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Intraoperatives Monitoring des N. cochlearis bei Eingriffen im Kleinhirnbrückenwinkel

Intraoperative monitoring of cochlear nerve function during cerebello-pontine angle surgery

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Zusammenfassung

Hintergrund

Bei Eingriffen im Kleinhirnbrückenwinkel (KHBW), z. B. zur operativen Therapie eines Vestibularisschwannoms, besteht das Risko der Schädigung des N. cochlearis. Als Folge können Hörminderungen bis zur Taubheit auftreten, mit wesentlicher Beeinträchtigung der Lebensqualität. Methoden zur intraoperativen Funktionsüberwachung können Risiken minimieren.

Fragestellung

Ziel war ein Überblick über aktuelle Methoden zur intraoperativen Überwachung des N. cochlearis sowie die Zusammenfassung neuerer Entwicklungen.

Material und Methoden

Es erfolgte die Auswertung und Zusammenfassung der Literatur und die Diskussion neuer Methoden.

Ergebnisse

Die frühen akustisch evozierten Potenziale (FAEP) mittels Klickreizen stellen nach wie vor die Standardmethode zur intraoperativen Funktionsüberwachung des N. cochlearis dar. Amplituden- und Latenzveränderungen der FAEP weisen auf das Risiko einer postoperativen Hörminderung hin, erlauben jedoch nur eingeschränkt eine weitere Differenzierung der postoperativen Hörqualität. Als neuere Methoden könnten Nahfeldableitungen eine schnellere Rückmeldung, Auditory Steady State Responses eine frequenzspezifische Testung ermöglichen.

Schlussfolgerungen

Die intraoperative Funktionsüberwachung des N. cochlearis ist ein integraler Bestandteil der KHBW-Chirurgie. Sie ermöglicht die Erkennung potenzieller Nervenschädigungen und trägt so zur Vermeidung postoperativer funktioneller Defizite bei. Die Entwicklung und Implementierung neuer und zusätzlicher Verfahren könnten den klinischen Nutzen weiter verbessern.

Abstract

Background

Surgical procedures in the cerebello-pontine angle (CPA), e. g. for vestibular schwannoma, have an increased risk for damage to the cochlear nerve. Consequently, hearing deterioration up to complete deafness may result with severe impact on quality of life. Methods for intraoperative monitoring of function may minimize such risks.

Objective

Review of current methods for intraoperative monitoring of the cochelar nerve and summary of new developments.

Materials and methods

Analysis and summary of literature, discussion of new methods.

Results

Early auditory evoked potentials using click stimuli remain the standard method for intraoperative monitoring of cochlear nerve function. Amplitude and latency changes indicate a risk of postoperative hearing deterioration; however demonstrate only limited further differentiation of hearing quality. As novel methods, near-field recordings may allow faster feedback and auditory steady state responses potentially enable frequency specific testing.

Conclusions

Intraoperative monitoring of the cochlear nerve is an integral component of CPA surgery. It enables detection of potential nerve damage and thus contributes to avoiding postoperative functional deficits. Development and implementation of novel and additional approaches may further improve its clinical value.

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Authors and Affiliations

  1. Universitätsklinik und Poliklinik für Neurochirurgie, Universitätsklinik Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland

    S. Rampp, C. Strauss & J. Prell

  2. Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinik Halle (Saale), Halle (Saale), Deutschland

    T. Rahne & S. K. Plontke

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  1. S. Rampp
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Correspondence to S. Rampp.

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Interessenkonflikt

S. Rampp, T. Rahne, S.K. Plontke, C. Strauss und J. Prell geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Rampp, S., Rahne, T., Plontke, S.K. et al. Intraoperatives Monitoring des N. cochlearis bei Eingriffen im Kleinhirnbrückenwinkel. HNO 65, 413–418 (2017). https://doi.org/10.1007/s00106-016-0262-3

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