P.008 Anterior skull base surgery future: intraoperative flash visual evoked potentials a novel technique to lessen intraoperative optic nerves and chiasmal injury

Abstract

Background: Optic nerve/chiasmal injury is a devastating outcome that may happen during endoscopic surgery. Additionally, one of the goals of endoscopic skull-base surgery is visual improvement, currently there is limited ability of intraoperative visual pathway monitoring. We examine a novel technique using continuous flash visual evoked potentials (FVEPs). Methods: Eyes were stimulated by light stimulators (3 LEDs on each side, 640 nm peak wavelength, 10 ms pulse width, 3000 mCd of luminous intensity). Uniform illumination was placed over eyelids. Recording electrodes were placed at Oz-Fz. The filter cuts were ≤5 Hz and 100 Hz with amplifier gain 20,000 or 50,000. EEG was recorded. Recordings were correlated to pre and post operative VFs and acuity. Droop in the FVEP was examined in relation to intraoprative events. Results: Thirty patients had FVEPs in addition to other neurophysiologic monitoring. Patients demographic data, co-morbidities, diagnosis, surgical approach, length of surgery, MAP, and blood loss during surgery were recorded. All patients’ visual acuity and field deficits were evaluated by neuro-opthalmologist before their surgery and within 30 days after surgery. Conclusions: FVEP is reproducible throughout surgery and can predict the post surgical outcome. Additionally, we found that FVEP is transiently affected by different stages of surgery. Also boluses of propofol and electrocautery can artificially affect FVEP.