Awake craniotomy for auditory brainstem implant in patients with neurofibromatosis type 2: Four case reports

doi:10.12998/wjcc.v9.i25.7512

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. Sep 6, 2021; 9(25): 7512-7519
Published online Sep 6, 2021. doi: 10.12998/wjcc.v9.i25.7512

Awake craniotomy for auditory brainstem implant in patients with neurofibromatosis type 2: Four case reports

De-Xiang Wang, Shuo Wang, Min-Yu Jian, Ru-Quan Han

De-Xiang Wang, Shuo Wang, Min-Yu Jian, Ru-Quan Han, Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

Author contributions: Wang DX and Wang S contributed equally to this work; Wang DX and Wang S were four patients’ anesthesiologists, reviewed the literature, and contributed to manuscript drafting; Jian MY contributed to the revision of the manuscript; Han RQ was responsible for the revision of the manuscript for important intellectual content; all authors have read and approve the final manuscript.

Supported by Beijing Municipal Administration of Hospitals Ascent Plan, No. DFL20180502.

Informed consent statement: Written informed consent was obtained from the patients’ families for the publication of this case series and the accompanying images.

Conflict-of-interest statement: The authors declare that they have no conflict of interest to state.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Ru-Quan Han, MD, Chief Doctor, Professor, Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119 Southwest 4th Ring Road, Fengtai District, Beijing 100070, China. ruquan.han@ccmu.edu.cn

Received: February 8, 2021
Peer-review started: February 8, 2021
First decision: June 7, 2021
Revised: June 9, 2021
Accepted: August 4, 2021
Article in press: August 4, 2021
Published online: September 6, 2021
Processing time: 204 Days and 1.4 Hours

Abstract

BACKGROUND

The auditory brainstem implant (ABI) is a significant treatment to restore hearing sensations for neurofibromatosis type 2 (NF2) patients. However, there is no ideal method in assisting the placement of ABIs. In this case series, intraoperative cochlear nucleus mapping was performed in awake craniotomy to help guide the placement of the electrode array.

CASE SUMMARY

We applied the asleep-awake-asleep technique for awake craniotomy and hearing test via the retrosigmoid approach for acoustic neuroma resections and ABIs, using mechanical ventilation with a laryngeal mask during the asleep phases, utilizing a ropivacaine-based regional anesthesia, and sevoflurane combined with propofol/remifentanil as the sedative/analgesic agents in four NF2 patients. ABI electrode arrays were placed in the awake phase with successful intraoperative hearing tests in three patients. There was one uncooperative patient whose awake hearing test needed to be aborted. In all cases, tumor resection and ABI were performed safely. Satisfactory electrode effectiveness was achieved in awake ABI placement.

CONCLUSION

This case series suggests that awake craniotomy with an intraoperative hearing test for ABI placement is safe and well tolerated. Awake craniotomy is beneficial for improving the accuracy of ABI electrode placement and meanwhile reduces non-auditory side effects.

Keywords: Awake craniotomy; Neurofibromatosis type 2; Auditory brainstem implant; Hearing test; Case report

Core Tip: The auditory brainstem implant (ABI) is a significantly beneficial treatment to restore hearing sensations for neurofibromatosis type 2 (NF2) patients. However, there is no ideal method in assisting the placement of ABI. The asleep-awake-asleep technique was applied for awake craniotomy and hearing test via the retrosigmoid approach for acoustic neuromas resections and ABI in four NF2 patients. ABI electrode arrays were placed in the awake phase with successful intraoperative hearing tests in three patients. There was one uncooperative patient whose awake hearing test needed to be aborted due to her restlessness. In all cases, tumor resection and ABI were performed safely. The awake craniotomy is beneficial to improve the accuracy of electrode placement in the ABI and meanwhile reduces non-auditory side effects.