http://www.aoico.it XIII Congresso Nazionale AOICO - Cava de’Tirreni (SA) Prima parte della Relazione tenuta dal dott. Antonio Della Volpe sulla indicazione all'impianto cocleare.

2. XIII Congresso Nazionale A.O.I.C.O.
20- 21 gennaio2012 Cava de’ Tirreni (SA)
Attuali indicazioni chirurgiche in ORL
L’Impianto Cocleare
Antonio della Volpe
SSD Chirurgia Protesica Sordità
AORN Santobono-Pausilipon
Napoli

3. IC: non è solo inserire un elettrodo

4. 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

5. for an “optimal” outcome
look better into the ear

6. Minimal Access Surgery

8. Immunohistochemistry of human cochlea
Neurofilament 160
Connexin 30
DAPI

9. Connexins in human ear
Connexin 30
Connexin 26
Merged
DAPI

10. Human gap junction
Köling & Rask-Andersen 1983
Connexin 30
Connexin 26
Merge
DAPI
cap
MC
ES
IC
BC
SL
SEM - Human Confocal microscopy - Human

11. Left Ear – Cadaver Temporal Bone
Chorda Tympani Nerve
(anterior border of Facial
Osseous Spiral Lamina (OSL) /Basilar
Recess
Membrane – Under Bone
Scala Vestibuli Anterior
(Completely opened)
Incus/stapedial joint
Scala Tympani
(Completely opened to Short process of incus – not
lateral wall, floor and True visible under ledge
osseous spiral lamina)
RWM
Antrum
Mastoid Tip
Incus Buttress Tegmen
Facial Nerve (Posterior
Cochleostomy Target Zone Lateral Semi-Circular Canal
Border of Facial Recess)
(“sweet” spot)
Sigmoid Sinus
Inferior

12. Surgical Technique
 device position
 resistance to displacement
 cochleostomy/round window
 abnormal cochleae
 explant/replant
 electrode choice

13. Approaches
Transmastoid Transmeatal
Approach Approach

14. Non-Mastoidectomy Approaches
Pericanal Transmeatal
Suprameatal Approach
approach Approach
R. Hausler (2001) – ( Minimal Access
(SMA):
- Post auricular skin Surgery)
J. Kronenberg incision with K. Taibah (2005)
(2001) -
parietal extension - Post auricular
- Post auricular skin incision.
incision - Tympanomeatal
flap - Tympanomeatal flap
- Tympanomeatal flap
- open tunnel in EAC - open tunnel in EAC
- Groove lateral to
chordi tympani with a groove for the
- glass ionomer
electrode.
- Suprameatal closed cement and bone
tunnel dust - Direct visualization
- The dura of the
middle cranial fossa
is exposed.

15. Skin Incision
right left