Monitoring of optic nerve function in Neurofibromatosis 2 children with optic nerve sheath meningiomas using multifocal visual evoked potentials

V. Jayanetti, A. I. Klistorner, S. L. Graham, M. Dexter, M. P. Flaherty, K. Jones, F. A. Billson, M. Wilson, K. North, J. R. Grigg, C. L. Fraser

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Abstract

Monitoring optic nerve sheath meningiomas (ONSM) in Neurofibromatosis type 2 (NF2) patients remains difficult. Other ocular manifestations of NF2 may obscure ophthalmic assessment of optic nerve function in these patients. Serial magnetic resonance imaging (MRI) used to assess the optic nerve is not without limitations, being expensive and often requiring general anaesthetic in children, with associated risks. This study was undertaken to describe the use of multifocal visual evoked potentials (multifocal VEP, mfVEP) in the regular monitoring of NF2 patients with ONSM. This study involved three NF2 patients with ONSM who undertook mfVEP testing at an academic ophthalmic centre. Same day mfVEP and routine ophthalmic testing were undertaken. Topographical function of the optic nerve was assessed, utilising tools such as asymmetry deviation and accumap severity index. Results were assessed alongside MRI and visual acuity (VA). From the three patients, five eyes had ONSMs, of which two caused unilateral blindness. The remaining three affected eyes had initial VAs 6/6, 6/24, and 6/18. Over follow up, ranging from 5 to 12 years, all tumours progressed, and VA declined for all patients. Multifocal VEP detected optic nerve functional loss corresponding with visual decline. This case series suggests mfVEP is effective in the objective topographic monitoring of optic nerve function in NF2 patients with ONSM. Due also to its safety in a paediatric population, the test may be considered in the routine monitoring of these patients, to be used to assist regular ophthalmic review and MRI scans.

LanguageEnglish
Pages262-267
Number of pages6
JournalJournal of Clinical Neuroscience
Volume50
DOIs
Publication statusPublished - 1 Apr 2018

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Neurofibromatosis 2
Visual Evoked Potentials
Meningioma
Optic Nerve
Magnetic Resonance Imaging
Visual Acuity
Eye Manifestations
General Anesthetics
Physiologic Monitoring
Blindness
Pediatrics
Safety

Keywords

  • neurofibromatosis type 2
  • optic nerve sheath meningoma
  • visual evoked potentials

Cite this

Jayanetti, V. ; Klistorner, A. I. ; Graham, S. L. ; Dexter, M. ; Flaherty, M. P. ; Jones, K. ; Billson, F. A. ; Wilson, M. ; North, K. ; Grigg, J. R. ; Fraser, C. L. / Monitoring of optic nerve function in Neurofibromatosis 2 children with optic nerve sheath meningiomas using multifocal visual evoked potentials. In: Journal of Clinical Neuroscience. 2018 ; Vol. 50. pp. 262-267.
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Monitoring of optic nerve function in Neurofibromatosis 2 children with optic nerve sheath meningiomas using multifocal visual evoked potentials. / Jayanetti, V.; Klistorner, A. I.; Graham, S. L.; Dexter, M.; Flaherty, M. P.; Jones, K.; Billson, F. A.; Wilson, M.; North, K.; Grigg, J. R.; Fraser, C. L.

In: Journal of Clinical Neuroscience, Vol. 50, 01.04.2018, p. 262-267.

Research output: Contribution to journalArticleResearchpeer-review

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