Shaare Zedek Hospital.
(photo credit: MARC ISRAEL SELLEM/THE JERUSALEM POST)
For the first time in Israel, Jerusalem’s Shaare Zedek Medical Center performed an advanced brain stem implant, on a fiveyear- old boy who was born deaf because he lacked an auditory nerve, the hospital announced on Friday.
Prof. Thomas Roland, head of the department of otolaryngology and head and neck surgery, was accompanied by colleagues from New York University Langone Medical Center who flew from Manhattan to assist in the unusual operation, which was performed and supervised by Shaare Zedek ear nose and throat surgeons, neurosurgeons and speech therapists.
Since the development of cochlear implants, the number of deaf people in the world has declined significantly, and in most cases the implant connects well with the auditory nerve and allows the deaf to hear. The implant is particularly successful in babies who are born deaf and undergo the surgery at an early age. It is also performed on adults who had normal hearing but became deaf for various reasons.
In a small number of cases in which the hearing nerve is absent or nonfunctional, cochlear implants are not the solution. In such cases, an innovative implant, called an advanced brain stem implant, is inserted surgically into a specific location on the brain stem in the area of the auditory nucleus, in order to bypass the missing auditory nerve.
Transplanting the device requires cooperation among three types of experts – otolaryngological surgeons, brain surgeons and communications disorder clinicians.
The complex operation is being performed today in only a small number of medical centers around the world.
After a series of tests discerned that the child had no auditory nerve and that a cochlear implant would not be sufficient, it was decided to perform the surgery with the participation of experts from NYU, with which Shaare Zedek regularly cooperates.
The surgery itself was carried out in several stages. In the first part, the brain stem was opened by an otolaryngological surgeon, and then a neurosurgeon located the correct position. The implant, similar in shape to a tiny brush, was then placed on the brain stem. The clinicians performed electrophysiological tests to ensure that the implant was in the optimal position for maximum auditory benefit and did not stimulate other areas, such as nearby motor areas.
“The opening of the neurosurgical department at Shaare Zedek allows us to perform complex and multidisciplinary actions that we could not perform in the past,” said Dr. Ronen Perez and Prof. Jean Yves Sichel, who headed the Israeli team.
“The addition of Dr. Nevo Margalit, who is an expert in surgery in the base of the brain, made it possible to access the brain stem and perform the implant.”
The operation, performed at the end of January, was successful, and appropriate electrical responses were received after the placement of the implant. The boy recovered well and was released to go home.
The doctors are very optimistic that the child’s ability to speak and communicate with his surroundings will improve over time. The NYU team came to Jerusalem again in March and activated the device, and they saw that it functions probably.
The boy can now hear, but he still needs to undergo rehabilitation.