Couloigner V, Gratacap M, Ambert-Dahan E, Borel S, Ettienne V, Kerouedan A, Bouccara D, Zerah M, Kalamarides M, Sterkers O
Service d'ORL pédiatrique, université Paris Descartes, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
Service d'ORL pédiatrique, université Paris Descartes, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
Neurochirurgie. 2014 Feb-Apr;60(1-2):17-26. doi: 10.1016/j.neuchi.2014.01.002. Epub 2014 Mar 20.
To present three pediatric cases of auditory brainstem implantation (ABI) and review literature data concerning this topic.
The first two children had a neurofibromatosis type II with bilateral sensorineural deafness; in both cases, the implant was inserted during the surgical removal of a vestibular schwannoma; the third patient had profound deafness due to bilateral cochlear nerve insufficiency associated with inner ear malformation.
Two postoperative complications were observed: patient 1 had a persistent fever which required the replacement of the fat graft used to seal the translabyrinthine approach; patient 3 had a CSF leakage requiring additional surgery and lumbar external drainage. In our three patients, the numbers of active electrodes were 6/22 (Cochlear ABI 24M ABI), 11/12 (Medel Opus II ABI) and 11/12 (implant Medel), respectively. Due to additional major surgical procedures and to disappointing functional results of the ABI, patient 1 stopped wearing her implant 18 months after implantation. Nine months after surgery, patient 2 achieved open-set speech recognition and was very satisfied with the implant. Six months after implantation, patient 3 (cochlear nerve deficiency), who was 3.5 years-old at the time, clearly reacted to some environmental sounds but was not yet able to achieve speech recognition.
ABI has now entered the list of treatments that can be proposed in pediatric profound sensorineural deafness. Its major risks of complications are CSF leakage and non-auditory side effects. Its outcomes are worse and less predictable than cochlear implants. Thus, its indications must remain restricted to cases meeting the following conditions: absence of alternative option to restore hearing, patients and parents high level of motivation and realistic expectations.
介绍三例小儿听觉脑干植入（ABI）病例，并回顾有关该主题的文献数据。
前两名儿童患有II型神经纤维瘤病并伴有双侧感音神经性耳聋；在这两例中，植入物均在手术切除前庭神经鞘瘤期间插入；第三名患者因双侧耳蜗神经功能不全伴内耳畸形而患有严重耳聋。
观察到两例术后并发症：患者1持续发热，需要更换用于封闭经迷路入路的脂肪移植物；患者3发生脑脊液漏，需要额外手术和腰椎外引流。在我们的三名患者中，有效电极数量分别为6/22（科利耳ABI 24M ABI）、11/12（梅德尔奥普斯II ABI）和11/12（梅德尔植入物）。由于额外的大手术以及ABI令人失望的功能结果，患者1在植入后18个月停止佩戴植入物。术后九个月，患者2实现了开放式言语识别，对植入物非常满意。植入后六个月，当时3.5岁的患者3（耳蜗神经缺陷）对一些环境声音有明显反应，但尚未能够实现言语识别。
ABI现已进入可用于小儿严重感音神经性耳聋的治疗方法清单。其主要并发症风险是脑脊液漏和非听觉副作用。其结果比人工耳蜗更差且更难预测。因此，其适应症必须限于符合以下条件的病例：没有恢复听力的替代选择、患者和家长积极性高且期望现实。
