Advertisement

Journal of Clinical Monitoring and Computing

, Volume 32, Issue 5, pp 889–895 | Cite as

A pilot study to record visual evoked potentials during prone spine surgery using the SightSaver™ photic visual stimulator

  • E. M. Soffin
  • R. G. Emerson
  • J. Cheng
  • K. Mercado
  • K. Smith
  • J. D. Beckman
Original Research

Abstract

This is a pilot study to assess the clinical safety and efficacy of recording real-time flash visual evoked potentials (VEPs) using the SightSaver TM Visual Stimulator mask during prone spine surgery. A prospective, observational pilot study. Twenty patients presenting for spine surgery (microdiscectomy, 1–2 level lumbar fusion, or > 2 levels thoraco-lumbar fusion) were enrolled. The SightSaver™ Visual Stimulator™ was used to elicit VEPs throughout surgery. Somatosensory evoked potentials (SSEPs) were simultaneously recorded. All patients underwent general anesthesia with a combination of intravenous and inhaled agents. The presence, absence, and changes in VEP were qualitatively analyzed. Reproducible VEPs were elicited in 18/20 patients (36/40 eyes). VEPs were exquisitely sensitive to changes in anesthesia and decayed with rising MAC of isoflurane and/or N2O. Decrements in VEPs were observed without concomitant changes in SSEPs. The mask was simple to apply and use and was not associated with adverse effects. The SightSaver™ mask represents an emerging technology for monitoring developing visual insults during surgery. The definitive applications remain to be determined, but likely include use in select patients and/or surgeries. Here, we have validated the device as safe and effective, and show that VEPs can be recorded in real time under general anesthesia in the prone position. Future studies should be directed towards understanding the ideal anesthetic regimen to facilitate stable VEP recording during prone spine surgery.

Keywords

Flash visual evoked potential Visual evoked potential Visual loss spine surgery Perioperative visual loss 

Notes

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Epstein NE. Perioperative visual loss following prone spinal surgery: a review. Surg Neurol Int. 2016;7(Suppl 3):S347–60.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Stambough JL, Dolan D, Werner R, et al. Ophthalmologic complications associated with prone positioning in spine surgery. J Am Acad Orthop Surg. 2007;15:156–65.CrossRefPubMedGoogle Scholar
  3. 3.
    Kamming D, Clarke S. Postoperative visual loss following prone spinal surgery. Br J Anaesth. 2005;95(2):257–60.CrossRefPubMedGoogle Scholar
  4. 4.
    Lee LA, Roth S, Posner KL, et al. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology 2006;105(4):652–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Berg KT, Harrison AR, Lee MS. Perioperative visual loss in ocular and nonocular surgery. Clin Ophthalmol. 2010;4:531–46.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Myers MA, Hamilton SR, Bogosian AJ, et al. Visual loss as a complication of spine surgery. A review of 37 cases. Spine 1997;22:1325–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Kodama K, Goto T, Sato A, et al. Standard and limitation of intraoperative monitoring of the visual evoked potential. Acta Neurochir. 2010;152:643–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Sasaki T, Itakura T, Suzuki K, et al. Intraoperative monitoring of visual evoked potential: introduction of a clinically useful method. J Neurosurg. 2010;112(2):273–84.CrossRefPubMedGoogle Scholar
  9. 9.
    Kamio Y, Sakai N, Sameshima T, et al. Usefulness of intraoperative monitoring of visual evoked potentials in transsphenoidal surgery. Neurol Med Chir. 2014;54(8):606–11.CrossRefGoogle Scholar
  10. 10.
    Uhl RR, Squires KC, Bruce DL, Starr A. Variations in visual evoked potentials under anesthesia. Prog Brain Res. 1980;54:463–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Watson KR, Shah MV. Clinical comparison of “single agent” anaesthesia with sevoflurane versus target controlled infusion of propofol. Br J Anaesth. 2000;85:541–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Neuloh G. Time to revisit VEP monitoring?. Acta Neurochir. 2010;152:649–50.CrossRefPubMedGoogle Scholar
  13. 13.
    Houlden DA, Turgeon CA, Polis T, et al. Intraoperative flash VEPs are reproducible in the presence of low amplitude EEG. J Clin Monit Comput. 2014;28(3):275–85.CrossRefPubMedGoogle Scholar
  14. 14.
    Luo Y, Regli L, Bozinov O, et al. Clinical utility and limitations of intraoperative monitoring of visual evoked potentials. PLoS ONE 2015;10(3):e0120525.  https://doi.org/10.1371/journal.pone.0120525.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Chung S-B, Park C-W, Seo D-W, et al. Intraoperative visual evoked potential has no association with postoperative visual outcomes in transsphenoidal surgery. Acta Neurochir. 2012;154:1505–10.CrossRefPubMedGoogle Scholar
  16. 16.
    Anschel Technologies. Sightsaver TM Visual Stimulator K113785. 510(k) summary: June 6, 2012.Google Scholar
  17. 17.
    Uribe AA, Mendel E, peters ZA, Shneker BF, et al. Comparison of visual evoked potential monitoring during spine surgeries under total intravenous anesthesia versus balanced general anesthesia. Clin Neurophysiol. 2017;128(10):2006–13.CrossRefPubMedGoogle Scholar
  18. 18.
    Odom JV, Bach M, Brigell M, et al. ISCEV standard for clinical visual evoked potentials: (2016 update). Doc Ophthalmol. 2016;133(1):1–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Harris PA, Taylor R, Thielke R, Payne J, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.CrossRefPubMedGoogle Scholar
  20. 20.
    Banoub M, Tetzlaff JE, Schubert A. Pharmacologic and physiologic influences affecting sensory evoked potentials: implications for perioperative monitoring. Anesthesiology 2003;99(3):716–37.CrossRefPubMedGoogle Scholar
  21. 21.
    Kabbara AI. What happened to the old visual evoked potential monitoring? Anesthesiology 2007;106(6):1249.CrossRefPubMedGoogle Scholar
  22. 22.
    Uribe AA, Baig MN, Puente EG, et al. Current intraoperative devices to reduce visual loss after spine surgery. Neurosurg Focus. 2012;33(2):E14.CrossRefPubMedGoogle Scholar
  23. 23.
    Creel D. Visually evoked potentials. In: Kolb H, Fernandez E, Nelson R, editors. Webvision: the organization of the retina and visual system. Salt Lake City: University of Utah Health Sciences Center; 2015.Google Scholar
  24. 24.
    Van Der Marel EH, Dagnelie G, Spekreijse H. Subdurally recorded pattern and luminance EPs in the alert rhesus monkey. Electroencephalogr Clin Neurophysiol. 1984;57:354–68.CrossRefPubMedGoogle Scholar
  25. 25.
    Kraut MA, Arezzo JC, Vaughan JG. Intracortical generators of the flash VEP in monkeys. Electroencephalogr Clin Neurophysiol. 1985;62:300–12.CrossRefPubMedGoogle Scholar
  26. 26.
    Ducati A, Fava E, Motti EDF. Neuronal generators of the visual evoked potentials: intracerebral recording in awake humans. Electroencephalogr Clin Neurophysiol. 1988;71:89–99.CrossRefPubMedGoogle Scholar
  27. 27.
    Pawela CP, Hudetz AG, Ward BD, et al. Modeling of region-specific fMRI BOLD neurovascular response functions in rat brain reveals residual differences that correlate with the differences in regional evoked potentials. Neuroimage 2008;41(2):525–34.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Kumar A, Bhattacharya A, Makhija N. Evoked potential monitoring in anaesthesia and analgesia. Anaesthesia 2000;55(3):225–41.CrossRefPubMedGoogle Scholar
  29. 29.
    Goto T, Tanaka Y, Kodama K, et al. Loss of visual evoked potential following temporary occlusion of the superior hypophyseal artery during aneurysm clip placement surgery. Case report. J Neurosurg. 2007;107(4):865–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Curatolo JM, Macdonnell RA, Berkovic SF, et al. Intraoperative monitoring to preserve central visual fields during occipital corticectomy for epilepsy. J Clin Neurosci. 2000;7(3):234–7.CrossRefPubMedGoogle Scholar
  31. 31.
    San-Juan, D., de Dios Del Castillo Calcaneo, J., Villegas, T.G. et al. Visual intraoperative monitoring of occipital arteriovenous malformation surgery. Clin Neurol Neurosurg. 2011;113(8):680–2.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2017

Authors and Affiliations

  • E. M. Soffin
    • 1
  • R. G. Emerson
    • 2
  • J. Cheng
    • 1
  • K. Mercado
    • 2
  • K. Smith
    • 2
  • J. D. Beckman
    • 1
  1. 1.Department of AnesthesiologyHospital for Special SurgeryNew YorkUSA
  2. 2.Department of NeurologyHospital for Special SurgeryNew YorkUSA

Personalised recommendations