ObjectiveIn the field of cochlear implantation, the current trend toward patient-specific electrode selection and the achievement of optimal audiologic outcomes has resulted in implant manufacturers developing a large portfolio of electrodes. The aim of this study was to bridge the gap between the known variability of cochlea length and this electrode portfolio.DesignRetrospective analysis on cochlear length and shape in micro–computed tomography and cone beam computed tomography data.SettingTertiary care medical center.Subjects and MethodsA simple 2-step approach was developed to accurately estimate the individual cochlear length as well as the projected length of an electrode array inside the cochlea. The method is capable of predicting the length of the cochlea and the inserted electrode length at any specific angle. Validation of the approach was performed with 20 scans of human temporal bones (micro–computed tomography) and 47 pre- and postoperative clinical scans (cone beam computed tomography).ResultsMean ± SD absolute errors in cochlear length estimations were 0.12 ± 0.10 mm, 0.38 ± 0.26 mm, and 0.71 ± 0.43 mm for 1, 1.5, and 2 cochlea turns, respectively. Predicted insertion angles based on clinical cone beam computed tomography data showed absolute deviations of 27° ± 18° to the corresponding postoperative measurements.ConclusionWith accuracy improvements of 80% to 90% in comparison with previously proposed approaches, the method is well suited for the use in individualized cochlear implantation.
ObjectivesThe aim of this study was to identify anatomical indication ranges for different lateral wall cochlear implant electrodes to support surgeons in the preoperative preparation.Methods272 patients who were implanted with a FLEX20, FLEX24, FLEX28, or a custom-made device (CMD) were included in this study. The cochlear duct length (CDL) and basal cochlear diameter (length A) were measured within preoperative imaging data. The parameter A was then employed to additionally compute CDL estimates using literature approaches. Moreover, the inserted electrode length (IEL) and insertion angle (IA) were measured in postoperative CT data. By combining the preoperative measurements with the IA data, the covered cochlea length (CCL) and relative cochlear coverage (CC) were determined for each cochlea.ResultsThe measurements of the CDL show comparable results to previous studies. While CDL measurements and estimations cover similar ranges overall, severe deviations occur in individual cases. The electrode specific IEL and CCL are fairly consistent and increase with longer electrodes, but relatively wide ranges of electrode specific CC values were found due to the additional dependence on the respective CDL. Using the correlation of IEL and CCL across electrode arrays, CDL ranges for selected arrays were developed (FLEX24: 31.3–34.4, FLEX28: 36.2–40.1, FLEXSoft: 40.6–44.9).ConclusionsOur analysis shows that electrode specific CC varies due to the CDL variation. Preoperative measurement of the CDL allows for an individualized implant length selection yielding optimized stimulation and a reduced risk of intraoperative trauma. The CDL, as derived from preoperative CT imaging studies, can help the implant surgeon select the appropriate electrode array to maximize the patient’s outcomes.
Spline curve reconstructions appear to be the best option for anatomical diagnostics in clinical practice. Retrospective studies can be performed to further evaluate model-based evaluations.
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