Miyazaki Hidemi, Caye-Thomasen Per
Adv Otorhinolaryngol. 2018;81:123-132. doi: 10.1159/000485577. Epub 2018 Apr 6.
A new electrophysiological system for intraoperative, continuous, near-real time monitoring of cochlear nerve function through acoustic stimulation in the ear canal and recording of the evoked dorsal cochlear nucleus potentials (DNAPs) by a specially designed DNAP electrode placed directly on the brainstem is described. The system is denominated "(cerebellopontine angle) CPA Master" and is designed for hearing preservation surgery in the cerebello-pontine angle, through the retro-sigmoid or the retro-labyrinthine approach. As an additional novelty within the field, the system allows intraoperative mapping and thus precise localization of the cochlear nerve in its entire trajectory from the brainstem to the fundus of the internal auditory canal, which is a major advance in relation to atraumatic dissection of the nerve. The system can be used for surgery of all types of CPA tumors, for example, vestibular schwannomas, meningiomas and epidermoid cysts, but also for vestibular nerve section and vascular decompression. The system also allows evaluation of the electrical functionality of an anatomically intact cochlear nerve in translabyrinthine surgery, thus predicting the benefit of optional cochlear implantation.
本文描述了一种新的电生理系统，该系统可通过耳道内的声刺激对耳蜗神经功能进行术中连续、近实时监测，并通过直接放置在脑干上的特制背侧耳蜗核电位（DNAP）电极记录诱发的DNAP。该系统被命名为“（小脑脑桥角）CPA Master”，设计用于通过乙状窦后或迷路后入路在小脑脑桥角进行听力保留手术。作为该领域的又一创新，该系统允许术中绘图，从而在从脑干到内耳道底部的整个轨迹中精确定位耳蜗神经，这相对于神经的无创解剖是一项重大进展。该系统可用于所有类型的CPA肿瘤手术，例如前庭神经鞘瘤、脑膜瘤和表皮样囊肿，也可用于前庭神经切断术和血管减压术。该系统还允许在经迷路手术中评估解剖结构完整的耳蜗神经的电功能，从而预测选择性人工耳蜗植入的益处。
