• Satoshi Kawajiri, Makoto Isozaki, Osamu Komori, Shinsuke Yamada, Yorhifumi Higashino, Takahiro Yamauchi, Ayumi Akazawa, Masamune Kidoguchi, Munetaka Yomo, Toshiaki Kodera, Hidetaka Arishma, Kousuke Awara, Masaru Inatani, and Kenichiro Kikuta.
• Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
• Neurosurgery. 2023 Jun 1; 92 (6): 127612861276-1286.

BackgroundThe role of visual evoked potential (VEP) in direct clipping of the paraclinoid internal carotid artery (ICA) aneurysm remains uncertain.ObjectiveTo examine whether intraoperative neuromonitoring with VEP can predict deterioration of visual function after direct clipping of the paraclinoid ICA aneurysm with anterior clinoidectomy.MethodsAmong consecutive 274 patients with unruptured cerebral aneurysm, we enrolled 25 patients with paraclinoid ICA aneurysm treated by direct clipping after anterior clinoidectomy with intraoperative neuromonitoring with VEP in this study. We evaluated the visual acuity loss (VAL) and visual field loss (VFL) before surgery, 1 month after surgery, and at the final follow-up.ResultsThe VAL at 1 month after surgery (VAL1M) and VAL at the final follow-up (Final VAL) were significantly related to the reduction rate of VEP amplitude at the end of surgery (RedEnd%), more than 76.5%, and the maximal reduction rate of VEP amplitude during surgery (MaxRed%), more than 66.7% to 70%. The VFL at 1 month after surgery (VFL1M) and the VFL at the final follow-up (Final VFL) were significantly related to MaxRed% more than 60.7%.ConclusionVAL1M, Final VAL, VFL1M, and Final VFL could be significantly predicted by the value of RedEnd% and MaxRed% in direct clipping of Al-Rodhan group Ia, Ib, and II paraclinoid ICA aneurysms with anterior clinoidectomy.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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