Initial Experience with Modification of Plontke Technique in Cochlear Schwannoma Resection and Simultaneous Placement of Cochlear Implant: Use of a Novel Micro-endoscope and Depth Gauge Stylet Technique

Introduction: Historically, the presence of a cochlear schwannoma was considered a contraindication to the placement of a cochlear implant in either unilateral or bilateral sensorineural hearing loss. However, since the advent of the Plontke technique which is performing the cochlear reconstruction through closure of the subtotal cochleoectomy defect with a cartilage- perichondrium compound transplant and bone pâté. Both the resection of the schwannoma and placement of a cochlear implant can be done successfully in single stage. We here describe our experience with this surgical technique for tumor removal, reconstruction of the defect, single stage cochlear implantation and hearing rehabilitation outcomes as well as the resection of cochlear schwannomas by using micro-endoscope and depth gauge stylet to ensure gross tumor removal.

Methods: Retrospective review of three patients with cochlear schwannomas who underwent challenging subtotal cochlear resection followed by placement of a perimodiolar cochlear implant electrodes.

Results: Three patients with cochlear schwannomas had complete resection of their tumors followed by placement of a perimodiolar electrode; one male and two females; ages were 86, 79, and 53 years. All patients with CI had good word recognition scores for numbers in quiet conditions (80–100% at 65 dB SPL, not later than 6 to 12 months post-CI activation and have no recurrence of the tumor within follow-up time of 12 months.

The use of a novel micro-endoscope (3NT Colibri) to evaluate the region around the modiolus as well as depth gauge stylet may help improve visualization, resection, and reduce the risk of tumor recurrence. One underwent external auditory canal closure and subtotal petrosectomy followed by placement of the implant in single stage; the other two patients underwent canal cuts that allowed anterior displacement of the canal wall.

Conclusion: The use of 3NT colibri endoscope and depth gauge stylet with Plontke technique is a useful approach to both resect cochlear schwannomas and place a cochlear implant in single stage. Successful outcomes with a CI can occur. The use of a micro-endoscope and depth gauge stylet technique may further improve surgical visibility and gross tumor resection.

Publication History

Article published online:
07 February 2025