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Padalino DJ, Melnyk V, Allott G, et al. Electroretinography during embolization of an ophthalmic arteriovenous fistula. Surg Neurol Int. 2013;4:40doi: 10.4103/2152-7806.109653.
Padalino, D. J., Melnyk, V., Allott, G., & Deshaies, E. M. (2013). Electroretinography during embolization of an ophthalmic arteriovenous fistula. Surgical neurology international, 440. https://doi.org/10.4103/2152-7806.109653
Padalino, David J, et al. "Electroretinography during embolization of an ophthalmic arteriovenous fistula." Surgical neurology international vol. 4 (2013): 40. doi: https://doi.org/10.4103/2152-7806.109653
Padalino DJ, Melnyk V, Allott G, Deshaies EM. Electroretinography during embolization of an ophthalmic arteriovenous fistula. Surg Neurol Int. 2013 Mar 28;4:40. doi: 10.4103/2152-7806.109653. Print 2013. PMID: 23607062; PMCID: PMC3622349.
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Surg Neurol Int. 2013 Mar 28;4:40. doi: 10.4103/2152-7806.109653. Print 2013.

Electroretinography during embolization of an ophthalmic arteriovenous fistula.

Surgical neurology international

David J Padalino, Vladyslav Melnyk, Geoffrey Allott, Eric M Deshaies

Affiliations

  1. Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA.

PMID: 23607062 PMCID: PMC3622349 DOI: 10.4103/2152-7806.109653

Abstract

BACKGROUND: Intraoperative neuromonitoring (IONM) is used for real-time evaluation of neuronal tracts and reflexes in the anesthetized patient, when a neurologic exam is not possible. Changes in IONM signals forewarn of possible neurological deficit. This real-time feedback allows for immediate alterations in therapeutic technique by the treating physician. Transcranial visual evoked potentials are not reliable for evaluating the integrity of the prechiasmatic visual system. Electroretinography (ERG) has been used in animal models for monitoring retinal ischemia and can be used in humans as well to monitor for prechiasmatic ischemia of the retinae and optic nerves.

CASE DESCRIPTION: We present a case where ERG signal amplitude and latency changed during ophthalmic arteriovenous fistula embolization, resulting in an intraprocedural decision to refrain from embolization of additional arterial pedicles to preserve vision. After awakening from general anesthesia, the patient had no deficits in visual acuity or field testing, but did complain of transient pain with eye movement that resolved the next day and worsened with episodes of blood pressure elevation.

CONCLUSIONS: ERG may be helpful for detecting prechiasmatic ischemic changes during endovascular procedures and may provide early warning signs to the surgeon before the onset of permanent retinal damage. Further investigation is needed to assess the utility of ERG monitoring during the treatment of orbital and periorbital vascular lesions.

Keywords: Arteriovenous; electroretinography; embolization; fistula; malformation; neurophysiology

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