Fluoroscopy guided electrode-array insertion for cochlear implantation with straight electrode-arrays: a valuable tool in most cases

Perazzini, Chiara; Puechmaille, M.; Saroul, N.; Plainfossé, Olivier; Montrieul, Laura; Becaud, J.; Gilain, L.; Chabrot, P.; Boyer, L.; Mom, T.

doi:10.1007/s00405-020-06151-z

Cited by 13 publications

(14 citation statements)

References 38 publications

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“…The EA-insertion was always performed at low speed (<1 mm/s) even before we used the RobOtol ® . This time was reported previously at less than 4 min [15]. The total radiation dose was calculated at 4053+/−1994 µGray m 2 , including the radiation due to the final cone beam CT scan responsible for the most part of the X-ray dose.…”

Section: Discussionmentioning

confidence: 73%

“…We know that even with the haptic feedback of the human hand, in some cases it is very difficult to feel certain errors during EA-insertion, such as EA-tip-foldover or EA-misrouting. Hopefully, these errors can be revealed by fluoroscopy [15]. It is therefore not surprising that, with no haptic control at all, a rob-EAI can result in a divergent EA winding around the modiolus.…”

Section: Discussionmentioning

confidence: 99%

“…Another positive point of using a hybrid room like the Angio suite Imabloc is that the RobOtol ® permits remote-EAI under fluoroscopy, limiting the irradiation delivered to the operating staff. The total fluoroscopic time has been previously precisely reported [15]. Because fluoroscopy only served for control of the EA-insertion, the exposition time of patients to radiation was very low, less than 5 min.…”

Section: Discussionmentioning

confidence: 99%

“…Although EA-translocation from the scala tympani into the scala vestibuli could result in damage to the fine cochlear structure, controversy exists in the literature, with some teams reporting better results in well-placed EAs within the scala tympani [8][9][10][11][12], while others did not [13,14]. Visual feedback through fluoroscopy has shown that it is possible to detect early in real -time errors such as EA-misrouting, EA-tip foldover, or EA-tip blockage within the cochlea and to immediately correct them [15]. Recently, a robotized EA insertion (rob-EAI) technique has been shown to perform less traumatic insertion, with a lower rate of scala translocation [16,17].…”

Section: Introductionmentioning

confidence: 99%

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Robotized Cochlear Implantation under Fluoroscopy: A Preliminary Series

Mom

Puechmaille

Yagoubi

et al. 2022

JCM

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It is known that visual feedback by fluoroscopy can detect electrode array (EA) misrouting within the cochlea while robotized EA-insertion (rob-EAI) permits atraumatic cochlear implantation. We report here our unique experience of both fluoroscopy feedback and rob-EAI in cochlear implant surgery. We retrospectively analyzed a cohort of consecutive patients implanted from November 2021-October 2022 using rob-EAI, with the RobOtol®, to determine the quality of EA-insertion and the additional time required. Twenty-three patients (10 females, 61+/−19 yo) were tentatively implanted using robot assistance, with a rob-EAI speed < 1 mm/s. Only three cases required a successful revised insertion by hand. Under fluoroscopy (n = 11), it was possible to achieve a remote rob-EAI (n = 8), as the surgeon was outside the operative room, behind an anti-radiation screen. No scala translocation occurred. The additional operative time due to robot use was 18+/−7 min with about 4 min more for remote rob-EAI. Basal cochlear turn fibrosis precluded rob-EAI. In conclusion, Rob-EAI can be performed in almost all cases with a low risk of scala translocation, except in the case of partial cochlear obstruction such as fibrosis. Fluoroscopy also permits remote rob-EAI.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Robotized Cochlear Implantation under Fluoroscopy: A Preliminary Series

Mom

Puechmaille

Yagoubi

et al. 2022

JCM

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“…The only technique, which can directly detect electrode position, is the uoroscopy [11][12][13] . Disadvantages of this technique are that the scan has to be performed in the Stenver´s projection and the ionizing radiation exposure at least to the surgeon and the patient.…”

Section: Introductionmentioning

confidence: 99%

Continuous Facial Nerve Stimulation During Cochlear Implantation – An Electrophysiological Technique to Control the Intracochlear Electrode Contact Position

Herrmann

Müller-Graff

Kaulitz

et al. 2021

Preprint

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Purpose: This proof of concept describes the use of evoked electromyographic (EMG) activation of the facial nerve for intraoperative monitoring of the electrode insertion during cochlear implantation (CI).Methods: Intraoperative EMG measurements from the facial nerve were conducted in nine patients undergoing CI implantation. Electric pulses were emitted from contacts on the CI array during and immediately after electrode insertion. For control, the results of EMG measurements were compared to postoperative flat panel volume computed tomography scans with secondary reconstruction (fpVCTSECO).Results: During insertion, the EMG response evoked by the electrical stimulation from the CI was growing with the stimulating contact approaching the facial nerve and declined with increasing distance. After full insertion, contacts on the apical half of the CI array stimulated higher EMG responses compared with those on the basal half. Comparison with postoperative imaging demonstrated that electrode contacts stimulating high EMG responses had the shortest distances to the facial nerve. Conclusion: It could be demonstrated that electrically evoked EMG activation of the facial nerve can be used to monitor the progress during CI electrode insertion and to control the intracochlear electrode position after full insertion.

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Towards inferring positioning of straight cochlear‐implant electrode arrays during insertion using real‐time impedance sensing

Riojas,

Bruns,

Granna

et al. 2024

Robotics Computer Surgery

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BackgroundCochlear‐implant electrode arrays (EAs) are currently inserted with limited feedback, and impedance sensing has recently shown promise for EA localisation.MethodsWe investigate the use of impedance sensing to infer the progression of an EA during insertion.ResultsWe show that the access resistance component of bipolar impedance sensing can detect when a straight EA reaches key anatomical locations in a plastic cochlea and when each electrode contact enters/exits the cochlea. We also demonstrate that dual‐sided electrode contacts can provide useful proximity information and show the real‐time relationship between impedance and wall proximity in a cadaveric cochlea for the first time.ConclusionThe access resistance component of bipolar impedance sensing has high potential for estimating positioning information of EAs relative to anatomy during insertion. Main limitations of this work include using saline as a surrogate for human perilymph in ex vivo models and using only one type of EA.

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Fluoroscopy guided electrode-array insertion for cochlear implantation with straight electrode-arrays: a valuable tool in most cases

Cited by 13 publications

References 38 publications

Robotized Cochlear Implantation under Fluoroscopy: A Preliminary Series

Robotized Cochlear Implantation under Fluoroscopy: A Preliminary Series

Continuous Facial Nerve Stimulation During Cochlear Implantation – An Electrophysiological Technique to Control the Intracochlear Electrode Contact Position

Towards inferring positioning of straight cochlear‐implant electrode arrays during insertion using real‐time impedance sensing

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