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ENT
Auditory Brainstem Implantation
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
10 sections · 80 slides
Overview
- Definition and purpose of the auditory brainstem implant
- Scope of auditory brainstem implantation
History of development
- First cochlear nucleus implant, 1979
- Mesh array experience at Huntington Medical Research Institute
- Development of the multichannel system
- Regulatory milestones of the multichannel ABI
Patient selection
- Neurofibromatosis type 2 as the primary indication
- Hearing preservation before implantation
- Approved candidacy criteria
- Absent auditory response after implantation
- Non-device factors that limit benefit
- Off-label indications for the ABI
- Off-label indications in detail
Preoperative evaluation and counselling
- Informed consent and expectation setting
- Motivation and compliance with follow-up
- Warnings given before surgery
- The multidisciplinary team
The device
- Cochlear ABI541 array design
- Auditory brainstem implant electrode arrays
- MED-EL Synchrony ABI and its test electrode
- Penetrating electrode ABI
Anatomic considerations
- Target nuclei for the electrode array
- Landmarks at the pontomedullary junction
- Cochlear nuclei region and the translabyrinthine surgical view
- Pitfalls in identifying the lateral recess
- Why the array is placed within the recess
Surgical technique
- Choice of surgical approach
- Operative setup and prophylaxis
- Incision and planned receiver stimulator site
- Preparing the receiver stimulator seat
- Completed translabyrinthine craniotomy with wire trench and receiver seat
- Securing the receiver stimulator
- Receiver stimulator seated in the drilled bone well
- Confirming the lateral recess with the Valsalva manoeuvre
- Inserting the electrode array
- Electrode array being placed into the lateral recess
- Intraoperative testing after placement
- Electric auditory brainstem response monitoring
- MED-EL test electrode sequence
- Securing the array and closure
- Fat obliteration of the surgical cavity
- Magnet handling and locating the receiver
Postoperative care and complications
- Postoperative care
- Retainer disk and transmitter coil position
- Cerebrospinal fluid leak after ABI
- Prevention of cerebrospinal fluid leak
- Escalating management of a persistent leak
- Blind sac closure and meningitis
Results
- Overall performance expectations
- Implantation numbers and device use
- Everyday auditory benefit
- Open-set speech discrimination
- Reading the pooled outcomes table
- ABI outcomes in NF 2
- ABI outcomes in NF 2 (continued)
- Recent improvements in open speech perception
- Surgical technique as an explanation for better outcomes
Non-NF2 and paediatric implantation
- Non-NF2 indications and the Verona experience
- Why non-tumour recipients perform better
- Paediatric outcomes
- Paediatric technique and timing
- Inferior colliculus as an alternative target
- Auditory midbrain implant trial results
- Summary of established practice
- Current directions
- References
- References (continued)
- References (continued)
- References (continued)
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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