Intraoperative Monitoring of the Cochlear Nerve during Neurofibromatosis Type-2 Vestibular Schwannoma Surgery and Description of a “Test Intracochlear Electrode”

Anand V. Kasbekar; Yu Chuen Tam; Robert P. Carlyon; John M. Deeks; Neil Donnelly; James Tysome; Richard Mannion; Patrick R. Axon

doi:10.1055/s-0038-1673649

Journal of Neurological Surgery Reports, Table of Contents

CC BY 4.0 · J Neurol Surg Rep 2019; 80(01): e1-e9
DOI: 10.1055/s-0038-1673649

Case Report

Georg Thieme Verlag KG Stuttgart · New York

Intraoperative Monitoring of the Cochlear Nerve during Neurofibromatosis Type-2 Vestibular Schwannoma Surgery and Description of a “Test Intracochlear Electrode”

Anand V. Kasbekar

¹Cambridge Skull Base Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom

²Department of Otorhinolaryngology, Head and Neck Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom

³NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom

,

Yu Chuen Tam

⁴Emmeline Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom

,

Robert P. Carlyon

⁵Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom

,

John M. Deeks

⁵Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom

,

Neil Donnelly

¹Cambridge Skull Base Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom

,

James Tysome

¹Cambridge Skull Base Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom

,

Richard Mannion

¹Cambridge Skull Base Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom

,

Patrick R. Axon

¹Cambridge Skull Base Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom

› Author Affiliations

Abstract

Objectives A decision on whether to insert a cochlear implant can be made in neurofibromatosis 2 (NF2) if there is objective evidence of cochlear nerve (CN) function post vestibular schwannoma (VS) excision. We aimed to develop intraoperative CN monitoring to help in this decision.

Design We describe the intraoperative monitoring of a patient with NF2 and our stimulating and recording set up. A novel test electrode is used to stimulate the CN electrically.

Setting This study was set at a tertiary referral center for skull base pathology.

Main outcome measure Preserved auditory brainstem responses leading to cochlear implantation.

Results Electrical auditory brainstem response (EABR) waveforms will be displayed from different stages of the operation. A cochlear implant was inserted at the same sitting based on the EABR.

Conclusion Electrically evoked CN monitoring can provide objective evidence of CN function after VS excision and aid in the decision-making process of hearing rehabilitation in patients who will be rendered deaf.

Keywords

cochlear nerve monitoring - neurofibromatosis type 2 - hearing preservation - EABR

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References

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