Interpretation of the causes of instability of flash visual evoked potentials in intraoperative monitoring and proposal of a recording method for reliable functional monitoring of visual evoked potentials using a light-emitting device

Abstract

OBJECTIVE Effective monitoring and application of visual evoked potentials (VEPs) during neurosurgery is a major challenge. While many monitoring methods have been effectively used, the use of VEPs as an objective determination method has not been established. The purpose of this report was to present a method for overcoming this limitation according to the use of a specific stimulus. METHODS Data analysis was performed in 26 cases of brain surgery. Observation was carried out for 2 groups of responses: the response derived from the start of light emission, described as the on response, and the response derived from the end of light emission, described as the off response. These reactions were separated by extending the light emission time. The waves from the visual cortex were selected from each reaction following the start and the end of light emission with consideration for the characteristics of the potential distribution. The waves were observed to characterize changes resulting from variations in duration and quantity of light emission. The results of the analysis were used to determine the optimal emission time and amount of light for effective use of wave components during VEP monitoring. RESULTS Stable and recordable waves were observed by monitoring the off response, consisting of the P1-N1-P2 component, with a wave latency of approximately 100 msec. Since the off response was correlated with the input, the stable wave derived from the off response could be adjusted by changing the light emission time and intensity. Individual differences in the latency of the off response were decreased by extending the light emission time and reducing the quantity of light. However, it was difficult to achieve stability by adjusting the light intensity and emission time using the on response. The off response was confirmed to be sufficiently stable for intraoperative monitoring. Moreover, during 1 case in which manipulation of the optic nerve was necessary, reduction in the off response was found to occur when the nerve was manipulated and to reverse when the manipulation stopped. CONCLUSIONS The off response was shown to have the capacity to function as a monitoring tool, providing more stable wave forms than the on response. Recording conditions could be adjusted to achieve a light-emitting time of 500 msec and a light quantity of 8000 Lx. Stable monitoring of VEPs using light-emitting stimuli can contribute toward improving surgical outcomes.