Dimak Balazs, Nagy Roland, Perenyi Adam, Jarabin Janos Andras, Schulcz Rebeka, Csanady Miklos, Jori Jozsef, Rovo Laszlo, Kiss Jozsef Geza
University of Szeged, Department of Oto-Rhino- Laryngology, Head and Neck Surgery, Szeged.
Ideggyogy Sz. 2020 Jan 30;73(1-2):53-59. doi: 10.18071/isz.73.0053.
Background - Several cochlear implant recipients experience functionality loss due to electrode array mal-positioning. The application of delicate perimodiolar electrodes has many electrophysiological advantages, however, these profiles may be more susceptible to tip fold-over. Purpose - The prompt realization of such complication following electrode insertion would be auspicious, thus the electrode could be possibly repositioned during the same surgical procedure. Methods - The authors present three tip fold-over cases, experienced throughout their work with Slim Modiolar Electrode implants. Implantations were performed through the round window approach, by a skilled surgeon. Standard intraoperative measurements (electric integrity, neural response telemetry, and electrical stapedial reflex threshold tests) were successfully completed. The electrode position was controlled by conventional radiography on the first postoperative day. Results - Tip fold-over was not tactilely sensated by the surgeon. Our subjects revealed normal intraoperative telemetry measurements, only the postoperative imaging showed the tip fold-over. Due to the emerging adverse perception of constant beeping noise, the device was replaced by a CI512 implant after 6 months in one case. In the two remaining cases, the electrode array was reloaded into a back-up sheath, and reinserted into the scala tympani successfully through an extended round window approach. Discussion - Future additional studies using the spread of excitation or electric field imaging may improve test reliability. As all of these measurements are still carried out following electrode insertion, real-time identification, unfortunately, remains questionable. Conclusion - Tip fold-over could be reliably identified by conventional X-ray imaging. By contrast, intraoperative electrophysiology was not sufficiently sensitive to reveal it.
背景 - 一些人工耳蜗植入者因电极阵列位置不当而出现功能丧失。纤细的蜗轴周围电极的应用具有许多电生理优势，然而，这些电极外形可能更容易出现尖端折叠。目的 - 电极插入后迅速发现这种并发症将是有利的，这样电极有可能在同一次手术过程中重新定位。方法 - 作者介绍了三例在使用纤细蜗轴电极植入物的工作中遇到的尖端折叠病例。植入手术由一名经验丰富的外科医生通过圆窗入路进行。成功完成了标准的术中测量（电完整性、神经反应遥测和镫骨肌电反射阈值测试）。术后第一天通过传统放射照相法控制电极位置。结果 - 外科医生在术中未触觉感知到尖端折叠。我们的受试者术中遥测测量结果正常，只有术后成像显示了尖端折叠。由于出现了持续蜂鸣声的不良感知，在一例中6个月后将设备更换为CI512植入物。在其余两例中，将电极阵列重新装入备用护套，并通过扩大的圆窗入路成功重新插入鼓阶。讨论 - 未来使用兴奋扩散或电场成像的进一步研究可能会提高测试的可靠性。由于所有这些测量仍在电极插入后进行，不幸的是，实时识别仍然存在疑问。结论 - 尖端折叠可通过传统X线成像可靠识别。相比之下，术中电生理对其显示不够敏感。
