Abstract
Introduction In the last 15 years, the surgery of the posterior cranial fossa, within the methods of neurosurgery and microneurosurgery, has improved and grown enormously. However, it is still a challenge for the surgeon, because of the importance of functional neural structures at risk. The recording of auditory pathways, to the peculiar characteristics of their course and the relationships with the brainstem structures that undertake this long, gives an effective system of neurophysiological monitoring for the protection of the central structures brainstem and for the preservation of hearing itself. The attempt to preserve hearing in the final of the small acoustic neuroma surgery, it is to be considered almost infeasible without the proper support of a neurophysiological monitoring. Materials and methods In the report it will be discussed and explained how to record Electrocochleography, C-NAP (Compound Acoustic Nerve Potential), and near field ABR (auditory brainstem response), which we record always simultaneously. The report shall also place the accent on how effective is the monitoring of the different methods, with an attempt to correlate anatomical and functional at risk structure. Results We will show several neurophysiological pictures, trying to correlate the findings to the etiology of suffering, laying the foundations for the solution of the problem as possible. Conclusion From our experience in the last 15 years, we were able to finalize selection of patients, a method of surgical approach and the neurophysiological monitoring system to enable us to preserve the hearing level “socially useful” in 52.6% of patients (case studies of recent 7 years of 113 patients). Particular attention is placed on the indication for intervention and the selection of patients with an adequate preoperative study.
Published Version
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