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. 2012 Feb 20:3:18.
doi: 10.3389/fneur.2012.00018. eCollection 2012.

The modified ampullar approach for vestibular implant surgery: feasibility and its first application in a human with a long-term vestibular loss

Raymond van de Berg  1 , Nils Guinand, Jean-Philippe Guyot, Herman Kingma, Robert J Stokroos
Affiliations

The modified ampullar approach for vestibular implant surgery: feasibility and its first application in a human with a long-term vestibular loss

Raymond van de Berg et al. Front Neurol. .

Abstract

Objective: To assess, for the first time in a human with a long-term vestibular loss, a modified approach to the ampullae and the feasibility of evoking a VOR by ampullar stimulation.

Materials and methods: Peroperative stimulation of the ampullae, using the ampullar approach, was performed under full anesthesia during cochlear implantation in a 21-year-old female patient, who had experienced bilateral vestibular areflexia and sensorineural hearing loss for almost 20 years.

Results: The modified ampullar approach was performed successfully with as minimally invasive surgery as possible. Ampullar stimulation evoked eye movements containing vectors congruent with the stimulated canal. As expected, the preliminary electrophysiological data were influenced by the general anesthesia, which resulted in current spread and reduced maximum amplitudes of eye movement. Nevertheless, they confirm the feasibility of ampullar stimulation.

Conclusion: The modified ampullar approach provides safe access to the ampullae using as minimally invasive surgery as possible. For the first time in a human with long-term bilateral vestibular areflexia, it is shown that the VOR can be evoked by ampullar stimulation, even when there has been no vestibular function for almost 20 years. This approach should be considered in vestibular surgery, as it provides safe access to one of the most favorable stimulus locations for development of a vestibular implant.

Keywords: acclimation; adaptation; ampullar approach; bilateral vestibular areflexia; bilateral vestibulopathy; neural prosthesis; vestibular implant; vestibular prosthesis.

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Figures

Figure 1
Figure 1
Lateral view of a right temporal bone. It shows the superior canal (SC), lateral canal (LC), and posterior canal (PC) which are fenestrated near the ampullary ends and marked with inserted plastic wires. Line X is the imaginary line through the stapes footplate, which indicates the location of the posterior ampulla, medial to the facial nerve.
Figure 2
Figure 2
Anterolateral view of a right temporal bone using cone beam CT-scan. It shows the fenestration and insertion of the cochleovestibular electrodes in the superior ampulla (SA), lateral ampulla (LA), and cochlea (C).
Figure 3
Figure 3
Anterolateral view of a right temporal bone using cone beam CT-scan. It shows the fenestration and insertion of the electrode (*) in the posterior ampulla (PA). (LC = lateral canal).
Figure 4
Figure 4
Maximum vertical and horizontal amplitudes of the eye during ampullar nerve stimulation of each canal.
Figure 5
Figure 5
(A) VOR vertical component during suprathreshold stimulation of the SAN. Vertical bars indicate the start and end of stimulation. (B) VOR horizontal component during suprathreshold stimulation of the SAN. Vertical bars indicate the start and end of stimulation.
See this image and copyright information in PMC

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