Auditory Thalamic Implant

描述(申请人提供)：耳聋神经纤维瘤病2型(NF2)患者的康复选择有限。由于双侧前庭神经鞘瘤，NF2患者听神经不完整，颅外植入人工耳蜗术是不合适的。颅内耳蜗核、脑干和下丘中脑植入术是两种可能的治疗方法。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温和的好处。目前NF2患者耳聋康复的概念性框架是在全身麻醉下通过幕下后颅窝开颅手术将颅内装置植入听觉结构。直接目视识别目标听核用于种植是占主导地位的外科技术。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果的策略是在局部麻醉下经幕上钻孔开颅术植入腹侧内侧膝状体。采用已建立的脑深部刺激和计算机辅助手术导航技术来瞄准听觉丘脑，将取代目前的手术实践。该项目建议朝着临床可展开的听觉丘脑植入物的发展迈出第一步。动物研究计划测量电驱动的腹侧内侧膝状体丘脑皮质的变化，这些变化将作为设计参数来设计合适的大脑探头和语音处理器。 公共卫生相关性：没有完整听神经的聋人，如患有2型神经纤维瘤病的聋人，康复选择非常有限。有必要研究开发一种更好的听力设备，以满足这一服务不足人群的通信需求。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.