A novel therapeutic pathway to the human cochlear nerve

Area of Science:

• Neurosurgery
• Regenerative Medicine
• Otolaryngology

Background:

• Direct access to the human cochlear nerve is challenging due to its location within the skull base.
• Current therapeutic strategies are limited by the nerve's bony encasement.

Purpose of the Study:

• To identify and validate a novel, minimally invasive surgical pathway for direct therapeutic access to the cochlear nerve.
• To establish a conduit for delivering regenerative therapies to the cochlear nerve.

Main Methods:

• Neuroanatomical studies were performed on 10 human cadaveric temporal bones.
• Three-dimensional anatomical simulations using synchrotron phase-contrast imaging were analyzed.
• The pathway was validated on 9 additional temporal bones using radio-opaque markers, contrast injection, and micro-computed tomography.

Main Results:

• A safe therapeutic pathway was identified through the medial modiolar wall of the cochlea via the round window.
• The approach targets the cochlear nerve in the fundus of the internal auditory meatus at a median depth of 1.48 mm.
• An effective conduit for therapeutic agent delivery to the cochlear nerve was established.

Conclusions:

• A minimally invasive surgical approach provides direct access to the cochlear nerve.
• This innovative pathway holds potential for delivering novel regenerative therapies for cochlear nerve conditions.
• The validated technique offers a promising solution for overcoming previous anatomical barriers.