients, visual acuity remained stable compared to baseline findings, in 2/10 patients, eyesight improved.
Conclusion: VEP monitoring in tumors affecting the visual pathway has become an indispensable tool in modern neurosurgery. While intraoperative deterioration of the VEP signal is often correlated with a postoperative worsening in visual acuity, it is not necessarily irreversible. A timely change of surgical strategy as well as improvement of perioperative parameters such as blood pressure and rheology might positively affect postoperative outcome.