Veria Operation Updated

Abstract

The Veria operation is a non-mastoidectomy technique for cochlear implantation. It uses the transcanal approach to the middle ear and the cochlea. The steps of the procedure are: (1) endaural approach, that offers a wide accessibility to the middle ear structures; (2) inspection of the middle ear anatomy; (3) straightening of the postero-superior bony canal wall, which is usually concave; (4) performing the cochleostomy through the outer ear canal; (5) drilling of the suprameatal hollow, which is used for the accommodation of the electrode excess; (6) drilling of the trans-wall direct tunnel, which is the pathway for the active electrode; (7) alignment of the direct tunnel to the cochleostomy; (8) extension of the incision and preparing of the flaps; (9) creating of the bed and fixing the device; (10) insertion of the electrodes; (11) manipulating the excess of the active electrode, and (12) closing. For this technique, two special instruments have been developed: a special perforator used for the drilling of the direct tunnel for the active electrode, making it completely safe, and a safety electrode forceps used to manipulate the active electrode during insertion. The direct tunnel can be enlarged superiorly permitting insertion of two electrodes, in cases where a double electrode array implant has to be used. The method is an efficient tool for handling all cochlear implant cases, including difficult ones such as revision cases, malformations, cochlear ossifications and poor mastoid development. It is safe without complications in over a hundred cases and easy to learn.

Non-mastoidectomy Cochlear Implant Approaches: A Literature Review

“…Transcanal operation can be summarized by the following steps: 1- endaural or retroauricular approach to the middle ear with elevation of a standard tympanomeatal flap, 2- inspection of the middle ear anatomy (cochlea, fallopian canal, round window niche), 3- straightening of the posterosuperior bony canal wall, 4- cochleostomy, 5- drilling the suprameatal hollow, 6- drilling the transcanal wall direct tunnel with alignment to the cochleostomy, 7- extension of the skin incision and preparation of the skin flaps and subperiosteal flap, 8- creating the bed and fixing the device, 9- insertion of the electrode, 10- manipulation of the excess electrode in the suprameatal hollow, and closing. 6 …”

“…So far, reports of facial nerve injury during facial recess surgery for CI show a consistent rate of less than 1%, with several studies reporting a rate of 0.7%. 1 2 3 4 5 6 7 The vast majority of these are partial weaknesses of brief duration or delayed pareses of a temporary nature. Nonetheless, uneasiness of some surgeons drilling near the facial nerve has led to the development of alternate techniques for CI 1 .…”

Endoscope-Assisted Cochlear Implantation

“…One of them is the transcanal exposure by elevating a tympanomeatal flap, identification of the RW membrane, followed by insertion of the array delivered into the middle ear through the aditus or facial recess, sometimes splitting the posterior canal wall or laying the electrode in a groove created in the external auditory canal (EAC) [ 12 , 17 - 20 ]. Suprameatal approach and its modifications [ 8 , 9 ], switching to an open cavity with reconstruction of the canal wall after implantation or blind sac closure of the EAC with fat obliteration of the cavity [ 14 ] are other techniques. Retrofacial [ 11 ] or middle fossa [ 7 ] approaches may rarely be used.…”

Advances in Surgical and Anesthetic Techniques for Cochlear Implantation

“…Many alternative approaches were described for CI. The most common are the suprameatal approach [18], the pericanal approach [19], transcanal (Veria) approach [20], and transattic approach [21].…”