AI Article Synopsis
- Endoscopic transsphenoidal surgery is commonly used to address sellar pathologies, particularly for relieving pressure on the optic nerves, but the effectiveness of visual-evoked potentials (VEPs) as a monitoring tool during surgery lacks consistent evidence.
- An 80-year-old male underwent this type of surgery for a pituitary macroadenoma, experiencing fluctuating VEP readings during the procedure, which ultimately did not prevent postoperative visual deficits.
- The case highlights the need for careful interpretation of VEP data, especially in patients with existing vision issues, and emphasizes the importance of anesthesia choices to minimize interference during monitoring.
Article Abstract
Background: Endoscopic transsphenoidal surgery has become a mainstay surgical approach for sellar pathologies and can effectively decompress mass effects on the optic nerves. Visual-evoked potentials (VEPs) have been utilized as an intraoperative adjunct during endoscopic transsphenoidal surgery to monitor the integrity of the optic pathways, but the data surrounding its reliability and efficacy remain heterogeneous.
Case Description: An 80-year-old male underwent endoscopic transsphenoidal resection of a pituitary macroadenoma with preoperative visual deficits related to optic nerve compression. During fat packing of the resection cavity, a decrease in VEPs was noted, which seemingly improved after partial fat removal, although with paradoxically reduced VEP latencies. Despite this, the patient developed a visual field deficit postoperatively, requiring re-operation for further removal of the fat packing.
Conclusion: This was a case of initially poorly formed VEPs that deteriorated and apparently improved following surgical intervention. The finding of shortened latencies of the VEPs was likely from noise contamination, creating the illusion of improved signal amplitudes. We recommend careful assessment of VEP data for baseline reproducibility, particularly in patients with pre-existing visual field deficits. Appropriate anesthetic selection is also important to reduce noise interference from the electroencephalogram.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544513 | PMC |
| http://dx.doi.org/10.25259/SNI_719_2024 | DOI Listing |
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