Wang DX, Wang S, Jian MY, Han RQ. Awake craniotomy for auditory brainstem implant in patients with neurofibromatosis type 2: Four case reports. World J Clin Cases 2021; 9(25): 7512-7519 [PMID: 34616820 DOI: 10.12998/wjcc.v9.i25.7512]
Corresponding Author of This Article
Ru-Quan Han, MD, Chief Doctor, Professor, Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119 Southwest 4th Ring Road, Fengtai District, Beijing 100070, China. ruquan.han@ccmu.edu.cn
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Sep 6, 2021; 9(25): 7512-7519 Published online Sep 6, 2021. doi: 10.12998/wjcc.v9.i25.7512
Awake craniotomy for auditory brainstem implant in patients with neurofibromatosis type 2: Four case reports
De-Xiang Wang, Shuo Wang, Min-Yu Jian, Ru-Quan Han
De-Xiang Wang, Shuo Wang, Min-Yu Jian, Ru-Quan Han, Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Author contributions: Wang DX and Wang S contributed equally to this work; Wang DX and Wang S were four patients’ anesthesiologists, reviewed the literature, and contributed to manuscript drafting; Jian MY contributed to the revision of the manuscript; Han RQ was responsible for the revision of the manuscript for important intellectual content; all authors have read and approve the final manuscript.
Supported byBeijing Municipal Administration of Hospitals Ascent Plan, No. DFL20180502.
Informed consent statement: Written informed consent was obtained from the patients’ families for the publication of this case series and the accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to state.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ru-Quan Han, MD, Chief Doctor, Professor, Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119 Southwest 4th Ring Road, Fengtai District, Beijing 100070, China. ruquan.han@ccmu.edu.cn
Received: February 8, 2021 Peer-review started: February 8, 2021 First decision: June 7, 2021 Revised: June 9, 2021 Accepted: August 4, 2021 Article in press: August 4, 2021 Published online: September 6, 2021 Processing time: 204 Days and 1.4 Hours
Abstract
BACKGROUND
The auditory brainstem implant (ABI) is a significant treatment to restore hearing sensations for neurofibromatosis type 2 (NF2) patients. However, there is no ideal method in assisting the placement of ABIs. In this case series, intraoperative cochlear nucleus mapping was performed in awake craniotomy to help guide the placement of the electrode array.
CASE SUMMARY
We applied the asleep-awake-asleep technique for awake craniotomy and hearing test via the retrosigmoid approach for acoustic neuroma resections and ABIs, using mechanical ventilation with a laryngeal mask during the asleep phases, utilizing a ropivacaine-based regional anesthesia, and sevoflurane combined with propofol/remifentanil as the sedative/analgesic agents in four NF2 patients. ABI electrode arrays were placed in the awake phase with successful intraoperative hearing tests in three patients. There was one uncooperative patient whose awake hearing test needed to be aborted. In all cases, tumor resection and ABI were performed safely. Satisfactory electrode effectiveness was achieved in awake ABI placement.
CONCLUSION
This case series suggests that awake craniotomy with an intraoperative hearing test for ABI placement is safe and well tolerated. Awake craniotomy is beneficial for improving the accuracy of ABI electrode placement and meanwhile reduces non-auditory side effects.
Core Tip: The auditory brainstem implant (ABI) is a significantly beneficial treatment to restore hearing sensations for neurofibromatosis type 2 (NF2) patients. However, there is no ideal method in assisting the placement of ABI. The asleep-awake-asleep technique was applied for awake craniotomy and hearing test via the retrosigmoid approach for acoustic neuromas resections and ABI in four NF2 patients. ABI electrode arrays were placed in the awake phase with successful intraoperative hearing tests in three patients. There was one uncooperative patient whose awake hearing test needed to be aborted due to her restlessness. In all cases, tumor resection and ABI were performed safely. The awake craniotomy is beneficial to improve the accuracy of electrode placement in the ABI and meanwhile reduces non-auditory side effects.
