Cochlear Anatomy via Microdissection with Clinical Implications by Charles G. Wright & Peter S. Roland

Author:Charles G. Wright & Peter S. Roland
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Fig. 3.10(A) Implant insertion in which the tip of an array met resistance in the middle turn and elevated the basilar membrane in the area indicated by the arrow. Although it was displaced upward, the basilar membrane remained intact. Upward displacement of the basilar membrane can occur transiently as the apical end of an array contacts the lateral wall of the cochlea and then resolves as the array continues advancing. The effects of transient elevations of the basilar membrane on postoperative cochlear function are unknown. Permanent displacements may also occur as seen here, most commonly in the mid-basal turn, where the basilar membrane is pushed upward by the middle or basal portions of an array (B) In this case, continued effort to advance the array resulted in buckling in the basal turn and fracture of the osseous spiral lamina (arrows). (From Roland and Wright [11]; with permission.) Once the tip of an array stops advancing, further attempts at insertion will result in buckling, either within the relatively wide basal portion of the basal turn or outside the cochlea. Each attempt to push the electrode in further will cause the array or its lead to buckle, but once the forward pressure is released, the buckled segment will straighten out again. Thus, postoperative imaging may fail to reveal what has occurred, and the damage resulting from the buckling event will not be suspected. Smaller cochleostomies and applying forward insertion pressure as close as possible to the cochlear opening seem to minimize buckling [16]

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