Detailed insight in intraoperative eABR measurements to assist auditory brainstem implantation in a patient with neurofi
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ORIGINAL ARTICLE
Detailed insight in intraoperative eABR measurements to assist auditory brainstem implantation in a patient with neurofibromatosis type 2 Magdalena Lachowska1 · Agnieszka Pastuszka1 · Lidia Mikołajewska1 · Przemysław Kunert2 · Kazimierz Niemczyk1 Received: 6 May 2019 / Accepted: 12 November 2019 © Belgian Neurological Society 2019
Abstract Auditory brainstem implant (ABI) is used to provide auditory sensations in patients with neurofibromatosis type 2 who lost their hearing due to a surgical removal of the tumor. ABI surgery, implant activation and follow-up sessions present unique challenges including the exact placement of the electrode pad in the lateral recess of the IVth ventricle, identification of electrodes that trigger non-auditory sensation and their deactivation which lowers the number of electrodes responsible for hearing, changes of T- and C-levels across follow-up sessions. We present a complete procedure using an example case starting from the surgical part with the detailed description of intraoperative eABR measurement as a guidance for pad placement to the ABI activation and first fitting sessions with auditory sensation assessment. Since the first ABI electrode pad position presented non-satisfactory intraoperative eABR results it was decided to move the pad slightly which resulted in better eABR (more electrodes with auditory responses). The discussed patient demonstrated great auditory and speech perception results after the first ABI fitting (which included three sessions over 2 consecutive days). Repositioning of the ABI electrode pad during the surgery was carried out taking into account the intraoperative eABR results and this led to an overall positive outcome for the patient. The placement of ABI electrode pad is crucial for later auditory results. This study provides detailed insight in this very specialized procedure that is not performed in every clinic and adds to the knowledge of intraoperative navigation using eABR measurements during ABI surgery. Keywords Hearing loss · Evoked potentials · Neurofibromatosis · Cochlear nerve · Cochlear nucleus · Auditory brainstem implant
Introduction Auditory brainstem implant (ABI) is used to provide auditory sensations in patients with neurofibromatosis type 2 (NF2) who lost their hearing due to a surgical removal of the tumor. ABI converts the acoustic signal into the electrical one for direct stimulation of the cochlear nucleus (CN) located in the brainstem bypassing the cochlea and the cochlear nerve. ABI surgery, implant activation and followup sessions present unique challenges including the exact * Magdalena Lachowska [email protected] 1
Department of Otolaryngology, Medical University of Warsaw, Warsaw, Poland
Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
2
placement of the electrode pad (electrode array) on the ventral cochlear nucleus in the lateral recess of the IVth ventricle, identification of electrodes that trigger non-auditory sensation, deactivation of those electrode
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