Abstract：
Visual evoked potential (VEP) is an established modality that allows safe brain tumor resection and preservation of optical function. We herein present a case of a pediatric craniopharyngioma with significant improvement in the VEP amplitude detected during endoscopic transsphenoidal surgery (ETS) and obvious postoperative improvement in visual acuity. A 13-year-old boy presented with visual acuity disturbance in his right eye and was followed up for 5 months by an ophthalmologist. His visual acuity rapidly worsened, and a suprasellar lesion with calcification was found on brain computed tomography. The patient underwent tumor resection during ETS with intraoperative transcranial VEP monitoring. Gross total tumor resection was achieved without injury to the perforators, including the superior hypophyseal arteries. The VEP amplitude was unstable, and significant waves were not detectable before tumor resection; however, a positive wave was detected after removing most of the tumor and exposing the bilateral optic nerves and optic chiasm. Subsequently, negative and positive VEP waves were continuously detected. Visual acuity improved remarkably on postoperative day 10. This case demonstrated both a significant increase in the intraoperative VEP amplitude and rapid postoperative improvement in visual acuity. We surmised that the preoperative rapid worsening of visual dysfunction, intraoperative increase in the VEP amplitude, and significant postoperative improvement in visual acuity were associated with the compression of the optic nerves by the internal carotid artery, anterior cerebral artery, and tumor.
摘要：
视觉诱发电位（VEP）是一种既定的模式，可以安全切除脑肿瘤并保留光学功能。我们在此介绍一例小儿颅咽管瘤，在内窥镜经蝶入路手术（ETS）期间检测到的VEP幅度显着改善，术后视力明显改善。一名13岁男孩的右眼出现视力障碍，并由眼科医生随访了5个月。他的视力迅速恶化，脑计算机断层扫描发现鞍上病变伴钙化。患者在ETS期间接受了肿瘤切除术，并进行了术中经颅VEP监测。在未损伤穿孔器的情况下实现了肿瘤的大体全切除，包括垂体上动脉.VEP振幅不稳定,在肿瘤切除前检测不到明显的波；然而，切除大部分肿瘤并暴露双侧视神经和视神经交叉后，发现了正波。随后，连续检测到负和正VEP波。术后第10天视力明显改善。此病例显示术中VEP幅度显着增加，术后视力迅速改善。我们推测术前视觉功能障碍迅速恶化，术中VEP振幅增加，术后视力的显着改善与颈内动脉压迫视神经有关，大脑前动脉,和肿瘤。
