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