Special Article   

Journal of Neurosurgical Sciences 2022 Nov 03

DOI: 10.23736/S0390-5616.22.05888-X

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Surgery of optic-chiasmatic tumors assisted by sodium fluorescein yellow fluorescence and visual evoked potentials monitoring

Camilla BONAUDO ¹ ✉, Simone ORLANDINI ¹, Andrea BOSCHI ¹, Cristiana MARTINELLI ², Riccardo CARRAI ², Andrea AMADORI ³, Alessandro DELLA PUPPA ¹

¹ Unit of Neurosurgery, Department of Neuroscience, Psychology, Pharmacology and Child Health, University Hospital of Careggi, University of Florence, Florence, Italy; ² Department of Neurophysiopathology, University Hospital of Careggi, Florence, Italy; ³ Intensive Care Unit, Department of Neuroanaesthesia, University Hospital of Careggi, Florence, Italy

BACKGROUND: Tumours of the anterior visual pathways are challenging to operate because of the crucial balance between extent of resection and sight preservation. Sodium Fluoresceine (SF) has already been reported in maximizing brain tumour resection but not when the optic-chiasmatic region is involved. The role of Visual Evoked Potentials (VEPs) in optic-chiasmatic tumours is still debated. The simultaneous use of both technique in this setting has not been reported so far. The aim of our work is to analyse the intraoperative combination of the use of SF and VEPs in the anterior visual pathway tumour surgery.
METHODS: Clinical and Intra-operative data from six surgical procedures on four patients affected by optic-chiasmatic tumours with preoperative visual deficits were retrospectively analysed.
RESULTS: In 5 procedures VEPs remained intraoperatively stable and no postoperative worsening of visual function was reported. In 1 case an intraoperative VEPs deterioration was predictive of a postoperative visual worsening. In all cases, tumour was fluorescent, and SF was intraoperatively helpful in guiding resection. The pattern of fluorescence was different according to the lesion histology.
CONCLUSIONS: Based on our preliminary experience, the simultaneous combination of SF and VEPs in surgery of the optic pathway tumours seems helpful to maximize tumour resection and predict postoperative functional outcome. Since we presented a small series, larger studies are needed to confirm our data.

KEY WORDS: Anterior pathways’ tumours; Visual evoked potentials monitoring; Sodium fluoresceine; Optimizing surgery of the anterior optic tumours