Real-Time Intraoperative Computed Tomography to Assist Cochlear Implant Placement in the Malformed Inner Ear

Bloom, Jason D.; Rizzi, Mark D.; Germiller, John A.

doi:10.1097/mao.0b013e31818d1cd2

Cited by 43 publications

(33 citation statements)

References 12 publications

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“…NRT also provides information regarding kinking and extra-cochlea positioning. If the resources are available, EABRs produce the most accurate routine on table assessment of electrode function, position, and evidence of kinking (Gibson et al, 2009), and more recently three-dimensional rotational X-ray (Grolman et al, 2009) and intra-operative CT (Bloom et al, 2009) have been described. The most accurate topographical available assessment is CT, but for the majority of cases, this is not necessary or practical and exposes the patients to relatively high doses of radiation, and so it is reserved for patients in whom a problem is suspected, that plain radiography has been unable to provide appropriate accuracy.…”

Section: Discussionmentioning

confidence: 98%

A practical, single-view alternative to Stenver's for plain radiographic unilateral and bilateral post-cochlear implant position check

Harris

Pepper

Lee

et al. 2011

Cochlear Implants International

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Section: Discussionmentioning

confidence: 98%

A practical, single-view alternative to Stenver's for plain radiographic unilateral and bilateral post-cochlear implant position check

Harris

Pepper

Lee

et al. 2011

Cochlear Implants International

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“…CT provides the most detailed information about the orientation of CI electrodes within the cochlea (Kong et al 2012; Sennaroglu et al 2002; Svrakic et al 2015). CI surgery for severe malformations of the inner ear also benefit from novel intraoperative CT approaches (Bloom et al 2009). …”

Section: Introductionmentioning

confidence: 99%

Auditory Brainstem Implant Array Position Varies Widely Among Adult and Pediatric Patients and Is Associated With Perception

et al. 2017

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Objectives The auditory brainstem implant (ABI) provides sound awareness to patients who are ineligible for cochlear implantation. Auditory performance varies widely among similar ABI cohorts. We hypothesize that differences in electrode array position contribute to this variance. Herein, we classify ABI array position based on postoperative imaging and investigate the relationship between position and perception. Design Retrospective review of pediatric and adult ABI users with postoperative computed tomography (CT). To standardize views across subjects, true-axial reformatted series of scans were created using the McRae line. Using multiplanar reconstructions, basion and electrode array tip coordinates and array angles from vertical were measured. From a lateral view, array angles (V) were classified into Types I-IV, and from posterior view, array angles (T) were classified into Types A-D. Array position was further categorized by measuring distance vertical from basion (D1) and lateral from midline (D2). Differences between array classifications were compared with audiometric thresholds, number of active electrodes, and pitch ranking. Results Pediatric (n=4, 2 with revisions) and adult (n=7) ABI subjects were included in this study. Subjects had a wide variety of ABI array angles, but most were aimed superiorly and posteriorly (Type II, n=7) from lateral view and upright or medially tilted from posterior view (Type A, n=6). Mean pediatric distances were 8 – 42% smaller than adults for D1 and D2. In subjects with perceptual data, electrical thresholds and the number of active electrodes differed among classification types. Conclusions In this first study to classify ABI electrode array orientation, array position varied widely. This variability may explain differences in auditory performance.

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“…Implantation in ears with malformations or following trauma is known to be challenging, and may involve a higher risk of incorrect placement of electrode arrays, facial nerve damage, or other complications [1]. Image guided navigation can prevent misplacement of electrodes [2] and is required for the further development of percutaneous cochlear implantation [3].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, intraoperative high-resolution computed tomographic (CT) imaging combined with image guided navigation has become available, which might enable improved intraoperative localization of anatomic structures and the electrode array [7]. This technology has potential to save time and resources, and possibly avoid the revision surgery associated with improper electrode positioning [2].…”

Section: Introductionmentioning

confidence: 99%

Image guided navigation by intraoperative CT scan for cochlear implantation

Stelter¹,

Ledderose²,

Hempel³

et al. 2012

Computer Aided Surgery

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Introduction: For successful cochlear implantation in difficult ears, image guided navigation systems can help identify surgical landmarks or confirm the surgeon's anatomical knowledge. In this pilot case study, exact navigation based on intraoperative CT scanning was investigated and helped confirm important and necessary landmarks, such as the facial nerve, cochlea and intracochlear structures, and at least adequate placement of a straight electrode array. Material and Methods: Intraoperative imaging was performed on a 40-slice sliding-gantry CT scanner (Siemens SOMATOM Sensation 40 Open) with an expanded gantry bore (82 cm). Raw image data were reconstructed with a slice thickness and increment of 0.6 mm and were imported to a frameless infrared-based navigation station (BrainLAB VectorVision Sky). In a preoperative accuracy and feasibility study, a phantom skull was scanned and registered five times by the navigation system. Based on the encouraging results, the system was then applied to a male patient with post-traumatic sensorineural hearing loss. The intraoperative target positioning error was measured by a ''blinded'' colleague who defined the distance of the pointer from different sections of the facial nerve without seeing the intraoperative field. Results: The average deviation in the phantom skull was 0.91 mm (SD 0.27 mm) on the mastoid, 1.01 mm (SD 0.21 mm) on the round window, and 0.9 mm (SD 0.18 mm) on the inner ear canal.Surgery could be performed without major complications. The distance of the pointer from the facial nerve could be defined exactly using navigation in ten measurements. The cochleostomy and electrode insertion were performed with the aid of navigation. After insertion, direct intraoperative control of the electrode position was achieved by means of a low-dose CT scan. Two months postoperatively, the patient had a satisfactory open-set speech understanding of 85%. Conclusion: With the use of intraoperative acquisition of CT images (or digital volume tomography devices) and automatic volumetric registration for navigation, surgical precision can be improved, thereby allowing successful cochlear implant surgery in patients with complex malformations or who have undergone multiple previous ear surgeries and consequently lack anatomical landmarks. Our study clearly shows that this high-technology combination is superior to other registration methods in terms of accuracy and precision. Further investigations should aim at developing automatic segmentation and applications for minimally invasive surgery of the lateral skull base.

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Real-Time Intraoperative Computed Tomography to Assist Cochlear Implant Placement in the Malformed Inner Ear

Abstract: Real-time intraoperative computed tomography is a new technology with many potential applications in surgery. In our patient, it allowed rapid and accurate determination of electrode position and helped achieve ideal placement in a severely malformed inner ear.

Cited by 43 publications

References 12 publications

A practical, single-view alternative to Stenver's for plain radiographic unilateral and bilateral post-cochlear implant position check

A practical, single-view alternative to Stenver's for plain radiographic unilateral and bilateral post-cochlear implant position check

Auditory Brainstem Implant Array Position Varies Widely Among Adult and Pediatric Patients and Is Associated With Perception

Image guided navigation by intraoperative CT scan for cochlear implantation

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