Auditory Thalamic Implant

描述（由申请人提供）：耳聋2型神经纤维瘤病（NF 2）患者的康复选择有限。颅外人工耳蜗植入不适用于没有完整听神经的NF2患者，这是双侧前庭神经鞘瘤的结果。颅内耳蜗核、脑干和下丘中脑植入是两种可能的治疗选择。与非NF2患者的人工耳蜗植入听力结果相比，这些设备提供了令人鼓舞但相对适度的益处。目前NF2患者耳聋康复的概念框架是在全身麻醉下通过幕下后颅窝开颅术将颅内装置植入听觉结构。直接视觉识别目标听核以进行植入是主要的手术技术。然而，电极的可靠放置和稳定定位一直是主要挑战。另一种可能改善治疗结局的策略是在局部麻醉下通过幕上钻孔开颅术植入腹侧内侧膝状体器械。适应既定的深部脑刺激和计算机辅助手术导航技术，以靶向听觉丘脑将取代目前的手术实践。该项目建议采取初步步骤，发展一种临床部署的听觉丘脑植入物。动物研究计划测量电驱动的腹内侧膝状体丘脑皮质的转换，将作为设计参数，工程师一个合适的大脑探头和语音处理器。 公共卫生相关性：没有完整听觉神经的耳聋患者，如患有2型神经纤维瘤病的患者，康复选择非常有限。研究开发更好的听力设备是必要的，以满足这一服务不足的人群的通信需求。从这个项目中获得的知识也可以帮助许多其他听力受损的人。

DESCRIPTION (provided by applicant): Deaf neurofibromatosis type 2 (NF2) patients have limited rehabilitation choices. Extracranial cochlear implants are inappropriate for NF2 patients without intact auditory nerves, a consequence of bilateral vestibular schwannomas. Intracranial cochlear nucleus brainstem and inferior colliculus midbrain implants are two possible treatment options. Those devices provide encouraging but relatively modest benefits compared to cochlear implant hearing outcomes in non-NF2 patients. The current conceptual framework for deafness rehabilitation in NF2 patients is implantation of intracranial devices to auditory structures accessible via infratentorial posterior fossa craniotomy under general anesthesia. Direct visual identification of the target auditory nucleus for implant placement is the dominant surgical technique. However, reliable placement and stable positioning of electrodes have been major challenges. An alternate strategy to possibly improve therapeutic outcomes is device implantation of the ventral medial geniculate body via supratentorial burr hole craniotomy under local anesthesia. Adaptation of established deep brain stimulation and computer assisted surgical navigation technologies to target the auditory thalamus would supplant current surgical practices. This project proposes taking initial step towards the development of a clinically deployable auditory thalamic implant. Animal studies are planned to measure electrically driven ventral medial geniculate body thalamocortical transformations that would serve as design parameters to engineer a suitable brain probe and speech processor. PUBLIC HEALTH RELEVANCE: Deaf patients without intact auditory nerves, such as those afflicted by neurofibromatosis type 2, have very limited rehabilitation options. Research to develop a better hearing device is necessary to meet communication needs of this underserved population. Knowledge derived from this project may also help many other hearing impaired individuals.