title: The modified ampullar approach for vestibular implant surgery: feasibility and its first application in a human with a long-term vestibular loss.
abstract: OBJECTIVE
  To assess, for the first time in a human with a long-term vestibular loss, a modified approach to the ampullae and the feasibility of evoking a VOR by ampullar stimulation.
  
  
  METHODS
  Peroperative stimulation of the ampullae, using the ampullar approach, was performed under full anesthesia during cochlear implantation in a 21-year-old female patient, who had experienced bilateral vestibular areflexia and sensorineural hearing loss for almost 20 years.
  
  
  RESULTS
  The modified ampullar approach was performed successfully with as minimally invasive surgery as possible. Ampullar stimulation evoked eye movements containing vectors congruent with the stimulated canal. As expected, the preliminary electrophysiological data were influenced by the general anesthesia, which resulted in current spread and reduced maximum amplitudes of eye movement. Nevertheless, they confirm the feasibility of ampullar stimulation.
  
  
  CONCLUSIONS
  The modified ampullar approach provides safe access to the ampullae using as minimally invasive surgery as possible. For the first time in a human with long-term bilateral vestibular areflexia, it is shown that the VOR can be evoked by ampullar stimulation, even when there has been no vestibular function for almost 20 years. This approach should be considered in vestibular surgery, as it provides safe access to one of the most favorable stimulus locations for development of a vestibular implant.
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Maastricht University Medical Centre Maastricht, Netherlands.
authors.forename: Raymond
authors.initials: R
authors.lastname: van de Berg
authors.forename: Nils
authors.initials: N
authors.lastname: Guinand
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Guyot
authors.forename: Herman
authors.initials: H
authors.lastname: Kingma
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stokroos