RESUMEN
OBJECTIVE: The purpose of this study was to evaluate the applicability of visual evoked potentials (VEP) for intraoperative visual pathway monitoring in epilepsy surgery of the posterior hemispheric quadrant (PHQ) and to correlate it with post-operative visual field status. METHODS: VEP monitoring was performed in 16 patients (12 females, 7 children). Flash-induced VEP were recorded with strip electrodes from the banks of the calcarine cortex. Latency and amplitude of the first component of VEP (V1-lat, V1-amp) were monitored. Evaluation of the visual field was performed pre- and post-operatively in all patients. RESULTS: All procedures were successfully completed without adverse events. In 10 patients the strip covered both the inferior and superior calcarine banks, while only one bank was sampled in 6 cases (inferior in 4, superior in 2). Considering one of the two calcarine banks, at the end of the resection VEP had disappeared in 4 patients, whereas a decrease >33.3% in 4 and <20% of V1-amp was recorded in 5 and in 4 cases respectively. The percentage of V1-amp reduction was significantly higher for the patients who experienced a post-operative visual field reduction (p < 0.001). Post-operative visual field deficits were found in patients presenting a reduction >33.3% of V1-amp. CONCLUSIONS: VEP monitoring is possible and safe in epilepsy surgery under general anesthesia. SIGNIFICANCE: Intraoperative recording of VEP from the banks of the calcarine cortex allows monitoring the integrity of post-geniculate visual pathways during PHQ resections for epilepsy and it is pivotal to prevent disabling visual field defects, including hemianopia and inferior quadrantanopia.
Asunto(s)
Anestesia General , Epilepsia , Potenciales Evocados Visuales , Monitorización Neurofisiológica Intraoperatoria , Campos Visuales , Vías Visuales , Humanos , Femenino , Masculino , Potenciales Evocados Visuales/fisiología , Niño , Anestesia General/métodos , Vías Visuales/fisiopatología , Vías Visuales/fisiología , Epilepsia/cirugía , Epilepsia/fisiopatología , Monitorización Neurofisiológica Intraoperatoria/métodos , Adolescente , Adulto , Campos Visuales/fisiología , Adulto Joven , Preescolar , Corteza Visual/fisiopatología , Corteza Visual/fisiología , Corteza Visual/cirugíaRESUMEN
BACKGROUND: Intracranial EEG data offer a unique spatio-temporal precision to investigate human brain functions. Large datasets have become recently accessible thanks to new iEEG data-sharing practices and tighter collaboration with clinicians. Yet, the complexity of such datasets poses new challenges, especially regarding the visualization and anatomical display of iEEG. NEW METHOD: We introduce HiBoP, a multi-modal visualization software specifically designed for large groups of patients and multiple experiments. Its main features include the dynamic display of iEEG responses induced by tasks/stimulations, the definition of Regions and electrodes Of Interest, and the shift between group-level and individual-level 3D anatomo-functional data. RESULTS: We provide a use-case with data from 36 patients to reveal the global cortical dynamics following tactile stimulation. We used HiBoP to visualize high-gamma responses [50-150â¯Hz], and define three major response components in primary somatosensory and premotor cortices and parietal operculum. COMPARISON WITH EXISTING METHODS(S): Several iEEG softwares are now publicly available with outstanding analysis features. Yet, most were developed in languages (Python/Matlab) chosen to facilitate the inclusion of new analysis by users, rather than the quality of the visualization. HiBoP represents a visualization tool developed with videogame standards (Unity/C#), and performs detailed anatomical analysis rapidly, across multiple conditions, patients, and modalities with an easy export toward third-party softwares. CONCLUSION: HiBoP provides a user-friendly environment that greatly facilitates the exploration of large iEEG datasets, and helps users decipher subtle structure/function relationships.