19 Future Development: Penetrating Multisite Microelectrodes as CochlearNucleus Implant



Martin Han and Douglas B. McCreery


Abstract


Auditory brainstem implants (ABIs) can restore useful hearing to patients with hearing loss who cannot benefit from cochlear implants. We provide an update on recent efforts to develop silicon-based, multisite, penetrating microelectrode arrays as a cochlear nucleus auditory prosthesis. We summarize technological advances with our devices in the feline model as steps toward validating the device for future clinical use.




19 Future Development: Penetrating Multisite Microelectrodes as Cochlear Nucleus Implant



19.1 Introduction



19.1.1 Auditory Brainstem Prosthesis


While cochlear implants have become the most widely used neuroprostheses, patients without a functional auditory nerve or with a deformed or ossified cochlea cannot benefit from them. Studies have shown that electrode array implanted on the surface of the cochlear nucleus do convey auditory percepts that enable users to recognize important environmental sounds and aid with lipreading.3 In some instances good recognition of speech (“open-set” speech recognition) has been reported for patients whose deafness was not due to neurofibromatosis type 2 (NF2), the most common indication for an auditory brainstem implantation. 4 In this context, an array of microelectrodes that penetrates into the ventral cochlear nucleus (VCN) may be applicable to non-NF2 as well as to NF2 patients. The non-NF2 group may include a subset of cochlear implant users who do not receive significant benefit from their cochlear implants. 4 A growing number of cochlear implant users who are middle-aged or older adults may lose their hearing by presbycusis including cochlear synaptopathy. 6 In a small clinical trial, an array of iridium oxide microwire electrodes with a single electrode site at the tip was implanted into the VCN of 10 patients following resection of auditory nerve tumors, but the effort had limited success. 11



19.2 Multisite Arrays for Auditory Brainstem Prosthesis


Among the micromachining technology-based devices, the only silicon-based microelectrode array that has FDA approval is the Blackrock array (a version of the Utah intracortical array). 2 This device is approved for humans for less than 30 days and has only one microstimulating site on each shank that penetrates into the neural tissue. As a result, this device may not provide much additional benefit as an auditory prosthesis or implant. In contrast, it is possible that an array of penetrating multisite microelectrodes whose safety has been validated by adequate preclinical data may enable selective and localized access to the tonotopic gradients of the cochlear nucleus (CN), and thereby convey improved speech recognition to the users. Fig. 19.1 illustrates such an array of multisite penetrating electrodes intended for implantation into the feline VCN. Microelectrode arrays with multiple electrically independent stimulating sites on each penetrating shank have the potential for conveying electrical stimulation with high spatial selectivity while minimizing the number of penetrating shanks and attendant risks of tissue injury. Having multiple electrode sites per shank (“multisite”), the device allows access to the topography of the cochlear nucleus. In the past, the Michigan/NeuroNexus probes have been widely used in animal studies, 1 , 10 mainly for recording neuronal activity. However, this device has not been approved by the FDA for human use, and their materials and designs are not generally known to satisfy the brainstem prosthesis requirements.

Fig. 19.1 Illustration of a three-dimensional penetrating multisite microelectrode array device configured for implantation into the ventral cochlear nucleus (VCN). Right: The device as it might be implanted into the human cochlear nucleus. Left: The device has eight silicon shanks, each with five activated iridium oxide microelectrodes distributed along the 2.5 mm from the tip of each shank. The geometric surface area of each microelectrode is approximately 2,000 μm2. The array has been extensively validated in the feline cochlear nucleus. (From McCreery et al.) 9


19.3 Device Development and In-Vivo Preclinical Evaluation


We developed our multisite silicon probes for neural stimulating and recording and validated their function and longevity through long-term implantation in the feline brainstem (Fig. 19.2 , left). 5 The photolithography-based micromachining technology allows the individual microstimulating sites to be three-dimensionally arranged as a cluster of multiple penetrating shanks. These probes are fabricated by the deep reactive ion etching process followed by and mechanical sharpening of their tip, yielding a mechanically sturdy shank with a sharpened tip that reduces insertion force and tissue displacement during implantation into the brain. The microelectrode sites are electroplated or sputter-coated with iridium oxide. We have implanted these multisite silicon-substrate microelectrodes into the cochlear nucleus of adult cats for up to 314 days and we have monitored the tonotopic specificity of the stimulation by recording in the central nucleus of the contralateral inferior colliculus (IC). 7 , 9 To our knowledge this is one of the longest durations of recordings and stimulation achieved by silicon-based multisite arrays. Histopathology evaluation of neurons and astrocytes using immunohistochemical stains indicated minimal alterations of tissue architecture after chronic implantation.

Fig. 19.2 Contour plots of the rate of action potentials elicited from a multiunit in a cat’s inferior colliculus (IC) in response to: (a) stimulation by a microelectrode in the contralateral posteroventral cochlear nucleus (PVCN), (b) stimulation via a macroelectrode on the surface of the dorsal cochlear nucleus (DCN), and (c) when the microelectrode and the surface electrode were pulsed simultaneously. The inner and outer contour lines delineate, respectively, 75 and 50% of the unit’s maximum discharge rate. The microelectrodes resulted in smaller foci than the surface electrodes (from McCreery et al 9 ).

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Jul 31, 2021 | Posted by in OTOLARYNGOLOGY | Comments Off on 19 Future Development: Penetrating Multisite Microelectrodes as CochlearNucleus Implant
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