Indicazioni all'impianto cocleare - parte 1
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Transcript of Indicazioni all'impianto cocleare - parte 1
L’Impianto Cocleare Antonio della Volpe
SSD Chirurgia Protesica SorditàAORN Santobono-Pausilipon
Napoli
XIII Congresso Nazionale A.O.I.C.O.
20- 21 gennaio2012 Cava de’ Tirreni (SA) Attuali indicazioni chirurgiche in ORL
IC: non è solo inserire un elettrodo
Patients Selection
In pre-operative protocol we suggest to study not only the ear and petrous mastoid region, but also the brain.In fact whole brain MRI can demonstrate anomalies also in children without neurological signs or symptoms and can explain the wide variation of performance across individual cochlear implant users
for an “optimal” outcome
look better into the ear
Minimal Access Surgery
Neurofilament 160Connexin 30DAPI
Immunohistochemistry of human cochlea
Connexin 30Connexin 26MergedDAPI
Connexins in human ear
Connexin 30Connexin 26MergeDAPI
cap
IC
MC
BC
SL
ES
Human gap junctionKöling & Rask-Andersen 1983
Confocal microscopy - HumanSEM - Human
Scala Tympani(Completely opened to lateral wall, floor and osseous spiral lamina)
Inferior
Anterior
Left Ear – Cadaver Temporal Bone
Scala Vestibuli
(Completely opened)
True RWM
Osseous Spiral Lamina (OSL) /Basilar Membrane – Under Bone
Cochleostomy Target Zone
(“sweet” spot)
Incus/stapedial joint
Lateral Semi-Circular Canal
Incus Buttress
Facial Nerve (Posterior Border of Facial Recess)
Chorda Tympani Nerve (anterior border of Facial
Recess
Tegmen
Sigmoid Sinus
Mastoid Tip
Antrum
Short process of incus – not visible under ledge
Surgical Techniquedevice positionresistance to displacementcochleostomy/round windowabnormal cochleaeexplant/replantelectrode choice
Approaches
TransmastoidApproach
TransmeatalApproach
Non-Mastoidectomy Approaches
Suprameatal approach (SMA):
J. Kronenberg (2001) -
- Post auricular skin incision
- Tympanomeatal flap
- Groove lateral to chordi tympani
- Suprameatal closed tunnel
- The dura of the middle cranial fossa is exposed.
Pericanal Approach
R. Hausler (2001) –
- Post auricular skin
incision with parietal extension - Tympanomeatal
flap - open tunnel in EAC - glass ionomer
cement and bone dust
Transmeatal Approach ( Minimal Access Surgery)
K. Taibah (2005) - Post auricular
incision. - Tympanomeatal flap - open tunnel in EAC with a groove for the
electrode. - Direct visualization
Skin Incision
right left