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. 1997;7(2):69–75. doi: 10.1055/s-2008-1058611

Advantages of a New, Atraumatic, Self-Retaining Electrode for Direct Cochlear Nerve Monitoring

Michael J Ruckenstein, Roberto A Cueva, George R Prioleau
PMCID: PMC1656591  PMID: 17170992

Abstract

Direct cochlear nerve monitoring during posterior fossa surgery offers the surgeon real-time information concerning auditory stams. However, routine utilization of this monitoring technique has been hampered by electrode designs that have not allowed the maintenance of a consistent contact between the nerve and electrode. We report on our experience with a new electrode designed to maintain consistent, atraumatic contact with the cochlear nerve and discuss the advantages of this electrode over existing wick and ball type electrodes.

The utilization of this electrode during 18 posterior fossa surgeries, performed at Kaiser Permanenie Hospital, San Diego, including 8 vestibular schwannoma resections, allowed for consistent recording of high amplitude cochlear compound action potentials. Long-term exposure to pulsating cerebrospinal fluid (CSF) did not displace the electrode. Minimal cochlear nerve action potential amplitude change was noted with the electrode imrnersed in CSF. The electrode caused no trauma to the nerve, even in cases where it was accidentally dislodged from the nerve. It is hoped that by overcoming the problems previously associated with direct cochlear nerve monitoring, this electrode will allow for increased use of this advantageous monitoring technique. As a by product of the real-time data provided to the surgeon, we anticipate increased rates of hearing preservation during cerebellopontine angle surgery.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cohen N. L., Lewis W. S., Ransohoff J. Hearing preservation in cerebellopontine angle tumor surgery: the NYU experience 1974-1991. Am J Otol. 1993 Sep;14(5):423–433. doi: 10.1097/00129492-199309000-00002. [DOI] [PubMed] [Google Scholar]
  2. Colletti V., Bricolo A., Fiorino F. G., Bruni L. Changes in directly recorded cochlear nerve compound action potentials during acoustic tumor surgery. Skull Base Surg. 1994;4(1):1–9. doi: 10.1055/s-2008-1058981. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Fischer G., Fischer C., Rémond J. Hearing preservation in acoustic neurinoma surgery. J Neurosurg. 1992 Jun;76(6):910–917. doi: 10.3171/jns.1992.76.6.0910. [DOI] [PubMed] [Google Scholar]
  4. Glasscock M. E., 3rd, Hays J. W., Minor L. B., Haynes D. S., Carrasco V. N. Preservation of hearing in surgery for acoustic neuromas. J Neurosurg. 1993 Jun;78(6):864–870. doi: 10.3171/jns.1993.78.6.0864. [DOI] [PubMed] [Google Scholar]
  5. Kuroki A., Møller A. R. Microsurgical anatomy around the foramen of Luschka in relation to intraoperative recording of auditory evoked potentials from the cochlear nuclei. J Neurosurg. 1995 Jun;82(6):933–939. doi: 10.3171/jns.1995.82.6.0933. [DOI] [PubMed] [Google Scholar]
  6. Lalwani A. K., Butt F. Y., Jackler R. K., Pitts L. H., Yingling C. D. Facial nerve outcome after acoustic neuroma surgery: a study from the era of cranial nerve monitoring. Otolaryngol Head Neck Surg. 1994 Nov;111(5):561–570. doi: 10.1177/019459989411100505. [DOI] [PubMed] [Google Scholar]
  7. Lambert P. R., Ruth R. A. Simultaneous recording of noninvasive ECoG and ABR for use in intraoperative monitoring. Otolaryngol Head Neck Surg. 1988 Jun;98(6):575–580. doi: 10.1177/019459988809800607. [DOI] [PubMed] [Google Scholar]
  8. Linden R. D., Tator C. H., Benedict C., Charles D., Mraz V., Bell I. Electrophysiological monitoring during acoustic neuroma and other posterior fossa surgery. Can J Neurol Sci. 1988 Feb;15(1):73–81. doi: 10.1017/s0317167100027232. [DOI] [PubMed] [Google Scholar]
  9. Møller A. R., Jannetta P. J. Monitoring auditory functions during cranial nerve microvascular decompression operations by direct recording from the eighth nerve. J Neurosurg. 1983 Sep;59(3):493–499. doi: 10.3171/jns.1983.59.3.0493. [DOI] [PubMed] [Google Scholar]
  10. Møller A. R., Jho H. D., Jannetta P. J. Preservation of hearing in operations on acoustic tumors: an alternative to recording brain stem auditory evoked potentials. Neurosurgery. 1994 Apr;34(4):688–693. doi: 10.1227/00006123-199404000-00018. [DOI] [PubMed] [Google Scholar]
  11. Møller A. R. Monitoring auditory function during operations to remove acoustic tumors. Am J Otol. 1996 May;17(3):452–460. [PubMed] [Google Scholar]
  12. Møller A. R., Møller M. B. Does intraoperative monitoring of auditory evoked potentials reduce incidence of hearing loss as a complication of microvascular decompression of cranial nerves? Neurosurgery. 1989 Feb;24(2):257–263. doi: 10.1227/00006123-198902000-00017. [DOI] [PubMed] [Google Scholar]
  13. Nadol J. B., Jr, Chiong C. M., Ojemann R. G., McKenna M. J., Martuza R. L., Montgomery W. W., Levine R. A., Ronner S. F., Glynn R. J. Preservation of hearing and facial nerve function in resection of acoustic neuroma. Laryngoscope. 1992 Oct;102(10):1153–1158. doi: 10.1288/00005537-199210000-00010. [DOI] [PubMed] [Google Scholar]
  14. Nedzelski J. M., Chiong C. M., Cashman M. Z., Stanton S. G., Rowed D. W. Hearing preservation in acoustic neuroma surgery: value of monitoring cochlear nerve action potentials. Otolaryngol Head Neck Surg. 1994 Dec;111(6):703–709. doi: 10.1177/019459989411100602. [DOI] [PubMed] [Google Scholar]
  15. Radtke R. A., Erwin C. W., Wilkins R. H. Intraoperative brainstem auditory evoked potentials: significant decrease in postoperative morbidity. Neurology. 1989 Feb;39(2 Pt 1):187–191. doi: 10.1212/wnl.39.2.187. [DOI] [PubMed] [Google Scholar]
  16. Silverstein H., McDaniel A. B., Norrell H. Hearing preservation after acoustic neuroma surgery using intraoperative direct eighth cranial nerve monitoring. Am J Otol. 1985 Nov;Suppl:99–106. [PubMed] [Google Scholar]
  17. Silverstein H., McDaniel A., Norrell H., Haberkamp T. Hearing preservation after acoustic neuroma surgery with intraoperative direct eighth cranial nerve monitoring: Part II. A classification of results. Otolaryngol Head Neck Surg. 1986 Oct;95(3 Pt 1):285–291. doi: 10.1177/01945998860953P104. [DOI] [PubMed] [Google Scholar]
  18. Silverstein H., Norrel H., Hyman S. M. Simultaneous use of CO2 laser with continuous monitoring of eighth cranial nerve action potential during acoustic neuroma surgery. Otolaryngol Head Neck Surg. 1984 Feb;92(1):80–84. doi: 10.1177/019459988409200117. [DOI] [PubMed] [Google Scholar]
  19. Wazen J. J. Intraoperative monitoring of auditory function: experimental observations and new applications. Laryngoscope. 1994 Apr;104(4):446–455. doi: 10.1288/00005537-199404000-00009. [DOI] [PubMed] [Google Scholar]
  20. ZappiaJJ, Wiet R. J., O'Connor C. A., Martone L. Intraoperative auditory monitoring in acoustic neuroma surgery. Otolaryngol Head Neck Surg. 1996 Jul;115(1):98–106. doi: 10.1016/S0194-5998(96)70144-4. [DOI] [PubMed] [Google Scholar]

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