Conclusion

L’étude VASCOCH a démontré que la méthode du monitorage des NA avec le PMC est facile d’utilisation et robuste en présence d'un environnement difficile et d'une déficience auditive préopératoire. L’amplitude du PMC a permis la détection de tous les événements chirurgicaux qui ont menacé la vascularisation cochléaire, et sa disparition peropératoire a mis en garde contre un mauvais résultat auditif sans fausse alarme. Les grands NA majoritairement testés dans cette étude ont comme attendu été enclins à donner lieu à de nombreux événements délétères pour l’audition pendant la chirurgie et ont été un avantage certain pour investiguer la méthode du PMC. Par exemple, le comportement du PMC lors du fraisage du CAI a permis de dévoiler une piste à la prédiction préopératoire d’une fragilité cochléaire et d’un risque élevé pour l’audition postopératoire. Cependant l’intérêt du PMC, au-delà de fournir une meilleure compréhension de toutes les mises à mal de la vascularisation cochléaire induites par la chirurgie, est limité. La plupart des événements nuisibles à l’audition, mis à part les phénomènes de vasospasme détectés par des fluctuations du PMC, bien que détectés immédiatement, ne peuvent pas être enrayés du fait de leurs irréversibilités. Le monitorage basé sur les PEAp ou l’ECoG, qui ont déjà des limitations supplémentaires au PMC en termes de perte auditive préopératoire et de taux d'échantillonnage peropératoire élevé, ne peut pas non plus éviter et renverser ces dégâts causés sur la cochlée. Néanmoins, le monitorage du PMC pendant les chirurgies de l’APC garde un intérêt, notamment pour les plus petits NA moins soumis aux nombreux risques opératoires pour l’audition. En effet, la transmission au chirurgien de la détection des fluctuations du PMC, pourrait déclencher des contre-mesures utiles telles que l’arrêt immédiat des manœuvres chirurgicales qui ont déclenché l’altération du PMC ou permettre une éventuelle récupération via l’administration d’un traitement vasoactif pour protéger le flux sanguin cochléaire. De plus, une perte durable du PMC peut alerter le chirurgien que l'audition est désespérément perdue, et pourrait justifier des changements dans la planification chirurgicale, comme autoriser un fraisage prolongé du CAI pour une résection plus facile.

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