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Morphometrische Studie zur Optimierung der Implantationstechnik zentraler Hörprothesen

Optimization of microsurgical operation technique to insert auditory brainstem implants, taking into account the results of a morphometric study

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Zusammenfassung

Wissensstand

Bei beidseitigem retrokochleären Hörverlust ist durch Hörprothesen zur elektrischen Reizung der Hörkernregion eine begrenzte Wiederherstellung des Hörvermögens möglich. Zu den Lageverhältnissen der Zielregion, v. a. am Ventrikelboden, lagen nur wenige Untersuchungen vor.

Ziele

Erhöhte Operationssicherheit durch genauere anatomische Orientierung zur Zielregion für mikrochirurgische Zugänge von lateral und medial oder ein stereotaktisches Vorgehen.

Methodik und Ergebnisse

Landmarken zur Elektrodenplatzierung wurden an einer Serie formalinfixierter menschlicher Hirnstämme untersucht und vermessen (n=28). Die morphometrisch in ihrer Variabilität erfassten Daten ermöglichen eine genauere Ziellokalisation als die elektrophysiologische Kontrolle und damit eine weitere Präzisierung praktizierter Operationstechniken von lateral.

Fazit

Die genauere Zielpunktlokalisation erhöht die Implantationssicherheit. Der neue Mittellinienzugang bietet die Chance das Indikationsspektrum der Implantate zu erweitern. Die Integration der erfassten Daten in stereotaktische Verfahren ist denkbar.

Abstract

State of the art

The surgical placement of auditory brainstem implants to stimulate the cochlear nuclear region in patients with acquired bilateral retrocochlear deafness allows limited restitution of hearing. However, there have been few studies on the topographical relations in the target region, particularly the floor of the IVth ventricle.

Topic of the study

Is it possible to obtain more precise anatomical data in order to improve the surgical approaches and techniques for the placement of auditory brainstem implants?

Aims

To obtain a more precise topo- anatomical orientation in the target region for microsurgical lateral and midline approaches or a stereotactic operative strategy.

Methods and results

Landmarks for the placement of an auditory brainstem implant via the IVth ventricle were examined and measured in a series of formalin-fixed human brainstems (n=28). These data, and knowledge of their variability, allow a more precise surgical lateral approach. It is essential to precisely localise the target region, as it can only be partly discerned under the microscope during an operation. For this reason, to date its precise localisation has been determined only electrophysiologically.

Conclusion

Exact target localisation improves safety. From an anatomical point of view the midline approach gives the chance to enlarge the indication spectrum for an implant. The anatomical data obtained here could also be integrated into a stereotactic surgical strategy.

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Danksagung

Die Untersuchungen wurden mit finanzieller Unterstützung durch das Bundesministerium für Bildung und Forschung durchgeführt, Förderkennzeichen: 01 VJ 9310/1 (Dr. med. R. Quester)

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Authors and Affiliations

  1. Zentrum für Neurochirurgie, Klinikum der Universität zu Köln, Seminar für Psychiatrie der Heilpädagogischen Fakultät, Universität zu Köln

    R. Quester

  2. Ehem. Abteilung für Neuropathologie, Klinikum der Universität zu Köln

    R. Schröder

  3. Zentrum für Neurochirurgie, Klinikum der Universität zu Köln

    N. Klug

  4. Zentrum für Neurochirurgie—Klinik für Allgemeine Neurochirurgie und Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln, Joseph-Stelzmann-Straße 9, 50931 , Köln

    R. Quester

  5. Vertretungsprofessor, Seminar für Psychiatrie und Psychotherapie, Heilpädagogische Fakultät, Universität zu Köln, IBW-Gebäude, Herbert-Lewin-Straße 2, 50931 , Köln

    R. Quester

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  1. R. Quester
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Correspondence to R. Quester.

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Quester, R., Schröder, R. & Klug, N. Morphometrische Studie zur Optimierung der Implantationstechnik zentraler Hörprothesen. HNO 52, 706–713 (2004). https://doi.org/10.1007/s00106-003-0985-9

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  • DOI: https://doi.org/10.1007/s00106-003-0985-9

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