Auditory brainstem implants: current neurosurgical experiences and perspective

The objective of this study was to present aspects of the current treatment protocol, such as patient evaluation and selection for therapy, multimodal ity monitoring for optimal auditory brainstem implant (ABI) positioning and radiological evaluation, that might have an impact on the functional resul ts of ABI. Out of a series of 145 patients with bilateral vestibular schwannomas 10 pa tients received an ABI, eight of which are reported here. Patient selection was based on disease course, clinical and radiological criteria (according to the Hannover evaluation and prognosis scaling of neurofibromatosis type 2 (NF2)), extensive otological test battery and psyche-social factors. ABI placement was controlled by multimodality electrophysiological monitoring in order to activate the auditory pathway and to prevent false stimulation of the cranial nerve nuclei or long sensory or motor tracts. Results of hea ring function were correlated with patients' ages, duration of deafness, tu mour extension, tumour-induced compression or deformation of the brainstem, and numbers of activated electrodes without any side-effects. Out of 59 patients with pre-operative deafness eight patients received an A BI of the Nucleus 22 type. All these patients became continuous users witho ut any side effects and experienced improved quality of life. Speech recept ion in combination with lip-reading was markedly improved, with further imp rovement over a long period. A short duration of deafness may be favourable for achieving good results, while age was not a relevant factor. Lateral r ecess obstruction may necessitate a more meticulous dissection, but did not prevent good placement of the ABI in the lateral recess. Pre-existing brai nstem compression did not prevent good results, but brainstem deformation a nd ipsi- and contralateral distortion were followed by a less favourable ou tcome. Among the factors that can be influenced by the therapy management are the selection of patients with a slow progressing NF2 disease, a short duration of deafness, a careful analysis of brainstem deformation and consideration of either side for implantation. Long-standing brainstem deformation might not lead to recovery, but instead lead to a low number of active electrode s and possibly only moderate results. ABI treatment is a safe procedure that can increase a patient's quality of life considerably. ABI placement along with neurophysiological control help s to prevent side effects and to improve acoustic activation. Further studi es on structural and functional changes of the brainstem after previous tum our compression and distortion should increase our understanding and facili tate a decision on the best side for ABI implantation.