Electrophysiological reactions to intraoperative irritation of the optic nerve. Case report and review of possible mechanisms.

Autor: Levin EA; Department of Angioneurology and Neurosurgery, Meshalkin National Medical Research Centre, Rechkunovskaya street, 15, 630055 Novosibirsk, Russian Federation. Electronic address: e_levin@meshalkin.ru., Kiselev RS; Department of Angioneurology and Neurosurgery, Meshalkin National Medical Research Centre, Rechkunovskaya street, 15, 630055 Novosibirsk, Russian Federation; Department of Neurosurgery, Meshalkin National Medical Research Centre, Rechkunovskaya street, 15, 630055 Novosibirsk, Russian Federation. Electronic address: r_kiselev@meshalkin.ru., Vasyatkina AG; Department of Neurosurgery, Meshalkin National Medical Research Centre, Rechkunovskaya street, 15, 630055 Novosibirsk, Russian Federation. Electronic address: a_vasjatkina@meshalkin.ru., Semin PA; Department of Neurosurgery, Meshalkin National Medical Research Centre, Rechkunovskaya street, 15, 630055 Novosibirsk, Russian Federation. Electronic address: semin_p@meshalkin.ru.
Jazyk: angličtina
Zdroj: Neuro-Chirurgie [Neurochirurgie] 2022 Feb; Vol. 68 (2), pp. 223-227. Date of Electronic Publication: 2021 Apr 15.
DOI: 10.1016/j.neuchi.2021.03.014
Abstrakt: Background: Intraoperative control of optic nerve function conservation during neurosurgical operations currently relies mainly on visual evoked potential monitoring. Unfortunately, this detects peril only when the visual pathways are already compromised, sometimes irreversibly. In contrast, electrophysiological stimulation mapping of the nerves can be a fully preventive measure. However, direct sensory nerve mapping requires the patient to be awake during surgery, which is unfeasible for surgeries targeting the optic nerve area. Another possible approach to sensory nerve mapping involves unconditioned electrophysiological responses evoked by sensory nerve stimulation. The key point for this approach is the possibility of obtaining such responses for a particular sensory nerve under surgical anesthesia.
Case Report: A 52-year-old woman presented with meningioma in the area of right optic nerve and chiasm. She underwent microsurgical removal of the tumor through the transciliary supraorbital approach. During surgery, electrodes at the inferior margin of the right orbit repeatedly recorded electrophysiological reactions following contacts and displacements of the right optic nerve by the surgical instruments.
Conclusions: The observed reactions suggest that either the unconditioned blink reflex or antidromic electroretinographic response to optic nerve irritation was conserved under total intravenous anesthesia. This observation might be of value for development of intraoperative optic nerve mapping. This in turn could increase patient safety by identifying the exact optic nerve location before any negative impact on it.
(Copyright © 2021 Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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