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Extended endoscopic endonasal resection of craniopharyngioma using intraoperative visual evoked potential monitoring: technical note

  • Technical Note - Brain Tumors
  • Published:
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Abstract

Background

To avoid deterioration of visual function, extended endoscopic endonasal transsphenoidal surgery (TSS) for craniopharyngioma was performed with visual evoked potential (VEP) monitoring using light-emitting diodes (LEDs).

Methods

The position of the optic chiasm was carefully evaluated on the preoperative midsagittal magnetic resonance (MR) images. Intraoperatively, direct and sharp dissection of the tumor from the optic chiasm was performed under VEP monitoring with LEDs through extended endoscopic endonasal TSS. If the VEP finding changed and became unstable, the operator were informed and stopped the surgical manipulation for the optic chiasm to recover. After 5–10 min, recovery of VEP findings was checked and the procedure resumed.

Results

Extended endoscopic endonasal TSS with VEP monitoring was performed in consecutive 7 adult patients with newly diagnosed suprasellar craniopharyngiomas with maximum diameters of 25–41 mm (mean 33.7 mm). VEPs were stable throughout the surgery in 5 cases, but showed temporary instability and amplitude decrease in 2 cases, although the VEPs had recovered at the end of the surgery. Visual function, evaluated using visual impairment score, was improved after surgery in all patients. Gross total removal was achieved in 5 cases, and subtotal removal (90%) in 2 cases.

Conclusions

Intraoperative VEP monitoring is the only way to test visual function during surgery, and may be important and helpful in extended endoscopic endonasal TSS, which requires direct dissection between the optic nerve and craniopharyngioma under the endoscope.

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Abbreviations

TSS:

Transsphenoidal surgery

VEP:

Visual evoked potential

LEDs:

Light-emitting diodes

VISs:

Visual impairment scores

MR:

Magnetic resonance

SHA:

Superior hypophyseal artery

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Funding

This study was partly supported by grants from the Ministry of Education, Science, Sports, and Culture.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Takaaki Miyagishima, Masahiko Tosaka, Rei Yamaguchi, Tomohito Nagaki, Nobukazu Ishii, Takeo Kojima & Yuhei Yoshimoto

Authors
  1. Takaaki Miyagishima
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  2. Masahiko Tosaka
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  3. Rei Yamaguchi
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  4. Tomohito Nagaki
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  5. Nobukazu Ishii
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  6. Takeo Kojima
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  7. Yuhei Yoshimoto
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Corresponding author

Correspondence to Masahiko Tosaka.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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

Informed consent

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

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Comments

The authors report on their experience with the use of VEP during endoscopic resection of suprasellar craniopharyngiomas. The series consists of 7 consecutive patients. The paper is well conceived, and the cases are well documented, probably with prospective inclusion and retrospective review of the data. The authors want to make two points: 1) novel techniques for VEP-monitoring are reliable, 2) VEP monitoring during resection of suprasellar craniopharyngiomas is helpful in preserving visual function. The authors advise to stop dissection of the optic chiasm when VEP becomes unstable and wait for more than 5 minutes, then repeating the VEP recording to evaluate the function of the optic structures. They state that continuous intraoperative trend observation of VEP to detect changes gives great reassurance to the surgeon concerning postoperative visual function. Using this technique, no deterioration of visual acuity and visual field occurred. Further studies and a larger experience with this technique are needed, but it seems promising for safer surgery in these patients.

Johannes van Loon

Belgium

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Miyagishima, T., Tosaka, M., Yamaguchi, R. et al. Extended endoscopic endonasal resection of craniopharyngioma using intraoperative visual evoked potential monitoring: technical note. Acta Neurochir 161, 2277–2284 (2019). https://doi.org/10.1007/s00701-019-04028-7

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  • DOI: https://doi.org/10.1007/s00701-019-04028-7

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