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Monitoring of intra-operative visual evoked potentials during functional endoscopic sinus surgery (FESS) under general anaesthesia

Published online by Cambridge University Press:  29 June 2007

S. S. M. Hussain ,
H. C. K. Laljee ,
J. M. Horrocks  and
A. R. H. Grace
S. S. M. Hussain*
Affiliation:
Department of Otolaryngology, York District Hospital, York, UK.
H. C. K. Laljee
Affiliation:
Department of Neurophysiology, York District Hospital, York, UK.
J. M. Horrocks
Affiliation:
Department of Neurophysiology, York District Hospital, York, UK.
A. R. H. Grace
Affiliation:
Department of Otolaryngology, York District Hospital, York, UK.
*
Address for correspondence: S. S. M. Hussain, Senior Lecturer Consultant ENT Surgeon, University of Newcastle, Freeman Hospital, Newcastle upon Tyne, NE7 7DN.
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Abstract

Functional endoscopic sinus surgery (FESS) is an effective treatment for inflammatory sinus disease. The potential for major complications during FESS is high particularly under general anaesthesia. The most serious of these is injury to the eye leading to blindness. We looked at the feasibility of monitoring flash visual evoked potentials (VEP) simultaneously from both eyes during FESS. Five patients were included in this preliminary study. A haptic contact lens connected by fibreoptic cable to a photostimulator was placed on the eyes and stimulus of comparable intensity to a conventional strobe was delivered. We found that an increase in P100 latency to be an indicator of optic nerve compression. However, for this to be useful the diastolic blood pressure should not fall below 50 mmHg, the oxygen saturation should be maintained at 98 per cent and bleeding should be minimized during surgery. The changes in the amplitude of P100 was not found to be useful.

While there is no substitute for learning endoscopic surgery by cadaveric dissection and supervised training we believe that in selected cases VEP monitoring can be employed with profit.

Keywords

Evoked potentialsvisualParanasal sinusessurgerycomplicationsEndoscopy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 110 , Issue 1 , January 1996 , pp. 31 - 36
Copyright
Copyright © JLO (1984) Limited 1996

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References

Costa E. Silva, I., Wang, A., Symon, L. (1985) The application of flash visual evoked potential during operations on anterior visual pathways. Neurological Research 7: 11–16.CrossRefGoogle ScholarPubMed
Cumberworth, V. L., Sudderick, R. M., Mackay, I. S. (1994) Major complications of functional endoscopic sinus surgery. Clinical Otolaryngology 19: 248–253.CrossRefGoogle ScholarPubMed
Harding, G. F. A., Bland, J. D. P., Smith, V. H. (1990) Visual evoked monitoring of optic nerve function during surgery. Journal of Neurology, Neurosurgery and Psychiatry 53: 890–895.CrossRefGoogle ScholarPubMed
Harding, G. F. A., Rubinstein, M. P. (1980) The scalp topography of human visual evoked subcortical potential. Investigative Ophthalmology and Visual Sciences 19: 318–321.Google ScholarPubMed
Harding, G. F. A., Smith, V. H., Yorke, H. C. (1987) A contact lens photostimulator for surgical monitoring. Electroencephalography and Neurophysiology 66: 322–326.CrossRefGoogle ScholarPubMed
Kennedy, D. W., Zinreich, S. J., Rosenbaum, A. E., Johns, M. E. (1985) Functional endoscopic sinus surgery. Theory and diagnosis. Archives of Otolaryngology, I-lead and Neck Surgery 111: 576–582.CrossRefGoogle Scholar
Kennedy, D. W. (1992) Prognostic factors, outcomes and staging in ethmoid sinus surgery. Laryngoscope 102: (Suppl No. 57) 1–18.Google ScholarPubMed
Mackay, I. S. (1992) Functional endoscopic sinus surgery. Clinical Otolaryngology 17: 1–2.CrossRefGoogle ScholarPubMed
Manigilia, A. J. (1991) Fatal and other major complications of endoscopic sinus surgery. Laryngoscope 101: 349–354.CrossRefGoogle Scholar
May, M., Levine, H. L., Mester, S. J., Schaitkin, B. (1994) Complications of endoscopic sinus surgery: analysis of 2108 patients – incidence and prevention. Laryngoscope 104: 1080–1083.CrossRefGoogle Scholar
Messerklinger, W. (1978) Endoscopy of the nose. Urban and Schwarzenberg, Munich and Baltimore, pp 49–50.Google Scholar
Ramadan, H. H., Allen, G. C. (1995) Complications of endoscopic sinus surgery in a residency training program. Laryngoscope 105: 376–379.CrossRefGoogle Scholar
Stammberger, H. (1986a) Endoscopic endonasal surgery. Concepts in treatment of recurring rhinosinusitis. Part I. Anatomic and pathophysiological considerations. Otolaryngology – Head and Neck Surgery 94: 143–147.CrossRefGoogle Scholar
Stammberger, H. (1986b) Endoscopic endonasal surgery. Concepts in treatment of recurring rhinosinusitis. Part II. Surgical techniques. Otolaryngology – Head and Neck Surgery 94: 147–156.CrossRefGoogle Scholar
Stankiewicz, J. A. (1987) Complications of endoscopic sinus surgery: Occurrence and treatment. American Journal of Rhinology 1: 45–49.CrossRefGoogle Scholar
Stankiewicz, J. A. (1989) Blindness and intranasal ethmoid ectomy: Prevention and management. Otolaryngology – Head and Neck Surgery 101: 320–329.CrossRefGoogle Scholar
Uhl, R. R., Squires, K. C., Bruce, D. L., Stan, A. (1980) Effect of halothane anesthesia on human cortical visual evoked response Anesthesiology 53: 273–276.CrossRefGoogle ScholarPubMed
Wright, J. F., Arden, G., Jones, B. R. (1973) Continuous monitoring of visual evoked response during intraorbital surgery. Transaction Ophthalmological Society UK 93: 311–314.Google Scholar
Xu, G. (1993) Comp1icatios of endoscopic sinus surgery.Chung Hua Erh Pi Yen Hou Tsad Chih (Chinese Journal of Otorhinolaryngology) 28: 284–286.Google Scholar