Bipolar cochlear nerve recording technique: a preliminary report

To preserve hearing during vestibular neurectomy and acoustic neuroma removal, the cochlear nerve must be identified. Present techniques, including monitoring eighth nerve action potentials, help the surgeon identify those maneuvers that increase the risk of nerve injury but do not help in the anatomic identification of the cochlear nerve or the cochlear-vestibular cleavage plane. The purpose of this study was to demonstrate an electrophysiologic method of identifying the cochlear portion of the eighth cranial nerve. A flush-tipped, bipolar electrode recording probe was used to directly record responses to monaural click stimuli from the cochlear nerve but not from surrounding tissue. It was also used to delineate the cochlear-vestibular cleavage plane. Stimulus intensity levels over 25 dB sensation level tended to reduce the accuracy of nerve identification, and lower levels prolonged recording time. This technique and its application to posterior fossa surgery is discussed.