Complications in Auditory Brainstem Implant Surgery in Adults and Children

Objective: Surgery for hearing restoration with auditory brain-stem implantation (ABI) in patients with neurofibromatosis type 2 (NF2) is considered safe, as no increase in postoperative complications related to surgery or device implantation has been observed. Over the last 10 years, we have extended the use of ABI to nontumor (NT) adults and children with cochlear or cochlear nerve malfunctions who would not or did not benefit from a cochlear implant (CI). This article examines the complications encountered in ABI surgery in all patient groups. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: One hundred fourteen ABI operations were performed in Verona (Italy) from 1997 to 2008 in 83 adults and 31 children. Thirty-six had NF2 (34 adults and 2 children), and 78 (49 adults and 29 children) had NT cochlear and cochlear nerve disorders. Intervention: A retrosigmoid-transmeatal approach was used in the NF2 cases, and a simple retrosigmoid approach was used in the NT patients. Main Outcome Measures: Surgical complications are tabulated according to standard reporting categories and are presented separately and analyzed statistically for NF2, NT adults, and NT children. Complication rates are compared with those of CI and microvascular decompression surgery. Results: ABI surgery has a very low major complication rate, particularly in non-NF2 patients. Minor complications were easily controlled with complete resolution in all cases. Although the potential complications of intradural ABI implantation are more severe than those of a transmastoid approach for CIs, the actual observed complication rates in ABI candidates without NF2 tumors are comparable to those of CI surgery in both adults and children. Conclusion: This study demonstrates that the ABI is a safe procedure when performed by an experienced surgical and rehabilitation team, and its benefits can be extended to a larger population of deaf patients.