Abstract
This paper reports the case of a patient with optic nerve schwannoma and the first use of neurophysiological intraoperative monitoring of visual evoked potentials during the removal of such tumor with no postoperative visual damage. Schwannomas are benign neoplasms of the peripheral nervous system arising from the neural crest-derived Schwann cells, these tumors are rarely located in the optic nerve and the treatment consists on surgical removal leading to high risk of damage to the visual pathway. Case report of a thirty-year-old woman with an optic nerve schwannoma. The patient underwent surgery for tumor removal on the left optic nerve through a left orbitozygomatic approach with intraoperative monitoring of left II and III cranial nerves. We used Nicolet Endeavour CR IOM (Carefusion, Middleton WI, USA) to performed visual evoked potentials stimulating binocularly with LED flash goggles with the patient´s eyes closed and direct epidural optic nerve stimulation delivering rostral to the tumor a rectangular current pulse. At follow up examinations 7 months later, the left eye visual acuity was 20/60; Ishihara score was 8/8 in both eyes; the right eye photomotor reflex was normal and left eye was mydriatic and arreflectic; optokinetic reflex and ocular conjugate movements were normal. In this case, the epidural direct electrical stimulation of optic nerve provided stable waveforms during optic nerve schwannoma resection without visual loss.
References
Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114:97–109. doi:10.1007/s00401-007-0243-4.
Kim D-S, Choi J-U, Yang K-H, Jung J-M. Optic sheath schwannomas: report of two cases. Childs Nerv Syst. 2002;18:684–9. doi:10.1007/s00381-002-0663-3.
Kinoshita Y, Kurosaki M, Kamitani H, Watanabe T. Schwannoma originating in the optic canal. Acta Neurochir (Wien). 2008;50:89–90. doi:10.1007/s00701-007-1452-2.
Kulkarni RG, Satalkar VY, Bhawthankar AW. Neurilemmoma of optic nerve. Indian J Ophthalmol. 1980;28:95–6.
Simpson RK, Harper RL, Kirkpatrick JB, Cooper B. Schwannoma of the optic sheath. J Clin Neuroophthalmol. 1987;7:219–22.
Ramey WL, Arnold SJ, Chiu A, Lemole M. A rare case of optic nerve Schwannoma: case report and review of the literature. Cureus. 2015;18(7):e265. doi:10.7759/cureus.265.
Cedzich C, Schramm J, Fahlbusch R. Are flash-evoked visual potentials useful for intraoperative monitoring of visual pathway function? Neurosurgery. 1987;21:709–15.
Cedzich C, Schramm J, Mengedoht CF, Fahlbusch R. Factors that limit the use of flash visual evoked potentials for surgical monitoring. Electroencephalogr Clin Neurophysiol. 1988;71:142–5.
Cedzich C, Schramm J. Monitoring of flash visual evoked potentials during neurosurgical operations. Int Anesthesiol Clin. 1990;28:165–9.
Chacko AG, Babu KS, Chandy MJ. Value of visual evoked potential monitoring during trans-sphenoidal pituitary surgery. Br J Neurosurg. 1996;10:275–8.
Chung S-B, Park C-W, Seo D-W, Kong D-S, Park S-K. Intraoperative visual evoked potential has no association with postoperative visual outcomes in transsphenoidal surgery. Acta Neurochir (Wien). 2012;154:1505–10. doi:10.1007/s00701-012-1426-x.
Costa e Silva I I, Wang AD, Symon L. The application of flash visual evoked potentials during operations on the anterior visual pathways. Neurol Res. 1985;7:11–6.
Feinsod M, Selhorst JB, Hoyt WF, Wilson CB. Monitoring optic nerve function during craniotomy. J Neurosurg. 1976;44:29–31. doi:10.3171/jns.1976.44.1.0029.
Goto T, Tanaka Y, Kodama K, Kusano Y, Sakai K, Hongo K. Loss of visual evoked potential following temporary occlusion of the superior hypophyseal artery during aneurysm clip placement surgery. Case report. J Neurosurg. 2007;107:865–7. doi:10.3171/JNS-07/10/0865.
Harding GF, Bland JD, Smith VH. Visual evoked potential monitoring of optic nerve function during surgery. J Neurol Neurosurg Psychiatry. 1990;53:890–5. doi:10.1136/jnnp.53.10.890.
Hussain SS, Laljee HC, Horrocks JM, Tec H, Grace AR. Monitoring of intra-operative visual evoked potentials during functional endoscopic sinus surgery (FESS) under general anaesthesia. J Laryngol Otol. 1996;110:31–6.
Kamada K, Todo T, Morita A, Masutani Y, Aoki S, Ino K, Kawai K, Kirino T. Functional monitoring for visual pathway using real-time visual evoked potentials and optic-radiation tractography. Neurosurgery. 2005;57:121–7.
Kamio Y, Sakai N, Sameshima T, Takahashi G, Koizumi S, Sugiyama K, Namba H. Usefulness of intraoperative monitoring of visual evoked potentials in transsphenoidal surgery. Neurol Med Chir (Tokyo). 2014;54:606–11.
Luo Y, Regli L, Bozinov O, Sarnthein J. Clinical utility and limitations of intraoperative monitoring of visual evoked potentials. PLoS One. 2015;10:e0133819. doi:10.1371/journal.pone.0133819.
Raudzens PA. Intraoperative monitoring of evoked potentials. Ann N Y Acad Sci. 1982;388:308–26.
Sasaki T, Itakura T, Suzuki K, Kasuya H, Munakata R, Muramatsu H, Ichikawa T, Sato T, Endo Y, Sakuma J, Matsumoto M. Intraoperative monitoring of visual evoked potential: introduction of a clinically useful method. J Neurosurg. 2010;112:273–84. doi:10.3171/2008.9.JNS08451.
Thirumala PD, Habeych ME, Crammond DJ, Balzer JR. Neurophysiologic intraoperative monitoring of olfactory and optic nerves. J Clin Neurophysiol. 2011;28:538–42. doi:10.1097/WNP.0b013e31823e954e.
Wiedemayer H, Fauser B, Armbruster W, Gasser T, Stolke D. Visual evoked potentials for intraoperative neurophysiologic monitoring using total intravenous anesthesia. J Neurosurg Anesthesiol. 2003;15:19–24.
Wiedemayer H, Fauser B, Sandalcioglu IE, Armbruster W, Stolke D. Observations on intraoperative monitoring of visual pathways using steady-state visual evoked potentials. Eur J Anaesthesiol. 2004;21:429–33.
Wilson WB, Kirsch WM, Neville H, Stears J, Feinsod M, Lehman RA. Monitoring of visual function during parasellar surgery. Surg Neurol. 1976;5:323–9.
Wright JE, Arden G, Jones BR. Continuous monitoring of the visually evoked response during intra-orbital surgery. Trans Ophthalmol Soc UK. 1973;93:311–4.
Kodama K, Goto T, Sato A, Sakai K, Tanaka Y, Hongo K. Standard and limitation of intraoperative monitoring of the visual evoked potential. Acta Neurochir (Wien). 2010;152:643–8.
Jones NS. Visual evoked potentials in endoscopic and anterior skull base surgery: a review. J Laryngol Otol. 1997;111:513–6.
Benedičič M, Bošnjak R. Intraoperative monitoring of the visual function using cortical potentials after electrical epidural stimulation of the optic nerve. Acta Neurochir (Wien). 2011;153:1919–27. doi:10.1007/s00701-011-1098-y.
Benedičič M, Bošnjak R. Optic nerve potentials and cortical potentials after stimulation of the anterior visual pathway during neurosurgery. Doc Ophthalmol. 2011;122:115–25. doi:10.1007/s10633-011-9265-2.
Bošnjak R, Bošnjak R. Direct epidural electrical stimulation of the optic nerve: a new method for intraoperative assessment of function. J Neurosurg. 2008;109:647–53. doi:10.3171/JNS/2008/109/10/0647.
Kikuchi Y, Sasaki T, Matsumoto M, Oikawa T, Itakura T, Kodama N. Optic nerve evoked potentials elicited by electrical stimulation. Neurol Med Chir. 2005;45:349–55.
Chi OZ, Ryterband S, Field C. Visual evoked potentials during thiopentone-fentanyl-nitrous oxide anaesthesia in humans. Can J Anaesth. 1989;36:637–40.
Domino EF, Corssen G, Sweet RB. Effects of various general anesthetics on the visually envoked response in man. Anesth Analg. 1963;42:735–47.
Wang AD, Costa e Silva I, Symon L, Jewkes D. The effects of halothane on somatosensory and flash visual evoked potentials during operations. Neurol Res. 1985;7:58–62.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Rights and permissions
About this article
Cite this article
San-juan, D., Escanio Cortés, M., Tena-Suck, M. et al. Neurophysiological intraoperative monitoring during an optic nerve schwannoma removal. J Clin Monit Comput 31, 1059–1064 (2017). https://doi.org/10.1007/s10877-016-9932-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10877-016-9932-7