The use of a surgical planning tool for evaluating the optimal surgical accessibility to the stapedius muscle via a retrofacial approach during cochlear implant surgery: a feasibility study

Márquez, Pedro; Volk, Gerd Fabian; Maule, Francesca; Korth, Daniela; Bitter, Thomas; Koscielny, Sven; Aschenbach, René; Guntinas‐Lichius, Orlando

doi:10.1007/s11548-020-02288-8

Cited by 8 publications

(7 citation statements)

References 14 publications

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“…Table 1). Our outcomes provide new findings supporting the potential of 3D imaging in general, anatomy comprehension, spatial orientation, preoperative planning and intraoperative proceedings, which has been already discussed in various studies (28,29).…”

Section: Discussionsupporting

confidence: 79%

Accessing the Stapedius Muscle Via Novel Surgical Retrofacial Approach: A Cadaveric Feasibility Study

Arnold

Schneider

Volk

et al. 2021

Otology &Amp; Neurotology

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Hypothesis: Despite the complete embodiment of the stapedius muscle (SM) into the pyramidal eminence, it is possible to safely gain access to the SM belly via a retrofacial approach. This presents a novel approach to directly measure the electrically evoked stapedius reflex threshold (eSRT). Background: Objective fitting of maximum comfortable loudness levels for cochlear implant users can improve the benefit introduced by the device. Sensing SM activity via direct surgical access represents a potential tool for objective eSRT fitting. Methods: Eighteen human temporal bones (TBs) were used. Micro-computed tomography was performed for six TBs. Standard computed tomography for six TBs. Manual 3Dsegmentation of the relevant middle and inner ear anatomy was performed on 12 TBs. Mastoidectomy and posterior tympanotomy allowed the access to middle ear of all 18 the TBs. Once identified the mastoidal segment of the facial nerve (FN), the retrofacial access to the SM was drilled.Results: The total access rate was 72.2%. Only in the first three cases the posterior semi-circular canal was hit. The SM access was identified posterior to the FN at a 4 AE 0.78 mm distance from the stapes' head, almost halfway to the chorda tympani's branching point along the FN direction. The drilling depth to access the SM posterior to the external surface of FN on average was 2 AE 0.30 mm. The exposure took on average of 5 to 8 minutes. Conclusions: The retrofacial approach seems to offer a feasible and reproducible access to the SM belly opening an avenue to electromyographic sensing of eSRT.

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Section: Discussionsupporting

confidence: 79%

Accessing the Stapedius Muscle Via Novel Surgical Retrofacial Approach: A Cadaveric Feasibility Study

Arnold

Schneider

Volk

et al. 2021

Otology &Amp; Neurotology

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“…The use of CBCT has been acknowledged in literature when it comes to visualize preoperative conditions in an individual temporal bone [ 36 ]. We suggest the posterior semicircular canal and facial nerve have to be evaluated before every RFA to the area of ST. 3D reconstruction may also help to easier understand the complicated relations between these structures [ 12 , 37 ]. We believe that the ability to do a proper analysis of multiplanar reconstructions has to be in the armamentarium of every otologic surgeon.…”

Section: Discussionmentioning

confidence: 99%

Sinus tympani revisited for planning retrofacial approach—radiologic study in pneumatized temporal bones and its surgical implications

Wojciechowski

Bartoszewicz

Szopiński

2022

Eur Arch Otorhinolaryngol

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Background and purpose Retrofacial approach (RFA) is an access route to sinus tympani (ST) and it is used in cholesteatoma surgery, especially when type C ST is encountered. It may also be used to gain an access to stapedius muscle to assess the evoked stapedius reflex threshold. The primary object of this study was to evaluate the morphology of sinus tympani and its relationship to facial nerve (FN) and posterior semicircular canal (PSC) in context of planning retrofacial approach in pneumatized temporal bones. Methods CBCT of 130 adults were reviewed. The type of sinus tympani was assessed according to Marchioni's classification. Width of entrance to sinus tympani (STW), depth of ST (STD), distance between the posterior semicircular canal and facial nerve (F-PSC), distance between the latter plane to the floor of ST at the right angle (P-ST) were measured at level of round window (RW) and pyramidal ridge (PR). Results All of the bones were well-aerated and classified in Dexian Tan pneumatization group 3 or 4. Type B of ST is dominant (70.8%) in adult population with no history of inflammatory otologic diseases, followed by type C (22.7%) and then type A (6.5%). The depth of ST (STD) presented significant deviations (ANOVA, p < 0.05) among all three types. STW reaches greater values on the level of PR. F-PSC does not correlate with type of ST. In over 75% of examined type C sinus tympani the distance P-ST was less than 1 mm. Conclusions The qualitative classification of the sinus tympani into types A, B and C, introduced by Marchioni is justified by statistically significant differences of depth between individual types of tympanic sinuses. The STW distance reaches greater values inferiorly—it may suggest that RFA should be performed in infero-superior manner rather than opposite direction. Preoperative assessment of temporal bones CT scans gives very important information about size of sinus tympani and distance between FN and PSC.

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“…The evaluation of the SM accessibility according to criteria described in [ 19 ] was performed ( Table 1 , column 5). In 5 cases, ID: #5, #7, #8, #9, and #16, to provide more information to the surgeons during the pre-surgical evaluation, the 3D reconstructions of each patient were fed into the recently developed surgical planning tool [ 20 ]. The surgical planning tool took on average 30 min to process one dataset and output the results.…”

Section: Methodsmentioning

confidence: 99%

“…The surgical access to the belly of the SM was drilled based on our previous results [ 18 , 20 , 21 ]. The access was performed posterior and medial to the mastoid portion of the FN, almost halfway between the stapes head level to the branching point of the chorda tympani (ChT) along the FN direction ( Fig 1 ).…”

Section: Methodsmentioning

confidence: 99%

Accessing the stapedius muscle via novel surgical retrofacial approach during cochlear implantation surgery: Intraoperative results on feasibility and safety

et al. 2022

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Human stapedius muscle (SM) can be directly and safely accessed via retrofacial approach, opening new approaches to directly measure the electrically evoked stapedius reflex threshold (eSRT). The measurement of the SM activity via direct surgical access represents a potential tool for objective eSRT fitting of cochlear implants (CI), increasing the benefit experienced by the CI users and leading to new perspectives in the development of smart implantable neurostimulators. 3D middle-ear reconstructions created after manual segmentation and related SM accessibility metrics were evaluated before the CI surgery for 16 candidates with assessed stapedius reflex. Retrofacial approach to access the SM was performed after facial recess exposure. In cases of poor exposition of SM, the access was performed anteriorly to the FN via drilling of the pyramidal eminence (PE). The total access rate of the SM via both the retrofacial and anterior approach of the FN was 100%. In 81.2% of cases (13/16), the retrofacial approach allowed to access the SM on previously categorized well exposed (8/8), partially exposed (4/5), and wholly concealed (1/3) SM with respect to FN. Following intraoperative evaluation in the remaining 18.8% (3/16), the SM was accessed anteriorly via drilling of the PE. Exposure of SM with respect to the FN and the sigmoid sinus’s prominence was a predictor for the suitable surgical approach. The retrofacial approach offers feasible and reproducible access to the SM belly, opening direct access to electromyographic sensing of the eSRT. Surgical planner tools can quantitatively assist pre-surgical assessment.

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The use of a surgical planning tool for evaluating the optimal surgical accessibility to the stapedius muscle via a retrofacial approach during cochlear implant surgery: a feasibility study

Cited by 8 publications

References 14 publications

Accessing the Stapedius Muscle Via Novel Surgical Retrofacial Approach: A Cadaveric Feasibility Study

Accessing the Stapedius Muscle Via Novel Surgical Retrofacial Approach: A Cadaveric Feasibility Study

Sinus tympani revisited for planning retrofacial approach—radiologic study in pneumatized temporal bones and its surgical implications

Accessing the stapedius muscle via novel surgical retrofacial approach during cochlear implantation surgery: Intraoperative results on feasibility and safety

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