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Bommakanti KK, Iyer JS, Sagi V, Brown A, Ma X, Gonzales M, Stankovic KM. Reversible contrast enhancement for visualization of human temporal bones using micro computed tomography. Front Surg 2022; 9:952348. [PMID: 36268215 PMCID: PMC9577409 DOI: 10.3389/fsurg.2022.952348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Sensorineural hearing loss (SNHL), which typically arises from the inner ear, is the most common sensory deficit worldwide. The traditional method for studying pathophysiology underlying human SNHL involves histological processing of the inner ear from temporal bones collected during autopsy. Histopathological analysis is destructive and limits future use of a given specimen. Non-destructive strategies for the study of the inner ear are urgently needed to fully leverage the utility of each specimen because access to human temporal bones is increasingly difficult and these precious specimens are required to uncover disease mechanisms and to enable development of new devices. We highlight the potential of reversible iodine staining for micro-computed tomography imaging of the human inner ear. This approach provides reversible, high-resolution visualization of intracochlear structures and is becoming more rapid and accessible.
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Affiliation(s)
- Krishna K. Bommakanti
- Department of Head / Neck Surgery, University of California Los Angeles, Los Angeles, CA, United States,Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States
| | - Janani S. Iyer
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States,Department of Otolaryngology, Harvard Medical School, Boston, MA, United States,Program in Speech and Hearing Bioscience and Technology, Harvard University Graduate School of Arts and Sciences, Cambridge, MA, United States
| | - Varun Sagi
- Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States,University of Minnesota Medical School, Minneapolis, MN, United States
| | - Alyssa Brown
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States
| | - Xiaojie Ma
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States,Department of Otolaryngology, Harvard Medical School, Boston, MA, United States
| | - Marissa Gonzales
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States
| | - Konstantina M. Stankovic
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States,Department of Otolaryngology, Harvard Medical School, Boston, MA, United States,Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States,Correspondence: Konstantina M. Stankovic
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Atalay B, Eser MB, Kalcioglu MT, Ankarali H. Comprehensive Analysis of Factors Affecting Cochlear Size: A Systematic Review and Meta-analysis. Laryngoscope 2021; 132:188-197. [PMID: 33764541 DOI: 10.1002/lary.29532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine the cochlea's average size in humans and evaluate the relationships between certain covariates and cochlear size. METHODS A systematic search on articles on cochlear size and published in English was conducted using Cochrane, PubMed, Web of Science, and Scopus databases up to September 15, 2020. Data were pooled using random-effects with three models. The effect of demographic, clinical, and measurement-related parameters was specifically analyzed. Meta-regression and subgroup analyses were conducted. The overall effect estimation was made for outcomes. RESULTS The meta-analysis included 4,708 cochleae from 56 studies. The overall length of the organ of Corti was 32.94 mm (95% confidence interval [CI]: 32.51-33.38). The first and second models revealed that age, gender, country, continent, measurement method (direct, indirect), measured structure ("A" value, cochlear lateral wall), origin (in vivo, in vitro), and type (histology specimens, plastic casts, imaging) of the cochlear material did not affect the cochlear size. However, study populations (general population, patients with a cochlear implant, and patients with congenital sensorineural hearing loss [CSNHL]) were found to affect the outcomes. Compared to the other populations, patients with CSNHL had shorter cochleae. Therefore, we developed a third model and found that the general population and patients with cochlear implants did not differ in cochlear size. CONCLUSION This meta-analysis investigated the factors that could affect the cochlear size and found that patients with CSNHL had significantly shorter cochleae, whereas other covariates had no significant effect. Laryngoscope, 2021.
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Affiliation(s)
- Basak Atalay
- Faculty of Medicine, Department of Radiology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mehmet Bilgin Eser
- Faculty of Medicine, Department of Radiology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mahmut Tayyar Kalcioglu
- Faculty of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Handan Ankarali
- Faculty of Medicine, Department of Biostatistics and Medical Informatics, Istanbul Medeniyet University, Istanbul, Turkey
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Fluoroscopy guided electrode-array insertion for cochlear implantation with straight electrode-arrays: a valuable tool in most cases. Eur Arch Otorhinolaryngol 2020; 278:965-975. [PMID: 32588170 DOI: 10.1007/s00405-020-06151-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To highlight the advantages of real time fluoroscopy guided electrode-array (EA) insertion (FGI) during cochlear implants surgery. METHODS All surgical procedures were performed in a dedicated operating room equipped with a robotic C-arm cone beam device, allowing for intraoperative real time 2D FGI and postoperative 3D imaging. Only straight EAs were used. Patients were sorted out in three groups: ANAT, with anatomical concerns; HP, with residual hearing; NPR: patients with no particular reason for FGI. In all cases the angle of EA-insertion was measured. In the HP group pre and postoperative hearing were compared. The radiation delivered to the patient was recorded. RESULTS Fifty-three cochlear implantation procedures were achieved under fluoroscopy in 50 patients from November 2015 to January 2020 (HP group: n = 10; ANAT group: n = 13; NPR group: n = 27). In the ANAT group, FGI proved to be helpful in 8 cases (61.5%), successfully guiding the surgeon during EA -insertion. On average, the angle of insertion was at 424° ± 55°. In the HP group, a controlled smooth EA-insertion was carried out in all cases but one. The targeted 360° angle of insertion was always reached. Hearing preservation was possible with an eventual average drop of 30 ± 1.5 dB. In the NPR group, FGI helped control the quality of insertion in all cases and appeared very informative in five (17.8%): one EA-misrouting, three stuck EAs, and one case with hidden electrodes out of the cochlea in revision surgery. Final 3D cone beam CT scan double-checked the EA position in all adults. The radiation dose was equivalent to a bit less than four digital subtract radiographs. CONCLUSION The FGI is a very useful adjunct in cochlear implantation in all cases of expected surgical pitfalls, in patients with residual hearing, and even in case without preoperative particular reason, with low irradiation.
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Perez E, Viziano A, Al-Zaghal Z, Telischi FF, Sangaletti R, Jiang W, Dietrich WD, King C, Hoffer ME, Rajguru SM. Anatomical Correlates and Surgical Considerations for Localized Therapeutic Hypothermia Application in Cochlear Implantation Surgery. Otol Neurotol 2020; 40:1167-1177. [PMID: 31318786 PMCID: PMC6750193 DOI: 10.1097/mao.0000000000002373] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Application of localized, mild therapeutic hypothermia during cochlear implantation (CI) surgery is feasible for residual hearing preservation.
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Affiliation(s)
| | - Andrea Viziano
- Department of Otolaryngology.,Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | | | | | - Weitao Jiang
- Department of Biomedical Engineering, University of Miami, Miami, Florida
| | - William Dalton Dietrich
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miami, Florida
| | | | | | - Suhrud M Rajguru
- Department of Otolaryngology.,Department of Biomedical Engineering, University of Miami, Miami, Florida
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Glueckert R, Johnson Chacko L, Schmidbauer D, Potrusil T, Pechriggl EJ, Hoermann R, Brenner E, Reka A, Schrott-Fischer A, Handschuh S. Visualization of the Membranous Labyrinth and Nerve Fiber Pathways in Human and Animal Inner Ears Using MicroCT Imaging. Front Neurosci 2018; 12:501. [PMID: 30108474 PMCID: PMC6079228 DOI: 10.3389/fnins.2018.00501] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/03/2018] [Indexed: 12/18/2022] Open
Abstract
Design and implantation of bionic implants for restoring impaired hair cell function relies on accurate knowledge about the microanatomy and nerve fiber pathways of the human inner ear and its variation. Non-destructive isotropic imaging of soft tissues of the inner ear with lab-based microscopic X-ray computed tomography (microCT) offers high resolution but requires contrast enhancement using compounds with high X-ray attenuation. We evaluated different contrast enhancement techniques in mice, cat, and human temporal bones to differentially visualize the membranous labyrinth, sensory epithelia, and their innervating nerves together with the facial nerve and middle ear. Lugol’s iodine potassium iodine (I2KI) gave high soft tissue contrast in ossified specimens but failed to provide unambiguous identification of smaller nerve fiber bundles inside small bony canals. Fixation or post-fixation with osmium tetroxide followed by decalcification in EDTA provided superior contrast for nerve fibers and membranous structures. We processed 50 human temporal bones and acquired microCT scans with 15 μm voxel size. Subsequently we segmented sensorineural structures and the endolymphatic compartment for 3D representations to serve for morphometric variation analysis. We tested higher resolution image acquisition down to 3.0 μm voxel size in human and 0.5 μm in mice, which provided a unique level of detail and enabled us to visualize single neurons and hair cells in the mouse inner ear, which could offer an alternative quantitative analysis of cell numbers in smaller animals. Bigger ossified human temporal bones comprising the middle ear and mastoid bone can be contrasted with I2KI and imaged in toto at 25 μm voxel size. These data are suitable for surgical planning for electrode prototype placements. A preliminary assessment of geometric changes through tissue processing resulted in 1.6% volume increase caused during decalcification by EDTA and 0.5% volume increase caused by partial dehydration to 70% ethanol, which proved to be the best mounting medium for microCT image acquisition.
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Affiliation(s)
- Rudolf Glueckert
- Department of Otolaryngology, Medical University of Innsbruck, Innsbruck, Austria.,University Clinics Innsbruck, Tirol Kliniken, University Clinic for Ear, Nose and Throat Medicine Innsbruck, Innsbruck, Austria
| | - Lejo Johnson Chacko
- Department of Otolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Dominik Schmidbauer
- Department of Otolaryngology, Medical University of Innsbruck, Innsbruck, Austria.,Department of Biotechnology and Food Engineering, Management Center Innsbruck (MCI), Innsbruck, Austria
| | - Thomas Potrusil
- Department of Otolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth J Pechriggl
- Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Romed Hoermann
- Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Erich Brenner
- Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Alen Reka
- Department of Otolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Stephan Handschuh
- VetImaging, VetCore Facility for Research, University of Veterinary Medicine, Vienna, Austria
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Chen D, Chen CH, Tang L, Wang K, Li YZ, Phan K, Wu AM. Three-dimensional reconstructions in spine and screw trajectory simulation on 3D digital images: a step by step approach by using Mimics software. JOURNAL OF SPINE SURGERY 2017; 3:650-656. [PMID: 29354744 DOI: 10.21037/jss.2017.10.09] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is a rapidly increasing amount of literature outlining the use of three-dimensional (3D) reconstruction and printing technologies in recent years. However, precise instructive articles which describe step-by-step methods of reconstructing 3D images from computed tomography (CT) or magnetic resonance imaging (MRI) remain limited. To address these issues, this article describes a detailed protocol which will allow the reader to easily perform the 3D reconstruction in their future research, to allow investigation of the appropriate surgical anatomy and allow innovative designs of novel screw fixation techniques or pre-operative surgical planning.
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Affiliation(s)
- Dong Chen
- Department of Spine Surgery, Digital Orthopedic Institute, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical College of Wenzhou Medical University, Zhejiang Spine Surgery Center, Wenzhou 325027, China
| | - Chun-Hui Chen
- Department of Spine Surgery, Digital Orthopedic Institute, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical College of Wenzhou Medical University, Zhejiang Spine Surgery Center, Wenzhou 325027, China
| | - Li Tang
- Department of Spine Surgery, Digital Orthopedic Institute, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical College of Wenzhou Medical University, Zhejiang Spine Surgery Center, Wenzhou 325027, China
| | - Kai Wang
- Department of Spine Surgery, Digital Orthopedic Institute, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical College of Wenzhou Medical University, Zhejiang Spine Surgery Center, Wenzhou 325027, China
| | - Yu-Zhe Li
- Department of Spine Surgery, Digital Orthopedic Institute, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical College of Wenzhou Medical University, Zhejiang Spine Surgery Center, Wenzhou 325027, China
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, University of New South Wales, Sydney, Australia
| | - Ai-Min Wu
- Department of Spine Surgery, Digital Orthopedic Institute, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical College of Wenzhou Medical University, Zhejiang Spine Surgery Center, Wenzhou 325027, China
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