'Veria Operation�: Cochlear Implantation without a Mastoidectomy and a Posterior Tympanotomy

Abstract

Surgery for cochlear implants has undergone several modifications since the beginning of cochlear implantations [1,2]. Nowadays the most frequently used technique worldwide, the so-called 'classic' technique, uses a mastoidectomy and a posterior tympanotomy approach to the middle ear and the cochlea, with several options, regarding soft tissue handling. Even though this classic technique has been very efficient for the vast majority of the cases, we feel that in certain cases there were two main disadvantages: limited accessibility to the cochlea and related structures and a lot of trauma. In order to overcome these problems, we designed our own surgical technique. This involves using a transcanal approach to the middle ear and the cochlea and a direct tunnel drilled through the posterior bony canal wall to the facial recess. This tunnel is used as the pathway for the active electrode, which is then absolutely protected from being in contact with canal skin. Methods and Patients Operation DesignThe steps of the operation are: (1) endaural approach to the middle ear, (2) inspection of the middle ear and facial nerve anatomy by a small atticotomy if necessary, to rule out any irregularities, (3) drilling a direct tunnel, from behind the suprameatal spine to the facial recess, (4) cochleostomy through the endaural approach, (5) extension of the skin incision superoposteriorly, to expose the temporomastoid region, (6) creation of two flaps: a skin flap inferiorly based and a fascial flap superiorly based, (7) drilling the well for the device,

Comparison of Complications of the Suprameatal Approach and Mastoidectomy with Posterior Tympanotomy Approach in Cochlear Implantation: A Meta-Analysis

“…However, this technique requires a simple mastoidectomy and a posterior tympanotomy. As access to the middle ear is narrow at this point and may harbor some potential complications including facial nerve palsy [8,9,10], it requires high precision and experienced skills of the surgeon. A number of alternative implantation approaches without mastoidectomy have recently been suggested [11,12].…”

Veria Operation

“…(3) In case there is any dehiscence of the cover of the tunnel, this can be closed with bone dust. (4) The existence of sufficient space for a safe drilling of the direct tunnel could always be predicted preoperatively on the HRCT scans [4] (fig. 1).…”

“…This tunnel is used as the pathway for the active electrode, which is then absolutely protected from being in contact with the canal skin. The new technique was first presented in 1997 and published in 2000 [4]. For details, see Part I in this issue.…”

Modifications on the Alternative Method for Cochlea Implantation

“…The classic technique has proven to be sufficient in the vast majority of cochlear implantations. Still complications concerning the facial nerve can occur due to the fact of drilling within a millimetre of the facial nerve making the posterior tympanotomy 4, 5 To avoid negative side effects as a temporary or permanent injury to the facial nerve Kronenberg et al 6 ,Kiratzidis 7 and later Hausler 8 designed a different approach in which no mastoidectomy was needed to create the pathway towards the cochleostomy. These new cochlear implantation techniques without a mastoidectomy and a posterior tympanotomy seem to be safe and effective procedures.…”