Brain tumour surgery in visual eloquent areas poses significant challenges to neurosurgeons and has reported inconsistent results. This is a single-centre prospective cohort study of patients admitted for asleep surgery of intra-axial lesions in visual eloquent areas. Demographic and clinical information, data from tractography and visual evoked potentials (VEPs) monitoring were recorded and correlated with visual outcomes. Thirty-nine patients were included (20 females, 19 males; mean age 52.51 ± 14.08 years). Diffuse intrinsic glioma was noted in 61.54% of patients. There was even distribution between the temporal, occipital and parietal lobes, while 55.26% were right hemispheric lesions. Postoperatively, 74.4% remained stable in terms of visual function, 23.1% deteriorated and 2.6% improved. The tumour infiltration of the optic radiation on tractography was significantly related to the visual field deficit after surgery (p= 0.016). Higher N75 (p= 0.036) and P100 (p= 0.023) amplitudes at closure on direct cortical VEP recordings were associated with no new postoperative visual deficit. A threshold of 40% deterioration of the N75 (p= 0.035) and P100 (p= 0.020) amplitudes correlated with a risk of visual field deterioration. To conclude, direct cortical VEP recordings demonstrated a strong correlation with visual outcomes, contrary to transcranial recordings. Invasion of the optic radiation is related to worse visual field outcomes.
视觉功能区脑肿瘤手术对神经外科医生构成重大挑战，且文献报道的手术效果存在不一致性。本研究为一项单中心前瞻性队列研究，纳入因视觉功能区轴内病变接受睡眠手术的患者。记录患者人口学特征、临床信息、神经传导束成像数据及视觉诱发电位监测结果，并与视觉预后进行相关性分析。共纳入39例患者（女性20例，男性19例；平均年龄52.51±14.08岁）。61.54%的患者为弥漫性内生性胶质瘤。病变在颞叶、枕叶和顶叶分布均匀，其中55.26%位于右侧半球。术后74.4%的患者视觉功能保持稳定，23.1%出现恶化，2.6%获得改善。神经传导束成像显示肿瘤对视辐射的浸润与术后视野缺损显著相关（p=0.016）。术中直接皮质视觉诱电位记录显示，术毕时较高的N75波幅（p=0.036）和P100波幅（p=0.023）与未出现新发术后视觉缺损相关。N75波幅（p=0.035）和P100波幅（p=0.020）下降40%的阈值与视野恶化风险相关。综上，与经颅记录相反，直接皮质视觉诱电位记录显示与视觉预后存在强相关性。视辐射受侵犯与较差的视野预后相关。
Intraoperative Neuromonitoring of the Visual Pathway in Asleep Neuro-Oncology Surgery
肿瘤(癌症)患者之家