Physiological identification of the auditory nerve during surgery for acoustic neuroma

We report the design and clinical use of an electrode which can locate the acoustic nerve fibres in the normal eighth nerve and also in eighth nerves deformed by acoustic neuromas. The improvement in facial nerve preservation during acoustic neuroma surgery is partly due to the use of a facial nerve stimulator to anatomically locate the fibres. Our new acoustic nerve detector has the capability of anatomical location of cochlear fibres which may help to improve hearing preservation in selected cases of acoustic neuroma. The device functions by detecting the compound action potential evoked by no frequency auditory simulation at 500 Hz. The 500 Hz compound action potential is detected with a bipolar probe and then amplified and filtered. This results in a 500 Hz tone when the probe contacts the auditory nerve. Detection is virtually instantaneous. The acoustic nerve detector (AND) is demonstrated in a normal eighth nerve complex and its use is then described in the total removal of an acoustic neuroma with a 1 cm extracanalicular extension in which useful hearing was saved post-operatively. The present prototype may not be sensitive enough to detect the very low signals that may result when cochlear fibres are widely distorted around a large tumour or in cases where slight contusion of the nerve occurs during dissection. In all other cases the real time anatomical information is extremely helpful in guiding acoustic nerve dissection and also in monitoring the effects of petrous bone drilling.