{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T06:03:05Z","timestamp":1778565785168,"version":"3.51.4"},"reference-count":46,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background:<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Case Description:<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Conclusion:<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_719_2024","type":"journal-article","created":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T09:25:57Z","timestamp":1729848357000},"page":"387","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Monitoring of visual-evoked potentials during fat packing in endoscopic resection of a giant pituitary adenoma"],"prefix":"10.25259","volume":"15","author":[{"given":"Christopher S","family":"Hong","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women\u2019s Hospital, Boston, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jakob VE","family":"Gerstl","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women\u2019s Hospital, Boston, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C Eduardo","family":"Corrales","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Brigham and Women\u2019s Hospital, Boston, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy R","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women\u2019s Hospital, Boston, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva K","family":"Ritzl","sequence":"additional","affiliation":[{"name":"Department of Neurology, Massachusetts General Hospital, Boston, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2024,10,25]]},"reference":[{"key":"10.25259\/SNI_719_2024\/ref-1","doi-asserted-by":"crossref","first-page":"455","DOI":"10.3389\/fneur.2019.00455","article-title":"Vision and vision-related measures in progressive multiple sclerosis","volume":"10","author":"Backner","year":"2019","journal-title":"Front Neurol"},{"key":"10.25259\/SNI_719_2024\/ref-2","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1007\/s00417-020-05023-w","article-title":"Correlations between visual morphological, electrophysiological, and acuity changes in chronic non-arteritic ischemic optic neuropathy","volume":"259","author":"Barbano","year":"2021","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"10.25259\/SNI_719_2024\/ref-3","doi-asserted-by":"crossref","first-page":"647","DOI":"10.3171\/JNS\/2008\/109\/10\/0647","article-title":"Direct epidural electrical stimulation of the optic nerve: A new method for intraoperative assessment of function","volume":"109","author":"Bosnjak","year":"2008","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_719_2024\/ref-4","doi-asserted-by":"crossref","first-page":"266","DOI":"10.2478\/raon-2013-0036","article-title":"Early outcome in endoscopic extended endonasal approach for removal of supradiaphragmatic craniopharyngiomas: A case series and a comprehensive review","volume":"47","author":"Bosnjak","year":"2013","journal-title":"Radiol Oncol"},{"key":"10.25259\/SNI_719_2024\/ref-5","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1038\/s41433-022-02096-1","article-title":"Visual outcomes and predictors in optic pathway glioma: A single centre study","volume":"37","author":"Bowman","year":"2023","journal-title":"Eye (Lond)"},{"key":"10.25259\/SNI_719_2024\/ref-6","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1097\/00004311-199002830-00006","article-title":"Monitoring of flash visual evoked potentials during neurosurgical operations","volume":"28","author":"Cedzich","year":"1990","journal-title":"Int Anesthesiol Clin"},{"key":"10.25259\/SNI_719_2024\/ref-7","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/0168-5597(88)90072-X","article-title":"Factors that limit the use of flash visual evoked potentials for surgical monitoring","volume":"71","author":"Cedzich","year":"1988","journal-title":"Electroencephalogr Clin Neurophysiol"},{"key":"10.25259\/SNI_719_2024\/ref-8","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1080\/02688699650040133","article-title":"Value of visual evoked potential monitoring during trans-sphenoidal pituitary surgery","volume":"10","author":"Chacko","year":"1996","journal-title":"Br J Neurosurg"},{"key":"10.25259\/SNI_719_2024\/ref-9","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1097\/00000542-198609000-00018","article-title":"Effects of isoflurane on visual evoked potentials in humans","volume":"65","author":"Chi","year":"1986","journal-title":"Anesthesiology"},{"key":"10.25259\/SNI_719_2024\/ref-10","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1007\/s00701-012-1426-x","article-title":"Intraoperative visual evoked potential has no association with postoperative visual outcomes in transsphenoidal surgery","volume":"154","author":"Chung","year":"2012","journal-title":"Acta Neurochir (Wien)"},{"key":"10.25259\/SNI_719_2024\/ref-11","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/j.jcms.2012.01.027","article-title":"Surgical decompression in endocrine orbitopathy. Visual evoked potential evaluation and effect on the optic nerve","volume":"40","author":"Clauser","year":"2012","journal-title":"J Craniomaxillofac Surg"},{"key":"10.25259\/SNI_719_2024\/ref-12","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1177\/1120672120925643","article-title":"Visual function assessed by visually evoked potentials in adults with orbital and other primary intracranial tumors","volume":"31","author":"Dotto","year":"2021","journal-title":"Eur J Ophthalmol"},{"key":"10.25259\/SNI_719_2024\/ref-13","doi-asserted-by":"crossref","first-page":"3261","DOI":"10.2147\/OPTH.S423526","article-title":"Changes in the parameters of visual evoked potentials in media opacities","volume":"17","author":"Elsaid","year":"2023","journal-title":"Clin Ophthalmol"},{"issue":"4","key":"10.25259\/SNI_719_2024\/ref-14","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1227\/01.NEU.0000255354.64077.66","article-title":"Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery","volume":"60","author":"Esposito","year":"2007","journal-title":"Oper Neurosurg (Hagerstown)"},{"key":"10.25259\/SNI_719_2024\/ref-15","doi-asserted-by":"crossref","first-page":"e136","DOI":"10.1016\/j.wneu.2019.01.278","article-title":"The predictive role of intraoperative visual evoked potentials in visual improvement after endoscopic pituitary tumor resection in large and complex tumors: Description and validation of a method","volume":"126","author":"Feng","year":"2019","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_719_2024\/ref-16","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1055\/s-0033-1338263","article-title":"Acellular dermal allograft for sellar repair after transsphenoidal approach to pituitary adenomas","volume":"74","author":"Gaynor","year":"2013","journal-title":"J Neurol Surg B Skull Base"},{"key":"10.25259\/SNI_719_2024\/ref-17","first-page":"654","article-title":"Intraoperative monitoring with visual evoked potentials for brain surgeries","volume":"130","author":"Gutzwiller","year":"2018","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_719_2024\/ref-18","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/WNP.0000000000000416","article-title":"Electrophysiology of olfactory and optic nerve in outpatient and intraoperative settings","volume":"35","author":"Hariharan","year":"2018","journal-title":"J Clin Neurophysiol"},{"key":"10.25259\/SNI_719_2024\/ref-19","doi-asserted-by":"crossref","first-page":"127","DOI":"10.4097\/kjae.2017.70.2.127","article-title":"Intraoperative monitoring of flash visual evoked potential under general anesthesia","volume":"70","author":"Hayashi","year":"2017","journal-title":"Korean J Anesthesiol"},{"key":"10.25259\/SNI_719_2024\/ref-20","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1186\/s12883-021-02315-4","article-title":"Intraoperative monitoring of visual evoked potentials in patients undergoing transsphenoidal surgery for pituitary adenoma: A systematic review","volume":"21","author":"Jashek-Ahmed","year":"2021","journal-title":"BMC Neurol"},{"key":"10.25259\/SNI_719_2024\/ref-21","doi-asserted-by":"crossref","first-page":"2525","DOI":"10.1007\/s00417-024-06411-2","article-title":"The clinical efficacy of preoperative flash visual evoked potential (VEP) for mature cataracts without a response to pattern VEP","volume":"262","author":"Jo","year":"2024","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"10.25259\/SNI_719_2024\/ref-22","doi-asserted-by":"crossref","first-page":"606","DOI":"10.2176\/nmc.oa.2014-0023","article-title":"Usefulness of intraoperative monitoring of visual evoked potentials in transsphenoidal surgery","volume":"54","author":"Kamio","year":"2014","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"10.25259\/SNI_719_2024\/ref-23","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1007\/s00701-010-0600-2","article-title":"Standard and limitation of intraoperative monitoring of the visual evoked potential","volume":"152","author":"Kodama","year":"2010","journal-title":"Acta Neurochir (Wien)"},{"issue":"5","key":"10.25259\/SNI_719_2024\/ref-24","first-page":"ONSE342","article-title":"\u201cGasket-seal\u201d watertight closure in minimal-access endoscopic cranial base surgery","volume":"62","author":"Leng","year":"2008","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_719_2024\/ref-25","doi-asserted-by":"crossref","first-page":"e0120525","DOI":"10.1371\/journal.pone.0120525","article-title":"Clinical utility and limitations of intraoperative monitoring of visual evoked potentials","volume":"10","author":"Luo","year":"2015","journal-title":"PLoS One"},{"key":"10.25259\/SNI_719_2024\/ref-26","doi-asserted-by":"crossref","first-page":"3421","DOI":"10.1007\/s00701-023-05778-1","article-title":"Reliability of intraoperative visual evoked potentials (iVEPs) in monitoring visual function during endoscopic transsphenoidal surgery","volume":"165","author":"Mattogno","year":"2023","journal-title":"Acta Neurochir (Wien)"},{"key":"10.25259\/SNI_719_2024\/ref-27","first-page":"692","article-title":"Effects of sevoflurane and propofol on evoked potentials during neurosurgical anesthesia","volume":"55","author":"Nakagawa","year":"2006","journal-title":"Masui"},{"key":"10.25259\/SNI_719_2024\/ref-28","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.4103\/0028-3886.236963","article-title":"Efficacy of the visual evoked potential monitoring in endoscopic transnasal transsphenoidal surgery as a real-time visual function","volume":"66","author":"Nishimura","year":"2018","journal-title":"Neurol India"},{"key":"10.25259\/SNI_719_2024\/ref-29","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1097\/00000542-198902000-00005","article-title":"Effects of halothane, enflurane, and isoflurane in nitrous oxide on multilevel somatosensory evoked potentials","volume":"70","author":"Pathak","year":"1989","journal-title":"Anesthesiology"},{"key":"10.25259\/SNI_719_2024\/ref-30","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1111\/j.1749-6632.1982.tb50799.x","article-title":"Intraoperative monitoring of evoked potentials","volume":"388","author":"Raudzens","year":"1982","journal-title":"Ann N Y Acad Sci"},{"key":"10.25259\/SNI_719_2024\/ref-31","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/00000542-198701000-00006","article-title":"Differential effects of isoflurane on human median nerve somatosensory evoked potentials","volume":"66","author":"Samra","year":"1987","journal-title":"Anesthesiology"},{"key":"10.25259\/SNI_719_2024\/ref-32","doi-asserted-by":"crossref","first-page":"273","DOI":"10.3171\/2008.9.JNS08451","article-title":"Intraoperative monitoring of visual evoked potential: Introduction of a clinically useful method","volume":"112","author":"Sasaki","year":"2010","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_719_2024\/ref-33","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1055\/s-0033-1343783","article-title":"Optic nerve monitoring","volume":"6","author":"Schumann","year":"2013","journal-title":"Craniomaxillofac Trauma Reconstr"},{"key":"10.25259\/SNI_719_2024\/ref-34","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1093\/bja\/58.6.580","article-title":"Evoked potentials during isoflurane anaesthesia","volume":"58","author":"Sebel","year":"1986","journal-title":"Br J Anaesth"},{"key":"10.25259\/SNI_719_2024\/ref-35","first-page":"13","article-title":"Further advances in the diagnosis and treatment of Leber\u2019s Hereditary Optic Neuropathy-a review","volume":"66","author":"Tabacaru","year":"2022","journal-title":"Rom J Ophthalmol"},{"key":"10.25259\/SNI_719_2024\/ref-36","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s10143-018-1024-3","article-title":"Effectiveness of intraoperative visual evoked potential in avoiding visual deterioration during endonasal transsphenoidal surgery for pituitary tumors","volume":"43","author":"Toyama","year":"2020","journal-title":"Neurosurg Rev"},{"key":"10.25259\/SNI_719_2024\/ref-37","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1097\/00000542-198010000-00001","article-title":"Effect of halothane anesthesia on the human cortical visual evoked response","volume":"53","author":"Uhl","year":"1980","journal-title":"Anesthesiology"},{"key":"10.25259\/SNI_719_2024\/ref-38","doi-asserted-by":"crossref","first-page":"2006","DOI":"10.1016\/j.clinph.2017.07.420","article-title":"Comparison of visual evoked potential monitoring during spine surgeries under total intravenous anesthesia versus balanced general anesthesia","volume":"128","author":"Uribe","year":"2017","journal-title":"Clin Neurophysiol"},{"key":"10.25259\/SNI_719_2024\/ref-39","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1007\/s00417-021-05100-8","article-title":"Electrophysiology as a prognostic indicator of visual recovery in diabetic patients undergoing cataract surgery","volume":"259","author":"Wang","year":"2021","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"10.25259\/SNI_719_2024\/ref-40","doi-asserted-by":"crossref","first-page":"1222581","DOI":"10.3389\/fonc.2023.1222581","article-title":"Intradural fat graft packing is not indispensable in preventing postoperative cerebrospinal fluid leakage in endoscopic endonasal pituitary adenoma surgeries","volume":"13","author":"Wang","year":"2023","journal-title":"Front Oncol"},{"key":"10.25259\/SNI_719_2024\/ref-41","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/00008506-200301000-00004","article-title":"Visual evoked potentials for intraoperative neurophysiologic monitoring using total intravenous anesthesia","volume":"15","author":"Wiedemayer","year":"2003","journal-title":"J Neurosurg Anesthesiol"},{"key":"10.25259\/SNI_719_2024\/ref-42","first-page":"323","article-title":"Monitoring of visual function during parasellar surgery","volume":"5","author":"Wilson","year":"1976","journal-title":"Surg Neurol"},{"key":"10.25259\/SNI_719_2024\/ref-43","first-page":"311","article-title":"Continuous monitoring of the visually evoked response during intra-orbital surgery","volume":"93","author":"Wright","year":"1973","journal-title":"Trans Ophthalmol Soc U K (1962)"},{"key":"10.25259\/SNI_719_2024\/ref-44","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1007\/s00701-020-04641-x","article-title":"Trends in cerebrospinal fluid leak rates following the extended endoscopic endonasal approach for anterior skull base meningioma: A meta-analysis over the last 20 years","volume":"163","author":"Zamanipoor Najafabadi","year":"2021","journal-title":"Acta Neurochir (Wien)"},{"key":"10.25259\/SNI_719_2024\/ref-45","doi-asserted-by":"crossref","first-page":"107149","DOI":"10.1016\/j.clineuro.2022.107149","article-title":"The clinical application of intraoperative visual evoked potential in recurrent craniopharyngiomas resected by extended endoscopic endonasal surgery","volume":"214","author":"Zhu","year":"2022","journal-title":"Clin Neurol Neurosurg"},{"key":"10.25259\/SNI_719_2024\/ref-46","doi-asserted-by":"crossref","first-page":"5271","DOI":"10.3390\/jcm10225271","article-title":"Macular morpho-functional and visual pathways functional assessment in patients with spinocerebellar type 1 ataxia with or without neurological signs","volume":"10","author":"Ziccardi","year":"2021","journal-title":"J Clin Med"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/monitoring-of-visual-evoked-potentials-during-fat-packing-in-endoscopic-resection-of-a-giant-pituitary-adenoma\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/monitoring-of-visual-evoked-potentials-during-fat-packing-in-endoscopic-resection-of-a-giant-pituitary-adenoma\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T09:26:18Z","timestamp":1729848378000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/monitoring-of-visual-evoked-potentials-during-fat-packing-in-endoscopic-resection-of-a-giant-pituitary-adenoma\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,25]]},"references-count":46,"alternative-id":["10.25259\/SNI_719_2024"],"URL":"https:\/\/doi.org\/10.25259\/sni_719_2024","relation":{},"ISSN":["2152-7806","2229-5097"],"issn-type":[{"value":"2152-7806","type":"electronic"},{"value":"2229-5097","type":"print"}],"subject":[],"published":{"date-parts":[[2024,10,25]]},"article-number":"387"}}