Prosthetic implantation of the human vestibular system.
Prosthetic implantation of the human vestibular system.
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DOI：
10.1097/mao.0000000000000003
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发表时间：
2014-01
期刊：
影响因子：
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通讯作者：
Rubinstein JT
中科院分区：
文献类型：
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作者：
Golub JS;Ling L;Nie K;Nowack A;Shepherd SJ;Bierer SM;Jameyson E;Kaneko CR;Phillips JO;Rubinstein JT
功能性前庭假体可以植入人体，使每个半规管的电刺激产生半规管特异性的眼球运动，同时保留前庭和听觉功能。许多前庭疾病可以通过前庭终末器官的假体刺激来治疗。我们之前已经在恒河猴中证明，基于 Nucleus Freedom 耳蜗植入物的前庭神经刺激器可以产生耳道特异性的电诱发眼球运动，同时保留听觉和前庭功能。已获得 FDA 的研究性设备豁免，以研究使用该设备治疗不受控制的梅尼埃病的可行性。 UW/Nucleus 前庭植入物被植入一位患有不受控制的梅尼埃病的人类受试者的三个半规管壶腹附近的外淋巴空间。评估术前和术后前庭和听觉功能。在术后两个时间点测量电诱发眼球运动。所有半规管的植入在技术上是可行的。水平耳道和听觉功能大部分（但并非全部）丧失。三个耳管中的两个的电极刺激导致了适合耳管的眼球运动。随着时间的推移，刺激阈值增加。人体半规管假体植入在技术上是可行的。电刺激会导致耳道特异性眼球运动，但阈值会随着时间的推移而增加。先前在动物身上观察到的天然听觉和前庭功能的保留并未在患有晚期梅尼埃病的单个受试者中得到证实。
A functional vestibular prosthesis can be implanted in human such that electrical stimulation of each semicircular canal produces canal-specific eye movements while preserving vestibular and auditory function. A number of vestibular disorders could be treated with prosthetic stimulation of the vestibular end organs. We have previously demonstrated in rhesus monkeys that a vestibular neurostimulator, based on the Nucleus Freedom cochlear implant, can produce canal-specific electrically evoked eye movements while preserving auditory and vestibular function. An investigational device exemption has been obtained from the FDA to study the feasibility of treating uncontrolled Ménière’s disease with the device. The UW/Nucleus vestibular implant was implanted in the perilymphatic space adjacent to the three semicircular canal ampullae of a human subject with uncontrolled Ménière’s disease. Pre and postoperative vestibular and auditory function were assessed. Electrically evoked eye movements were measured at two time points postoperatively. Implantation of all semicircular canals was technically feasible. Horizontal canal and auditory function were largely, but not totally, lost. Electrode stimulation in two of three canals resulted in canal-appropriate eye movements. Over time, stimulation thresholds increased. Prosthetic implantation of the semicircular canals in humans is technically feasible. Electrical stimulation resulted in canal-specific eye movements, although thresholds increased over time. Preservation of native auditory and vestibular function, previously observed in animals, was not demonstrated in a single subject with advanced Ménière’s disease.