共 27 条
An Evidence-Based Algorithm for Intraoperative Monitoring During Cochlear Implantation
被引:78
作者:
Cosetti, Maura K.
[1
]
Troob, Scott H.
[1
]
Latzman, Jonathan M.
[1
]
Shapiro, William H.
[1
]
Roland, John Thomas, Jr.
[1
]
Waltzman, Susan B.
[1
]
机构:
[1] NYU, Sch Med, Dept Otolaryngol Head & Neck Surg, New York, NY 10016 USA
关键词:
Cochlear implants;
Electrode impedance;
Intraoperative monitoring;
Intraoperative imaging;
Neural response telemetry;
Spread of excitation;
NEURAL RESPONSE TELEMETRY;
ROTATIONAL X-RAY;
REVISION;
FAILURES;
SURGERY;
EXCITATION;
PLACEMENT;
CHILDREN;
SYSTEM;
SPREAD;
D O I:
10.1097/MAO.0b013e3182423175
中图分类号:
R74 [神经病学与精神病学];
学科分类号:
摘要:
Objective: To generate an evidence-based algorithm for the use of intraoperative testing during cochlear implantation (CI). Study Design: Retrospective review. Setting: Tertiary referral center. Patients: A total of 277 children (aged 6 mo to 17 yr) and adults 18 years and older with normal cochlear anatomy who underwent primary and revision cochlear implantation at a single center between 2005 and 2010 were included. Intervention: Intraoperative electrophysiologic monitoring and intraoperative Stenver's view plain film radiography. Main Outcome Measure: Intraoperative testing included the following: 1) individual electrode impedance measurements; 2) neural response telemetry (tNRT) levels for electrodes E20, E15, E10, and E5; and 3) plain film radiograph assessment of electrode position. Results: No patient demonstrated abnormalities on all 3 modalities. Open or short electrodes on impedance testing were found in 6% of patients; half of these normalized when remeasured. Absent tNRT responses on 1 or more electrodes occurred in 14% of patients, although complete lack of response was rare (1.4%) and did not correlate with a dysfunctional device. Spread of excitation was performed in 1 patient and was consistent with a tip rollover. Intraoperative radiography identified tip-rollover and extracochlear electrode placement in all cases (n = 5, 1.8%) and prompted the use of the backup device. Conclusion: Immediate intraoperative determination of device functionality and optimal electrode placement is advantageous. Of the modalities tested, including electrode impedance, tNRT, and plain radiograph, only the radiographic results impacted intraoperative surgical decision making and led to the use of the backup device.
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页码:169 / 176
页数:8
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