OBJECTIVE Postoperative visual outcome is a major concern of neurosurgeons for patients with craniopharyngiomas. The current study aimed to investigate the value of visual evoked potential (VEP) amplitude reduction (N75-P100 and P100-N145) for predicting postoperative visual dysfunction (POVD) and refining current warning criteria for VEP monitoring. METHODS Data from 96 patients who underwent the extended endoscopic endonasal approach for craniopharyngiomas between October 2020 and November 2021 were retrospectively reviewed. VEP amplitude reduction ratios were calculated and compared between patients with POVD and those without. Subsequently, the critical threshold values of VEP amplitude reduction ratios for predicting POVD were obtained through receiver operating characteristic curve analysis. Finally, multivariate binary logistic regression analysis was applied to evaluate the effect of potential factors on the probability of experiencing POVD. RESULTS Both N75-P100 and P100-N145 amplitude reduction ratios were significantly higher in patients with POVD (p < 0.001 for both). The threshold value of the N75-P100 amplitude reduction ratio for predicting POVD was 51.76% with an area under the curve (AUC) of 0.816 (p < 0.001), while the threshold value of the P100-N145 amplitude reduction ratio was 38.80% with an AUC of 0.738 (p < 0.001). Both N75-P100 and P100-N145 amplitude reduction ratios were identified as independent predictors for POVD via multivariate analysis (p < 0.001 and p = 0.018, respectively). CONCLUSIONS Both N75-P100 and P100-N145 amplitude reduction ratios showed great potential to be indicators for POVD in patients with craniopharyngiomas. Regarding warning criteria for VEP monitoring, the authors recommend that both N75-P100 and P100-N145 amplitude reduction should be considered, with early warning criteria of a 50% reduction for N75-P100 amplitude and/or a 40% reduction for P100-N145 amplitude.

中文翻译：

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术中视觉诱发潜在振幅降低在预测颅咽管瘤扩大内镜鼻内切除术后视觉结果方面的功效。

目的 颅咽管瘤患者的术后视力结果是神经外科医生最关心的问题。本研究旨在探讨视觉诱发电位 (VEP) 振幅降低（N75-P100 和 P100-N145）对于预测术后视觉功能障碍 (POVD) 的价值，并完善当前 VEP 监测的警告标准。方法 回顾性分析 2020 年 10 月至 2021 年 11 月期间接受扩大内镜鼻内入路治疗颅咽管瘤的 96 例患者的数据。计算并比较患有 POVD 的患者与未患有 POVD 的患者之间的 VEP 振幅降低比率。随后，通过接受者操作特征曲线分析获得了预测POVD的VEP波幅下降率的临界阈值。最后，应用多元二元逻辑回归分析来评估潜在因素对发生 POVD 概率的影响。结果 POVD 患者的 N75-P100 和 P100-N145 振幅降低比率均显着较高（两者均 p < 0.001）。预测 POVD 的 N75-P100 振幅下降比率阈值为 51.76%，曲线下面积（AUC）为 0.816（p < 0.001），而预测 POVD 的 P100-N145 振幅下降比率阈值为 38.80%。 AUC 为 0.738（p < 0.001）。通过多变量分析，N75-P100 和 P100-N145 振幅降低率均被确定为 POVD 的独立预测因子（分别为 p < 0.001 和 p = 0.018）。结论 N75-P100 和 P100-N145 振幅降低比均显示出作为颅咽管瘤患者 POVD 指标的巨大潜力。关于 VEP 监测的预警标准，作者建议应考虑 N75-P100 和 P100-N145 幅度降低，早期预警标准为 N75-P100 幅度降低 50% 和/或 P100-N145 幅度降低 40%振幅。