Functional monitoring for visual pathway using real-time visual evoked potentials and optic-radiation tractography

被引:82
作者
Kamada, K
Todo, T
Morita, A
Masutani, Y
Aoki, S
Ino, K
Kawai, K
Kirino, T
机构
[1] Univ Tokyo, Dept Neurosurg, Bunkyo Ku, Tokyo 1138655, Japan
[2] Univ Tokyo, Dept Radiol, Tokyo, Japan
关键词
diffusion tenser imaging; functional neuronavigation; optic radiation; tractography; visual evoked potentials;
D O I
10.1227/01.NEU.0000163526.60240.B6
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE: It has been difficult to obtain anatomic and functional information about the visual pathway during neurosurgical operations. The aim of this study was to combine the information of the visual evoked potentials (VEPs) and the anatomic navigation of the optic radiation by diffusion tensor imaging-based tractography for functional monitoring of the visual pathway. METHODS: The subjects were two patients with brain lesions adjacent to the visual pathway. Diffusion tensor imaging-based tractography of the optic radiation was performed by selecting appropriate regions of interest and by fractional anisotropy. During surgery, cortical VEPs were recorded continuously under general anesthesia with sevoflurane. In Patient 2, the results of optic radiation tractography were imported to a neuronavigation system to better understand the spatial relationships between the lesions and the visual pathway (functional neuronavigation). RESULTS: In Patient 1, the lesion did not seem to be attached to the optic radiation, and VEP profiles remained stable during resection. In Patient 2, who had a lesion adjacent to the posterior horn of the lateral ventricle, VEPs suddenly diminished when resection reached the optic radiation as illustrated on the neuronavigation system. AS a result, complete left hemianopia developed after surgery in Patient 2. CONCLUSION: We confirmed functional correlations of the results of diffusion tensor imaging-based tractography by monitoring intraoperative VEPs. The combination of continuous VEP and optic-radiation tractography is reliable to monitor the visual function and is helpful in performing neurosurgical planning near the visual pathway.
引用
收藏
页码:121 / 126
页数:6
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