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Savoca E, Smith B, Shaffer AD, Kitsko D, Chi D. Utility of Intraoperative Radiographs in Pediatric Cochlear Implant Surgery. Otolaryngol Head Neck Surg 2023; 169:1282-1289. [PMID: 37051895 DOI: 10.1002/ohn.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/04/2023] [Accepted: 03/25/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To evaluate the role of intraoperative radiographs to confirm electrode position following pediatric cochlear implantation (CI). STUDY DESIGN Retrospective chart review. SETTING Single tertiary care pediatric center. METHODS A retrospective chart review was conducted, including all pediatric patients undergoing CI at UPMC Children's Hospital of Pittsburgh over a 13-year period. RESULTS We identified 326 patients undergoing 492 procedures. Across the cohort, there were 7 cases that required intraoperative electrode reinsertion due to malposition or presumed malposition. For 6 of the 7 cases, intraoperative X-ray identified electrode malposition. Neural response telemetry (NRT) testing was also abnormal for 4 of these cases prior to reinsertion. Implantation of Cochlear's Slim Modiolar electrode was associated with an abnormal perioperative X-ray (odds ratio [OR]: 9.2, p = 0.03) and increased change in management (OR: 9.2, p = 0.03) compared to Cochlear's Contour Advance (CA). Incidence of abnormal X-rays was 1.24% overall, 4% in the Slim Modiolar group, and 0.3% in the CA group. The Slim Modiolar electrode accounted for 4 of 7 cases requiring reinsertion, and in all 4 of these cases, electrode fold-over was identified on the X-ray. NRT was normal in 1 of these 4 cases. CONCLUSION The use of Cochlear's Slim Modiolar electrode was associated with a significantly increased risk of abnormal intraoperative X-ray compared to the CA electrode. Given the risk of fold-over with routine insertion and normal electrical testing using the Slim Modiolar electrode, we recommend routine use of intraoperative skull X-ray to confirm electrode position.
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Affiliation(s)
- Emily Savoca
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Ear, Nose & Throat Surgeons of Western New England, Springfield, Massachusetts, USA
| | - Brandon Smith
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amber D Shaffer
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dennis Kitsko
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Chi
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Waldeck S, Schmidt S, von Falck C, Chapot R, Brockmann M, Overhoff D. New hybrid multiplanar cone beam computed tomography-laser-fluoroscopic-guided approach in cochlear implant surgery. Int J Comput Assist Radiol Surg 2022; 17:1837-1843. [PMID: 35816271 PMCID: PMC9467958 DOI: 10.1007/s11548-022-02703-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 06/10/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Cochlea implant surgery with proper positioning of the cochlear electrode can be challenging. Intraoperative real-time hybrid laser-fluoroscopic-guided navigation based on a multiplanar cone beam computed tomography (CBCT) dataset opens up the opportunity to immediate radiological control of primary electrode misalignments and offering new insights into the cochlea electrode insertion routes and favorable cochlear implant-insertion angle. METHODS In this retrospective study, 50 cases (29 males, 18 females) of conventional electrode implantation (without intraoperative image control; group A) and nine cases (7 males, 2 females) of CBCT-laser-fluoroscopic-guided surgery (group B) were included in the present study. CBCT-laser-guided surgery under real-time fluoroscopic control was conducted using an intraoperative C-arm CBCT. All patients received preoperative cross-sectional imaging (CT and MRI), in which cochlear malformation could be excluded. Postoperatively, we looked for electrode misplacements. RESULTS In group A, electrode misalignment was detected postoperatively in 14 of 50 cases (28.0%). In group B, primary electrode misalignment was detected intraoperatively in two patients (22.2%). In both patients, the misalignments were corrected in the same session. The comparison of cochlear insertion angles showed significant differences. Group A: 47.5 ± 2.6° (actual conventional surgery) vs 17.6 ± 2.8° (theoretical CBCT-laser-fluoroscopic-guided surgery) P < 0.001. Group A vs group B: 47.5 ± 2.6° (actual conventional surgery; Group A) vs 17.9 ± 2.5° (actual CBCT-laser-fluoroscopic-guided surgery; Group B) P < 0.001. CONCLUSION We consider that an intraoperative hybrid CBCT-laser-fluoroscopic-controlled approach in cochlear implant surgery using a C-arm CT can be beneficial, because electrode misalignments can be reduced and if it does occur, remedied in the same surgical session.
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Affiliation(s)
- Stephan Waldeck
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, Rübenacher Straße 170, 56072, Koblenz, Germany. .,Institute of Neuroradiology, University Medical Centre Johannes Gutenberg University Mainz, Mainz, Langenbeckstraße 1, 55131, Germany.
| | - Sandra Schmidt
- Department of ENT Surgery, Bundeswehr Central Hospital Koblenz, Rübenacher Straße 170, 56072, Koblenz, Germany
| | - Christian von Falck
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - René Chapot
- Department of Neuroradiology, Alfried Krupp Krankenhaus, Alfried-Krupp-Strasse 21, 45131, Essen, Germany
| | - Marc Brockmann
- Institute of Neuroradiology, University Medical Centre Johannes Gutenberg University Mainz, Mainz, Langenbeckstraße 1, 55131, Germany
| | - Daniel Overhoff
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, Rübenacher Straße 170, 56072, Koblenz, Germany.,Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Fernandes V, Wang Y, Yeung R, Symons S, Lin V. Effectiveness of skull X-RAY to determine cochlear implant insertion depth. J Otolaryngol Head Neck Surg 2018; 47:50. [PMID: 30176926 PMCID: PMC6122652 DOI: 10.1186/s40463-018-0304-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 08/27/2018] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Cochlear implant (CI) insertion depth can affect residual hearing preservation, tonotopic range coverage, and Mapping. Therefore, determining insertion depth has the potential to maximize CI performance. A post-op skull X-RAY is commonly used to assess insertion depth, however its effectiveness has not been well established. Our primary objective was to assess the accuracy of post-op skull X-RAYs to determine insertion depth, compared to CT as the gold standard. Secondary objectives were to compare experience level of raters and different skull X-RAY views. METHODS Thirteen patients with Advanced Bionic HiRes 90 K implants, and post-operative temporal bone CT scans were selected from the CI database at Sunnybrook Health Sciences Centre. Medical students, otology fellows, and CI surgeons evaluated insertion depths on post-op skull X-RAYs, while neuroradiologists evaluated CT scans. Descriptive statistics, regression analysis, and paired t-tests were used to compare the two types of imaging. RESULTS X-RAYs and CTs provided an equivalent mean insertion depth of 337 degrees (p = 0.93), a mean difference of - 0.9 degrees and a standard deviation of paired differences of 43 degrees. Although means were similar across rater groups, CI surgeons (45 degrees) had the lowest standard deviation of paired differences. Comparing X-RAY views, Caldwell (29 degrees) had less variation than Towne (59 degrees) for standard deviation of paired differences. CONCLUSIONS Skull X-RAYs provide accurate and reliable measurements for CI insertion depth. The Caldwell view alone may be sufficient for evaluations of insertion depth, and experience has a minor impact on the variability of estimates.
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Affiliation(s)
- Vinay Fernandes
- Division of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Yiqiao Wang
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.
| | - Robert Yeung
- Division of Radiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sean Symons
- Division of Radiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Vincent Lin
- Division of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
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Jia H, Torres R, Nguyen Y, De Seta D, Ferrary E, Wu H, Sterkers O, Bernardeschi D, Mosnier I. Intraoperative Conebeam CT for Assessment of Intracochlear Positioning of Electrode Arrays in Adult Recipients of Cochlear Implants. AJNR Am J Neuroradiol 2018; 39:768-774. [PMID: 29472297 DOI: 10.3174/ajnr.a5567] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/28/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Intraoperative conebeam CT has been introduced into the operating room and provides quick radiologic feedback. This study aimed to investigate its utility in the assessment of the positioning of the electrode array after cochlear implantation. MATERIALS AND METHODS This was a retrospective study of 51 patients (65 ears) with intraoperative imaging by conebeam CT (O-arm) after cochlear implantation between 2013 and 2017. Correct placement into the cochlea was immediately identified. Positioning assessments were later analyzed with OsiriX software. RESULTS Intraoperative imaging was quickly performed in all cases. No misplacement into the vestibule or semicircular canals was found. A foldover of the implanted array was identified in 1 patient. Secondary analysis by 2 raters showed excellent agreement on insertion depth angle (intraclass correlation = 0.96, P < .001) and length of insertion of the electrode array (intraclass correlation coefficient = 0.93, P = .04) measurements. The evaluation of the number of extracochlear electrodes was identical between the 2 raters in 78% of cases (Cohen κ = 0.55, P < .001). The scalar position was inconsistent between raters. When we compared O-arm and high-resolution CT images in 14 cases, the agreement was excellent for insertion depth angle (intraclass correlation coefficient = 0.97, P < .001) and insertion length (intraclass correlation coefficient = 0.98, P < .001), good for the number of extracochlear electrodes (Cohen κ = 0.63, P = .01), but moderate for the scalar position (Cohen κ = 0.59, P = .02). CONCLUSIONS Intraoperative conebeam CT using the O-arm is a safe, rapid, easy, and reliable procedure to immediately identify a misplacement or foldover of an electrode array. The insertion depth angle, insertion length, and number of electrodes inserted can be accurately assessed.
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Affiliation(s)
- H Jia
- From the Unité de Réhabilitation Chirurgicale Mini-Invasive Robotisée de l'Audition (H.J., R.T., Y.N., D.D.S., E.F., O.S., D.B., I.M.), Sorbonne Universités, Université Pierre et Marie Curie Paris 6, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Otologie, Implants Auditifs et Chirurgie de la Base du Crane (H.J., Y.N., D.D.S., E.F., O.S., D.B., I.M.), Paris Assistance Publique, GHU Pitié-Salpêtrière, Service ORL, Paris, France.,Department of Otolaryngology-Head and Neck Surgery (H.J., H.W.), Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (H.J.), Jiaotong University School of Medicine, Shanghai, China
| | - R Torres
- From the Unité de Réhabilitation Chirurgicale Mini-Invasive Robotisée de l'Audition (H.J., R.T., Y.N., D.D.S., E.F., O.S., D.B., I.M.), Sorbonne Universités, Université Pierre et Marie Curie Paris 6, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Y Nguyen
- From the Unité de Réhabilitation Chirurgicale Mini-Invasive Robotisée de l'Audition (H.J., R.T., Y.N., D.D.S., E.F., O.S., D.B., I.M.), Sorbonne Universités, Université Pierre et Marie Curie Paris 6, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Otologie, Implants Auditifs et Chirurgie de la Base du Crane (H.J., Y.N., D.D.S., E.F., O.S., D.B., I.M.), Paris Assistance Publique, GHU Pitié-Salpêtrière, Service ORL, Paris, France
| | - D De Seta
- From the Unité de Réhabilitation Chirurgicale Mini-Invasive Robotisée de l'Audition (H.J., R.T., Y.N., D.D.S., E.F., O.S., D.B., I.M.), Sorbonne Universités, Université Pierre et Marie Curie Paris 6, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Otologie, Implants Auditifs et Chirurgie de la Base du Crane (H.J., Y.N., D.D.S., E.F., O.S., D.B., I.M.), Paris Assistance Publique, GHU Pitié-Salpêtrière, Service ORL, Paris, France
| | - E Ferrary
- From the Unité de Réhabilitation Chirurgicale Mini-Invasive Robotisée de l'Audition (H.J., R.T., Y.N., D.D.S., E.F., O.S., D.B., I.M.), Sorbonne Universités, Université Pierre et Marie Curie Paris 6, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Otologie, Implants Auditifs et Chirurgie de la Base du Crane (H.J., Y.N., D.D.S., E.F., O.S., D.B., I.M.), Paris Assistance Publique, GHU Pitié-Salpêtrière, Service ORL, Paris, France
| | - H Wu
- Department of Otolaryngology-Head and Neck Surgery (H.J., H.W.), Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - O Sterkers
- From the Unité de Réhabilitation Chirurgicale Mini-Invasive Robotisée de l'Audition (H.J., R.T., Y.N., D.D.S., E.F., O.S., D.B., I.M.), Sorbonne Universités, Université Pierre et Marie Curie Paris 6, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Otologie, Implants Auditifs et Chirurgie de la Base du Crane (H.J., Y.N., D.D.S., E.F., O.S., D.B., I.M.), Paris Assistance Publique, GHU Pitié-Salpêtrière, Service ORL, Paris, France
| | - D Bernardeschi
- From the Unité de Réhabilitation Chirurgicale Mini-Invasive Robotisée de l'Audition (H.J., R.T., Y.N., D.D.S., E.F., O.S., D.B., I.M.), Sorbonne Universités, Université Pierre et Marie Curie Paris 6, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Otologie, Implants Auditifs et Chirurgie de la Base du Crane (H.J., Y.N., D.D.S., E.F., O.S., D.B., I.M.), Paris Assistance Publique, GHU Pitié-Salpêtrière, Service ORL, Paris, France
| | - I Mosnier
- From the Unité de Réhabilitation Chirurgicale Mini-Invasive Robotisée de l'Audition (H.J., R.T., Y.N., D.D.S., E.F., O.S., D.B., I.M.), Sorbonne Universités, Université Pierre et Marie Curie Paris 6, Institut National de la Santé et de la Recherche Médicale, Paris, France .,Otologie, Implants Auditifs et Chirurgie de la Base du Crane (H.J., Y.N., D.D.S., E.F., O.S., D.B., I.M.), Paris Assistance Publique, GHU Pitié-Salpêtrière, Service ORL, Paris, France
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Kim CS, Maxfield AZ, Foyt D, Rapoport RJ. Utility of intraoperative computed tomography for cochlear implantation in patients with difficult anatomy. Cochlear Implants Int 2017; 19:170-179. [PMID: 29188758 DOI: 10.1080/14670100.2017.1403146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE AND IMPORTANCE To describe cases that illustrate the utility of intraoperative computed tomography (CT) in cochlear implantation of patients with difficult temporal bone anatomy. CLINICAL PRESENTATION A 2-year-old male with congenital X-linked stapes gusher syndrome and a 2-year-old female with enlarged vestibular aqueduct underwent successful cochlear implantation with the help of intraoperative CT. In the latter case, the initial intraoperative C-arm fluoroscopy suggested malposition of the electrode, however, was not able to provide details for adjustments. In both cases, intraoperative CT changed the insertion technique of the operating surgeon and allowed for improved electrode positioning. A 47-year-old female with polyostotic fibrous dysplasia and a 55-year-old male with post-meningitis near-total cochlear obliteration underwent successful cochlear implantation with confirmation of electrode position with intraoperative CT. In the former case, the image-guided navigation system was also implemented. Finally, a 72-year-old female underwent cochlear implantation during which intraoperative C-arm fluoroscopy suggested intra-cochlear insertion. However, postoperative CT showed the electrode extending into the internal auditory canal (IAC), illustrating the limitations of C-arm fluoroscopy. INTERVENTION Intraoperative CT imaging and image-guided navigation system. CONCLUSION When faced with challenging temporal bone anatomy, intraoperative CT can provide critical details of the patient's microanatomy that allows for improved localization of the electrode and adjustments in operative techniques for successful cochlear implantation.
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Affiliation(s)
- Christine S Kim
- a Division of Otolaryngology (CSK, DF) , Albany Medical Center , 50 New Scotland Avenue, MC41, Albany , NY , USA
| | - Alice Z Maxfield
- b Division of Otolaryngology-Head and Neck Surgery (AZM) , Brigham and Women's Hospital , 45 Francis Street, Boston , MA , USA
| | - David Foyt
- a Division of Otolaryngology (CSK, DF) , Albany Medical Center , 50 New Scotland Avenue, MC41, Albany , NY , USA
| | - Robert J Rapoport
- c Department of Medical Imaging (RJR) , St. Peter's Hospital , 315 South Manning Blvd, Albany , NY , USA
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