Cochlear Implant in a Child with a Large Arachnoid Cyst and Cysto-peritoneal Shunt
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CLINICAL REPORT
Cochlear Implant in a Child with a Large Arachnoid Cyst and Cysto-peritoneal Shunt Aanchal Aggarwal Mittal1 • Apurva Kumar2 • Abhilash Bansal3 Sumit Kumar Gaur1 • Sunil Narayan Dutt1
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Received: 28 August 2020 / Accepted: 10 September 2020 Ó Association of Otolaryngologists of India 2020
Abstract Profound hearing loss requiring cochlear implantation and arachnoid cyst requiring placement of Cysto-Peritoneal Shunt (CPS) are two commonly seen entities. However, there are very few published cases of patients requiring both of them. The present report describes the importance of multidisciplinary surgical planning in one such patient. Keywords Arachnoid cyst Cochlear implantation Trans-Tympanic Electrically-evoked Auditory Brainstem Response (TTEABR) Cysto-peritoneal shunt
membrane exists, these lesions are commonly found on the surface of the brain near the main brain fissures, middle cranial fossa being the most common site [3]. The patients often present with cranial enlargement, epileptic seizures, hydrocephalus and psychomotor retardation [4]. There may be underlying mal-development of the cortex, especially the temporal lobe. This is the report of a 3-year-old child with a large arachnoid cyst in the left middle cranial fossa and bilateral profound hearing loss who was treated with a Cysto-Peritoneal Shunt (CPS) and subsequently a left ear cochlear implantation.
Introduction Case Report Arachnoid cysts are collections of Cerebro-Spinal Fluid (CSF) contained within the arachnoid membrane and subarachnoid space of the cisterns and major cerebral fissures. Most of the cases represent congenital lesions (primary arachnoid cysts) resulting from alterations in CSF flow in the early phase of subarachnoid space formation [1]. Although some cysts remain stable, a majority become symptomatic in early childhood, with 60–90% of all patients with arachnoid cysts being children [2]. Although arachnoid cysts can occur at any site where the arachnoid & Aanchal Aggarwal Mittal [email protected] 1
Department of Otolaryngology and Head and Neck Surgery, Apollo Hospitals, Bannerghatta Road, Bengaluru 560076, India
2
Ashadeep ENT Centre, Bengaluru, India
3
Department of Neurosurgery, Apollo Hospitals, Bannerghatta Road, Bengaluru 560076, India
A 3-year-old male child presented with a history of profound hearing loss since birth. He was earlier diagnosed to have a large arachnoid cyst in the left middle cranial fossa extending into the left sylvian fissure and along the left cerebral convexity, into the pre-pontine and interpeduncular cistern with adjacent mass effect and communication with the third ventricle (Fig. 1a, b). A complete audiological work up was performed. Brainstem Evoked Response Audiometry (BERA) showed no replicable peak V even at 110 dBnHL and Distortion Product Oto-Acoustic Emissions (DPOAE) were absent in both ears. Auditory Steady State Response (ASSR) was also suggestive of bilateral profound hearing loss. Tympanometry showed a type ‘A’ graph in both ears, suggestive
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