Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Triggered Electrooculography for Identification of Oculomotor and Abducens Nerves during Skull Base Surgery

  • Jeong, Ha-Neul (Department of Neurology, Yonsei University College of Medicine) ;
  • Ahn, Sang-Il (Department of Neurology, Yonsei University College of Medicine) ;
  • Na, Minkyun (Department of Neurosurgery, Yonsei University College of Medicine) ;
  • Yoo, Jihwan (Department of Neurosurgery, Yonsei University College of Medicine) ;
  • Kim, Woohyun (Department of Neurosurgery, Yonsei University College of Medicine) ;
  • Jung, In-Ho (Department of Neurosurgery, Yonsei University College of Medicine) ;
  • Kang, Soobin (Department of Neurology, Yonsei University College of Medicine) ;
  • Kim, Seung Min (Department of Neurology, Yonsei University College of Medicine) ;
  • Shin, Ha Young (Department of Neurology, Yonsei University College of Medicine) ;
  • Chang, Jong Hee (Department of Neurosurgery, Yonsei University College of Medicine) ;
  • Kim, Eui Hyun (Department of Neurosurgery, Yonsei University College of Medicine)
  • Received : 2020.06.22
  • Accepted : 2020.08.10
  • Published : 2021.03.01
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Abstract

Objective : Electrooculography (EOG) records eyeball movements as changes in the potential difference between the negatively charged retina and the positively charged cornea. We aimed to investigate whether reliable EOG waveforms can be evoked by electrical stimulation of the oculomotor and abducens nerves during skull base surgery. Methods : We retrospectively reviewed the records of 18 patients who had undergone a skull base tumor surgery using EOG (11 craniotomies and seven endonasal endoscopic surgeries). Stimulation was performed at 5 Hz with a stimulus duration of 200 μs and an intensity of 0.1-5 mA using a concentric bipolar probe. Recording electrodes were placed on the upper (active) and lower (reference) eyelids, and on the outer corners of both eyes; the active electrode was placed on the contralateral side. Results : Reproducibly triggered EOG waveforms were observed in all cases. Electrical stimulation of cranial nerves (CNs) III and VI elicited positive waveforms and negative waveforms, respectively, in the horizontal recording. The median latencies were 3.1 and 0.5 ms for craniotomies and endonasal endoscopic surgeries, respectively (p=0.007). Additionally, the median amplitudes were 33.7 and 46.4 μV for craniotomies and endonasal endoscopic surgeries, respectively (p=0.40). Conclusion : This study showed reliably triggered EOG waveforms with stimulation of CNs III and VI during skull base surgery. The latency was different according to the point of stimulation and thus predictable. As EOG is noninvasive and relatively easy to perform, it can be used to identify the ocular motor nerves during surgeries as an alternative of electromyography.

Keywords

Acknowledgement

This study was funded in part by the Basic Science Research Program through the NRF of Korea (NRF-2018R1C1B5042687) funded by the Korean Ministry of Science, ICT and Future Planning (Eui Hyun Kim). This work was presented at the 7th Congress of the international society of intraoperative neurophysiology, Vienna, Austria (October 31 to November 2, 2019).

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