Intraoperative electrooculographic monitoring of oculomotor nerve function during skull base surgery

Technical note

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✓ Intraoperative monitoring techniques for protecting the integrity of the oculomotor nerves during skull base surgery have been reported by several investigators, all of which involved the use of electromyographic responses to extraocular muscles. However, these techniques have not yet become popular because of the complexity of the procedures. The authors report an extremely simple and far more reliable technique in which electrooculographic (EOG) monitoring is used. The oculomotor nerves were stimulated with a monopolar electrode during skull base exposure. The polarity of the EOG responses recorded with surface electrodes placed on the skin around the eyeball yielded precise information concerning the location and function of the oculomotor and abducent nerves. In addition, with the aid of continuous EOG monitoring that detected transient changes in the background waves, surgical procedures that might impinge on oculomotor nerve function could be avoided. The present technique has been used in eight patients with skull base tumors and with it, the authors have achieved excellent results.

Article Information

Address reprint requests to: Chikashi Fukaya, M.D., Department of Neurological Surgery, Nihon University School of Medicine, Tokyo 173–8610, Japan. email: Yoichik@bekkoame.or.jp.

© AANS, except where prohibited by US copyright law.

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    Electrooculographic recordings showing that when the surgeon stimulated the oculomotor nerve intracranially in the left eyeball, an ocular movement toward the right side was induced. It yielded a clear positive wave with a high reproducibility. Likewise, when the surgeon stimulated the abducent nerve, an ocular movement toward the left side was induced. It yielded a negative wave.

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    Electrooculographic recordings showing spontaneous ocular movements recorded as intermittent polyphasic waves when the surgeon manipulated (during dissection from the tumor) the abducent nerve (indicated by horizontal bar).

References

  • 1.

    Daube JR: Intraoperative monitoring of cranial motor nerves in Schramm JMøller AR (eds): Intraoperative Neurophysiologic Monitoring in Neurosurgery. Berlin: Springer-Verlag1991 pp 246267Daube JR: Intraoperative monitoring of cranial motor nerves in Schramm J Møller AR (eds): Intraoperative Neurophysiologic Monitoring in Neurosurgery. Berlin: Springer-Verlag 1991 pp 246–267

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    • Export Citation
  • 2.

    Kawaguchi MOhnishi HSakamoto Tet al: Intraoperative electrophysiologic monitoring of cranial motor nerves in skull base surgery. Surg Neurol 43:1771811995Kawaguchi M Ohnishi H Sakamoto T et al: Intraoperative electrophysiologic monitoring of cranial motor nerves in skull base surgery. Surg Neurol 43:177–181 1995

    • Search Google Scholar
    • Export Citation
  • 3.

    Marg E: Development of electro-oculography. Standing potential of the eye in registration of eye movement. Arch Ophthalmol 45:1691851951Marg E: Development of electro-oculography. Standing potential of the eye in registration of eye movement. Arch Ophthalmol 45:169–185 1951

    • Search Google Scholar
    • Export Citation
  • 4.

    Møller AR: Evoked Potentials in Intraoperative Monitoring. Baltimore: Williams & Wilkins1988 pp 99120Møller AR: Evoked Potentials in Intraoperative Monitoring. Baltimore: Williams & Wilkins 1988 pp 99–120

    • Search Google Scholar
    • Export Citation
  • 5.

    Sekiya THatayama TIwabuchi Tet al: Intraoperative recordings of evoked extraocular muscle activities to monitor ocular motor nerve function. Neurosurgery 32:2272351993Sekiya T Hatayama T Iwabuchi T et al: Intraoperative recordings of evoked extraocular muscle activities to monitor ocular motor nerve function. Neurosurgery 32:227–235 1993

    • Search Google Scholar
    • Export Citation
  • 6.

    Sekiya THatayama TIwabuchi Tet al: A ring electrode to record extraocular muscle activities during skull base surgery. Acta Neurochir 117:66691992Sekiya T Hatayama T Iwabuchi T et al: A ring electrode to record extraocular muscle activities during skull base surgery. Acta Neurochir 117:66–69 1992

    • Search Google Scholar
    • Export Citation
  • 7.

    Uemura TSuzuki JHozawa Jet al: Neuro-Otological Examination. With Special Reference to Equilibrium Function Tests. Baltimore: University Park Press1977 pp 4766Uemura T Suzuki J Hozawa J et al: Neuro-Otological Examination. With Special Reference to Equilibrium Function Tests. Baltimore: University Park Press 1977 pp 47–66

    • Search Google Scholar
    • Export Citation

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