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Child's Nervous System

, Volume 34, Issue 9, pp 1745–1752 | Cite as

Surgical anatomy of lateral recess in paediatric auditory brainstem implant patients and its clinical correlates including grades of flocculus

  • Shyam Sundar Krishnan
  • Pulak Nigam
  • Poonam Mohanty
  • Madabhushi Chakravarthy Vasudevan
  • Mohan Kameswaran
Original Paper

Abstract

Introduction

Auditory brainstem implant (ABI), a standard technique in treatment of profound sensorineural hearing loss in patients with neurofibromatosis 2, is now being increasingly employed in children with congenital bilateral sensorineural hearing loss, as in Michele’s deformity. A detailed knowledge of the relevant surgical anatomy of the lateral recess and its anatomical landmarks including the flocculus, the choroid plexus and the root entry zones of facial-vestibulocochlear and glossopharyngeal-vagus nerve complexes and their anatomical variants is mandatory, as it is the conduit for electrode array placement. The placement of electrode may be eased or impeded by these variations.

Materials and methods

Thirty-two children with congenital bilateral hearing loss underwent surgery through retromastoid suboccipital approach for placement of auditory brainstem implant. The preoperative anatomy was reviewed in detail during procedure and again later in the operative videos.

Results

The flocculus was classified into four grades based on its anatomy and relations. Among these, grade II (11 children) was the commonest while grade IV (five children) was least common. Choroid plexus was variable in size across grades of flocculus. Difficulty in defining the anatomy was significantly more (p value = 0.003) in the group with higher grade flocculus (grade III and IV) than in lower grade flocculus (grade I and II).

Conclusion

The flocculus in these patients is classifiable into one of the four grades and the surgical nuances such as difficulty in defining the anatomy for placement of ABI are dependent on the characteristics exhibited by the floccular anatomy and relations.

Keywords

Flocculus Lateral recess Choroid plexus Auditory brainstem implant 

Notes

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licencing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Institutional Ethics Committee, Voluntary Health Services Multi-speciality Hospital & Research Centre, Chennai) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Shyam Sundar Krishnan
    • 1
  • Pulak Nigam
    • 1
  • Poonam Mohanty
    • 1
  • Madabhushi Chakravarthy Vasudevan
    • 1
  • Mohan Kameswaran
    • 2
  1. 1.Dr. Achantha Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological SurgeryVoluntary Health Services Multi-Speciality Hospital & Research CentreChennaiIndia
  2. 2.Madras ENT Research FoundationChennaiIndia

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