Auditory Thalamic Implant

描述（由申请人提供）：2型聋人神经纤维瘤病（NF2）患者的康复选择有限。对于双侧前庭神经鞘瘤导致的听神经不完整的NF2患者，颅外人工耳蜗是不合适的。颅内耳蜗核脑干植入和中脑下丘植入是两种可能的治疗选择。与非nf2患者的人工耳蜗听力结果相比，这些设备提供了令人鼓舞但相对有限的好处。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窝开颅术将颅内装置植入听觉结构。直接目视识别目标听觉核植入是主要的外科技术。然而，可靠的放置和稳定的电极定位一直是主要的挑战。另一种可能改善治疗效果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。适应已建立的深部脑刺激和计算机辅助手术导航技术，以听觉丘脑为目标，将取代目前的外科实践。该项目建议采取初步步骤，朝着临床部署听觉丘脑植入物的发展。动物实验计划测量电驱动的腹内侧膝状体丘脑皮质转化，这将作为设计参数来设计合适的大脑探针和语音处理器。

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.