Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
Otolaryngol Head Neck Surg. 2023 Jun;168(6):1485-1493. doi: 10.1002/ohn.220. Epub 2023 Jan 29.
To evaluate the safety and outcomes of cochlear implantation (CI) in patients with ventriculoperitoneal (VP) shunts to inform clinical practice.
Historical cohort study.
Tertiary referral centers.
A multi-institutional historical cohort of patients with VP shunts and CI was identified and analyzed.
A total of 46 patients (median age 8 years [interquratile range, IQR: 2-46]) with VP shunts and CI were identified. Of these, 41 (89%) patients had a VP shunt prior to CI. Based on institutional preference and individual patient factors, CI was performed contralateral to a pre-existing VP shunt in 24 of these 41 cases (59%) and ipsilateral in 17 (41%). Furthermore, pre-CI relocation of the VP shunt was performed in 3 cases (7%), and 2 patients (5%) underwent planned revision of their VP shunt concurrent with CI. In total, 2 of 27 pediatric patients (7%) required unanticipated revision shunt surgery, both contralateral to CI device placement, given VP shunt malfunction. One of 19 adult patients (5%) required shunt revision during CI due to shunt damage noted intraoperatively. Among 43 patients with available follow-up, 38 (88%) are regular CI users, with a median consonant-nucleus vowel-consonant word: score of 58% (IQR: 28-72).
CI can be performed at low risk, either contralateral or ipsilateral, to a VP shunt, and does not mandate shunt revision in most cases. Additional considerations regarding CI receiver-stimulator placement are necessary with programmable shunts to mitigate device interaction. Preoperative planning, including coordination of care with neurosurgery, is important to achieving optimal outcomes.
评估伴有脑室-腹腔（VP）分流管的患者行人工耳蜗植入（CI）的安全性和效果，为临床实践提供参考依据。
历史性队列研究。
三级转诊中心。
确定并分析了一个伴有 VP 分流管和 CI 的多机构历史性队列患者。
共确定了 46 例（中位年龄 8 岁[四分位距，IQR：2-46]）伴有 VP 分流管和 CI 的患者。其中，41 例（89%）患者在 CI 前就有 VP 分流管。根据机构偏好和个体患者因素，24 例（59%）同侧植入 CI，41 例（41%）对侧植入 CI。此外，3 例（7%）在 CI 前对 VP 分流管进行了重新定位，2 例（5%）同时计划对 VP 分流管进行修复。共有 2 例（7%）儿童患者（27 例中的 2 例）需要进行意外的分流管手术，这 2 例均为 CI 装置放置的对侧，VP 分流管功能障碍。1 例（5%）成人患者（19 例中的 1 例）在 CI 期间因术中发现分流管损坏而需要分流管修复。在 43 例有随访信息的患者中，38 例（88%）为常规 CI 用户，其辅音-核元音-辅音词得分中位数为 58%（IQR：28-72）。
VP 分流管对侧或同侧行 CI 风险低，大多数情况下无需进行分流管修复。对于具有可程控分流管的患者，需要考虑 CI 接收器-刺激器的放置位置，以减轻设备间的相互作用。术前计划，包括与神经外科的协调，对获得最佳效果很重要。
