The present study examined the relationship between spouses' attachment styles, coping strategies, and marital satisfaction. The study included 263 couples who responded to an attachment questionnaire, the Coping Inventory for Stressful Situations, and the Dyadic Adjustment Scale. Secure attachment was positively related to task-focused coping whereas anxious/ambivalent attachment was related to emotion-focused coping. Avoidant attachment was related to avoidance coping strategies. Wives' anxious/ambivalent and secure attachments and task-oriented coping accounted for a significant portion of the variance associated with husbands' marital adjustment. Husbands' anxious/ambivalent attachment and emotion focused coping were significant predictors of their wives' marital adjustment. Finally, task-oriented coping weakened the negative relation between anxious/ambivalent or avoidant attachment and marital satisfaction whereas avoidance strategies strengthened the negative association between anxious/ambivalent attachment and marital adjustment.

Flash visual evoked potentials (FVEPs) are often irreproducible during surgery. We assessed the relationship between intraoperative FVEP reproducibility and EEG amplitude. Left then right eyes were stimulated by goggle light emitting diodes, and FVEPs were recorded from Oz–Fz′ (International 10-20 system) in 12 patients. Low cut filters were ≤5 Hz in all patients; two patients also had recordings using 10 and 30 Hz. The reproducibility of FVEP and the amplitude of the concomitant EEG from C4′–Fz were measured. Nine patients had low amplitude EEG (<30 μV); reproducible FVEPs were obtained from all eyes with normal pre-operative vision. The other three patients had high amplitude EEG (>50 μV); FVEPs were absent from three of four eyes with normal pre-operative vision (the other normal eye had a present but irreproducible FVEP). Raising the low cut filter to 10 and 30 Hz (in two patients) progressively reduced EEG and FVEP amplitude, reduced amplifier blocking time and improved FVEP reproducibility. FVEPs were more reproducible in the presence of low amplitude EEG than high amplitude EEG. This is the first report describing the effect of EEG amplitude on FVEP reproducibility during surgery

ABSTRACT:Objective: To determine the relationship between intraoperative flash visual evoked potential (FVEP) monitoring and visual function. Methods: Intraoperative FVEPs were recorded from electrodes placed in the scalp overlying the visual cortex (Oz) after flashing red light stimulation delivered by Cadwell LED stimulating goggles in 89 patients. Restrictive filtering (typically 10–100 Hz), optimal reject window settings, mastoid reference site, total intravenous anesthetic (TIVA), and stable retinal stimulation (ensured by concomitant electroretinogram [ERG] recording) were used to enhance FVEP reproducibility. Results: The relationship between FVEP amplitude change and visual outcome was determined from 179 eyes. One eye had a permanent intraoperative FVEP loss despite stable ERG, and this eye had new, severe postoperative visual dysfunction. Seven eyes had transient significant FVEP change (>50% amplitude decrease that recovered by the end of surgery), but only one of those had a decrease in postoperative visual acuity. FVEP changes in all eight eyes (one permanent FVEP loss plus seven transient FVEP changes) were related to surgical manipulation. In each case the surgeon was promptly informed of the FVEP deterioration and took remedial action. The other eyes did not have FVEP changes, and none of those eyes had new postoperative visual deficits. Conclusions: Our FVEP findings relate to visual outcome with a sensitivity and specificity of 1.0. New methods for rapidly acquiring reproducible FVEP waveforms allowed for timely reporting of significant FVEP change resulting in prompt surgical action. This may have accounted for the low postoperative visual deficit rate (1%) in this series.

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INTRODUCTION Optic nerve/chiasmal injury is a devastating outcome that may happen during endoscopic surgery. A key goal of endoscopic skull-base surgery is visual improvement. Currently, however, there is limited intraoperative visual pathway monitoring. We examine a novel technique that uses continuous flash visual evoked potentials (FVEPs). METHODS Eyes were stimulated by light stimulators (3 LEDs on each side, 640 nm peak wavelength, 10 ms pulse width, 3000 mCd of luminous intensity). Uniform illumination was placed over eyelids. Recording electrodes were placed at Oz-Fz. The filter cuts were = 5 Hz and 100 Hz with amplifier gain 20,000 or 50,000. EEG was recorded. Recordings were correlated to pre and post operative VFs and acuity. Dropping in the FVEP was examined in relation to intraoperative events. A drop of 50% from the base line was considered positive. RESULTS >101 patients had FVEPs in addition to other neurophysiologic monitoring. Patients demographic data, co-morbidities, diagnosis, surgical approach, length of surgery, MAP, and blood loss during surgery were recorded. All patients' visual acuity and field deficits were evaluated by neuro-ophthalmologist before their surgery and within 30 days after surgery. In our cohort, one patient had true positive pre-chiasmatic while another patient had false negative test result. However, the latter patient's deficit was post chiasmatic with no optic nerve or chiasmal injury. Another patient had false positive test (drop of 60%). Eight patients had transient changes related to traction of the chiasm or optic nerves. For predicting optic nerve or chiasmal injury, our study showed sensitivity of 100% (CI2.5-100), specificity of 99% (CI94.5-99.97) and negative predicted value of 100%. CONCLUSION FVEP is reproducible throughout surgery and can predict the post surgical outcome. Additionally, we found that FVEP is transiently affected by different stages of surgery. Further validation is required given the small number of optic/chiasmal injuries in our study.