Skip to main content

Neurophysiological intraoperative monitoring during an optic nerve schwannoma removal

Journal of Clinical Monitoring and Computing volume 31, pages 1059–1064 (2017)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  4. Kulkarni RG, Satalkar VY, Bhawthankar AW. Neurilemmoma of optic nerve. Indian J Ophthalmol. 1980;28:95–6.

    CAS  PubMed  Google Scholar 

  5. Simpson RK, Harper RL, Kirkpatrick JB, Cooper B. Schwannoma of the optic sheath. J Clin Neuroophthalmol. 1987;7:219–22.

    Article  PubMed  Google Scholar 

  6. 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.

    Google Scholar 

  7. Cedzich C, Schramm J, Fahlbusch R. Are flash-evoked visual potentials useful for intraoperative monitoring of visual pathway function? Neurosurgery. 1987;21:709–15.

    CAS  Article  PubMed  Google Scholar 

  8. 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.

    CAS  Article  PubMed  Google Scholar 

  9. Cedzich C, Schramm J. Monitoring of flash visual evoked potentials during neurosurgical operations. Int Anesthesiol Clin. 1990;28:165–9.

    CAS  Article  PubMed  Google Scholar 

  10. Chacko AG, Babu KS, Chandy MJ. Value of visual evoked potential monitoring during trans-sphenoidal pituitary surgery. Br J Neurosurg. 1996;10:275–8.

    CAS  Article  PubMed  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    CAS  Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  16. 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.

    CAS  Article  PubMed  Google Scholar 

  17. 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.

    PubMed  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Raudzens PA. Intraoperative monitoring of evoked potentials. Ann N Y Acad Sci. 1982;388:308–26.

    CAS  Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  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.

    CAS  Article  PubMed  Google Scholar 

  25. 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.

    CAS  PubMed  Google Scholar 

  26. 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.

    CAS  PubMed  Google Scholar 

  27. 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.

    Article  Google Scholar 

  28. Jones NS. Visual evoked potentials in endoscopic and anterior skull base surgery: a review. J Laryngol Otol. 1997;111:513–6.

    CAS  PubMed  Google Scholar 

  29. 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.

    Article  Google Scholar 

  30. 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.

    Article  PubMed  Google Scholar 

  31. 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.

    Article  PubMed  Google Scholar 

  32. 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.

    Article  Google Scholar 

  33. Chi OZ, Ryterband S, Field C. Visual evoked potentials during thiopentone-fentanyl-nitrous oxide anaesthesia in humans. Can J Anaesth. 1989;36:637–40.

    CAS  Article  PubMed  Google Scholar 

  34. Domino EF, Corssen G, Sweet RB. Effects of various general anesthetics on the visually envoked response in man. Anesth Analg. 1963;42:735–47.

    CAS  Article  PubMed  Google Scholar 

  35. 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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinical Neurophysiology Department, National Institute of Neurology and Neurosurgery, Av. Insurgentes Sur 3877, Col. La Fama, Tlalpan, 14269, Mexico City, DF, Mexico

    Daniel San-juan, Adolfo Josué Orozco Garduño & Maricarmen Fernández Gónzalez-Aragón

  2. Neurological Center, Medical Center ABC Santa Fe, Mexico City, Mexico

    Daniel San-juan

  3. Neuro-ophtalmology Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico

    Manuel Escanio Cortés

  4. Neuropathology Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico

    Martha Tena-Suck

  5. Faculty of Medicine, University of Colima, Colima, Mexico

    Jesús Alejandro López Pizano

  6. Health Sciences Division, Medicine and Nutrition Department, University of Guanajuato, Guanajuato, Mexico

    Jonathan Villanueva Domínguez

  7. Neurosurgery Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico

    Juan Luis Gómez-Amador

Authors
  1. Daniel San-juan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Manuel Escanio Cortés
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martha Tena-Suck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adolfo Josué Orozco Garduño
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jesús Alejandro López Pizano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jonathan Villanueva Domínguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maricarmen Fernández Gónzalez-Aragón
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Juan Luis Gómez-Amador
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel San-juan.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10877-016-9932-7

Keywords

  • Optic nerve schwannoma
  • Intraoperative monitoring
  • Visual evoked potential
  • Neurilemmoma