DIRECT COCHLEAR NERVE ACTION-POTENTIALS AS AN AID TO HEARING PRESERVATION IN MIDDLE FOSSA ACOUSTIC NEUROMA RESECTION

A new application of auditory evoked potentials using direct cochlear nerve action potentials (CNAPs) for monitoring middle fossa acoustic n euroma resection with attempted hearing preservation is described. Twe nty patients have been studied to date. With this technique, a monitor ing electrode is secured between the floor of the internal auditory ca nal and the dura adjacent to the cochlear nerve in an extradural locat ion. Standard auditory evoked potential techniques with click stimuli and microelectrical recording allow observation of nearfield waveforms in seconds versus several minutes required for farfield potentials re corded from the scalp. Advantages of this technique over auditory brai nstem response monitoring may include nearly real time measurement of potentials, improved surgeon learning curve and possibly higher rates of hearing preservation, and applicability to all patients undergoing hearing-preservation surgery independent of presence or absence of ABR tracing. Immediate changes in amplitude and latency of waveforms appe ar to compare with reversible and irreversible auditory system damage, thereby guiding surgical maneuvers.