Ruckenstein M J, Cueva R A, Prioleau G R
Skull Base Surg. 1997;7(2):69-75. doi: 10.1055/s-2008-1058611.
Direct cochlear nerve monitoring during posterior fossa surgery offers the surgeon real-time information concerning auditory stams. However, routine utilization of this monitoring technique has been hampered by electrode designs that have not allowed the maintenance of a consistent contact between the nerve and electrode. We report on our experience with a new electrode designed to maintain consistent, atraumatic contact with the cochlear nerve and discuss the advantages of this electrode over existing wick and ball type electrodes.The utilization of this electrode during 18 posterior fossa surgeries, performed at Kaiser Permanenie Hospital, San Diego, including 8 vestibular schwannoma resections, allowed for consistent recording of high amplitude cochlear compound action potentials. Long-term exposure to pulsating cerebrospinal fluid (CSF) did not displace the electrode. Minimal cochlear nerve action potential amplitude change was noted with the electrode imrnersed in CSF. The electrode caused no trauma to the nerve, even in cases where it was accidentally dislodged from the nerve. It is hoped that by overcoming the problems previously associated with direct cochlear nerve monitoring, this electrode will allow for increased use of this advantageous monitoring technique. As a by product of the real-time data provided to the surgeon, we anticipate increased rates of hearing preservation during cerebellopontine angle surgery.
后颅窝手术期间的直接蜗神经监测为外科医生提供有关听神经束的实时信息。然而，这种监测技术的常规应用一直受到电极设计的阻碍，这些设计无法使神经与电极保持持续接触。我们报告了一种旨在与蜗神经保持持续、无创伤接触的新型电极的使用经验，并讨论了该电极相对于现有的灯芯型和球型电极的优势。在圣地亚哥凯撒永久医疗中心进行的18例后颅窝手术中使用了这种电极，其中包括8例前庭神经鞘瘤切除术，能够持续记录到高振幅的蜗复合动作电位。长期暴露于搏动性脑脊液（CSF）中并没有使电极移位。将电极浸入脑脊液中时，蜗神经动作电位幅度的变化最小。即使在电极意外从神经上脱落的情况下，该电极也不会对神经造成损伤。希望通过克服以前与直接蜗神经监测相关的问题，这种电极将使这种有益的监测技术得到更广泛的应用。作为提供给外科医生的实时数据的一个附带成果，我们预计在桥小脑角手术期间听力保留率会提高。
