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Waring NA, Chern A, Vilarello BJ, Cheng YS, Zhou C, Lang JH, Olson ES, Nakajima HH. Hampshire Sheep as a Large-Animal Model for Cochlear Implantation. J Assoc Res Otolaryngol 2024; 25:277-284. [PMID: 38622382 PMCID: PMC11150341 DOI: 10.1007/s10162-024-00946-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/28/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Sheep have been proposed as a large-animal model for studying cochlear implantation. However, prior sheep studies report that the facial nerve (FN) obscures the round window membrane (RWM), requiring FN sacrifice or a retrofacial opening to access the middle-ear cavity posterior to the FN for cochlear implantation. We investigated surgical access to the RWM in Hampshire sheep compared to Suffolk-Dorset sheep and the feasibility of Hampshire sheep for cochlear implantation via a facial recess approach. METHODS Sixteen temporal bones from cadaveric sheep heads (ten Hampshire and six Suffolk-Dorset) were dissected to gain surgical access to the RWM via an extended facial recess approach. RWM visibility was graded using St. Thomas' Hospital (STH) classification. Cochlear implant (CI) electrode array insertion was performed in two Hampshire specimens. Micro-CT scans were obtained for each temporal bone, with confirmation of appropriate electrode array placement and segmentation of the inner ear structures. RESULTS Visibility of the RWM on average was 83% in Hampshire specimens and 59% in Suffolk-Dorset specimens (p = 0.0262). Hampshire RWM visibility was Type I (100% visibility) for three specimens and Type IIa (> 50% visibility) for seven specimens. Suffolk-Dorset RWM visibility was Type IIa for four specimens and Type IIb (< 50% visibility) for two specimens. FN appeared to course more anterolaterally in Suffolk-Dorset specimens. Micro-CT confirmed appropriate CI electrode array placement in the scala tympani without apparent basilar membrane rupture. CONCLUSIONS Hampshire sheep appear to be a suitable large-animal model for CI electrode insertion via an extended facial recess approach without sacrificing the FN. In this small sample, Hampshire specimens had improved RWM visibility compared to Suffolk-Dorset. Thus, Hampshire sheep may be superior to other breeds for ease of cochlear implantation, with FN and facial recess anatomy more similar to humans.
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Affiliation(s)
- Nicholas A Waring
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Otolaryngology-Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Alexander Chern
- Department of Otolaryngology-Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Brandon J Vilarello
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Otolaryngology-Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Yew Song Cheng
- Department of Otolaryngology-Head & Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Chaoqun Zhou
- Department of Otolaryngology-Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Jeffrey H Lang
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Elizabeth S Olson
- Department of Otolaryngology-Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.
- Department of Biomedical Engineering, Columbia University, New York, NY, USA.
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Waring NA, Chern A, Vilarello BJ, Lang JH, Olson ES, Nakajima HH. Sheep as a Large-Animal Model for Otology Research: Temporal Bone Extraction and Transmastoid Facial Recess Surgical Approach. J Assoc Res Otolaryngol 2023; 24:487-497. [PMID: 37684421 PMCID: PMC10695901 DOI: 10.1007/s10162-023-00907-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/17/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE Sheep are used as a large-animal model for otology research and can be used to study implantable hearing devices. However, a method for temporal bone extraction in sheep, which enables various experiments, has not been described, and literature on middle ear access is limited. We describe a method for temporal bone extraction and an extended facial recess surgical approach to the middle ear in sheep. METHODS Ten temporal bones from five Hampshire sheep head cadavers were extracted using an oscillating saw. After craniotomy and removal of the brain, a coronal cut was made at the posterior aspect of the orbit followed by a midsagittal cut of the occipital bone and disarticulation of the atlanto-occipital joint. Temporal bones were surgically prepared with an extended facial recess approach. Micro-CT scans of each temporal bone were obtained, and anatomic dimensions were measured. RESULTS Temporal bone extraction was successful in 10/10 temporal bones. Extended facial recess approach exposed the malleus, incus, stapes, and round window while preserving the facial nerve, with the following surgical considerations: minimally pneumatized mastoid; tegmen (superior limit of mastoid cavity) is low-lying and sits below temporal artery; chorda tympani sacrificed to optimize middle ear exposure; incus buttress does not obscure view of middle ear. Distance between the superior aspect of external auditory canal and tegmen was 2.7 (SD 0.9) mm. CONCLUSION We identified anatomic landmarks for temporal bone extraction and describe an extended facial recess approach in sheep that exposes the ossicles and round window. This approach is feasible for studying implantable hearing devices.
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Affiliation(s)
- Nicholas A Waring
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Otolaryngology-Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, NY, New York, USA
| | - Alexander Chern
- Department of Otolaryngology-Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, NY, New York, USA
| | - Brandon J Vilarello
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Otolaryngology-Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, NY, New York, USA
| | - Jeffrey H Lang
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Elizabeth S Olson
- Department of Otolaryngology-Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, NY, New York, USA.
- Department of Biomedical Engineering, Columbia University, New York, NY, USA.
| | - Hideko Heidi Nakajima
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
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Li Q, Gu G, Wang L, Song R, Qi L. Using EMG signals to assess proximity of instruments to nerve roots during robot-assisted spinal surgery. Int J Med Robot 2022; 18:e2408. [PMID: 35472826 DOI: 10.1002/rcs.2408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/13/2022] [Accepted: 04/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Detecting neural threats using electromyography (EMG) has gained recognition in the field of spinal surgery. To provide an efficient approach to detect neural threats during the operation of the spinal surgery robot, an automated method based the internal connection between EMG signal and neural proximity (NP) was explored by experiments. METHODS A NP classifier was designed to distinguish the pattern of the threats. Then, it was evaluated in rabbit models in vivo. The experiments were conducted using 20 rabbits. In each rabbit, two puncture paths were created using a surgical robot. For each path, EMG signals were recorded at series of path-points with different neural proximities, and were constructed as datasets after data cleaning and processing. The proposed NP classifier was trained and tested on the datasets. RESULTS Classification accuracy of Path 1 and Path 2 were 99.1% and 94.0%, respectively. CONCLUSION This feasibility study proved that EMG can be used to detect the proximity of surgical instruments to nerve roots during robot-assisted spinal surgery. As the methods of detecting neural threats for surgical robots are still scarce, we believe this work will improve the clinical performance of spinal surgery robots and help the doctors to perform surgery safely.
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Affiliation(s)
- Qianqian Li
- School and Hospital of Stomatology, Shandong University, Jinan, China
| | - Guanghui Gu
- Orthopedics Department, Qilu Hospital, Shandong University, Jinan, China
| | - Liang Wang
- Orthopedics Department, Qilu Hospital, Shandong University, Jinan, China
| | - Rui Song
- School of Control Science and Engineering, Shandong University, Jinan, China
| | - Lei Qi
- Orthopedics Department, Qilu Hospital, Shandong University, Jinan, China
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Ansó J, Dür C, Apelt M, Venail F, Scheidegger O, Seidel K, Rohrbach H, Forterre F, Dettmer MS, Zlobec I, Weber K, Matulic M, Zoka-Assadi M, Huth M, Caversaccio M, Weber S. Prospective Validation of Facial Nerve Monitoring to Prevent Nerve Damage During Robotic Drilling. Front Surg 2019; 6:58. [PMID: 31632981 PMCID: PMC6781655 DOI: 10.3389/fsurg.2019.00058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/09/2019] [Indexed: 11/30/2022] Open
Abstract
Facial nerve damage has a detrimental effect on a patient's life, therefore safety mechanisms to ensure its preservation are essential during lateral skull base surgery. During robotic cochlear implantation a trajectory passing the facial nerve at <0.5 mm is needed. Recently a stimulation probe and nerve monitoring approach were developed and introduced clinically, however for patient safety no trajectory was drilled closer than 0.4 mm. Here we assess the performance of the nerve monitoring system at closer distances. In a sheep model eight trajectories were drilled to test the setup followed by 12 trajectories during which the ENT surgeon relied solely on the nerve monitoring system and aborted the robotic drilling process if intraoperative nerve monitoring alerted of a distance <0.1 mm. Microcomputed tomography images and histopathology showed prospective use of the technology prevented facial nerve damage. Facial nerve monitoring integrated in a robotic system supports the surgeon's ability to proactively avoid damage to the facial nerve during robotic drilling in the mastoid.
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Affiliation(s)
- Juan Ansó
- ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Cilgia Dür
- Department of Head and Neck Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Mareike Apelt
- ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Frederic Venail
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France
| | | | - Kathleen Seidel
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Helene Rohrbach
- Vetsuisse Faculty, Veterinary Hospital, University of Bern, Bern, Switzerland
| | - Franck Forterre
- Vetsuisse Faculty, Veterinary Hospital, University of Bern, Bern, Switzerland
| | | | - Inti Zlobec
- Institute of Pathology, University of Bern, Bern, Switzerland
| | | | | | | | - Markus Huth
- Department of Head and Neck Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Department of Head and Neck Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Weber
- ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
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Ansó J, Scheidegger O, Wimmer W, Gavaghan K, Gerber N, Schneider D, Hermann J, Rathgeb C, Dür C, Rösler KM, Mantokoudis G, Caversaccio M, Weber S. Neuromonitoring During Robotic Cochlear Implantation: Initial Clinical Experience. Ann Biomed Eng 2018; 46:1568-1581. [PMID: 30051248 DOI: 10.1007/s10439-018-2094-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
During robotic cochlear implantation a drill trajectory often passes at submillimeter distances from the facial nerve due to close lying critical anatomy of the temporal bone. Additional intraoperative safety mechanisms are thus required to ensure preservation of this vital structure in case of unexpected navigation system error. Electromyography based nerve monitoring is widely used to aid surgeons in localizing vital nerve structures at risk of injury during surgery. However, state of the art neuromonitoring systems, are unable to discriminate facial nerve proximity within submillimeter ranges. Previous work demonstrated the feasibility of utilizing combinations of monopolar and bipolar stimulation threshold measurements to discretize facial nerve proximity with greater sensitivity and specificity, enabling discrimination between safe (> 0.4 mm) and unsafe (< 0.1 mm) trajectories during robotic cochlear implantation (in vivo animal model). Herein, initial clinical validation of the determined stimulation protocol and nerve proximity analysis integrated into an image guided system for safety measurement is presented. Stimulation thresholds and corresponding nerve proximity values previously determined from an animal model have been validated in a first-in-man clinical trial of robotic cochlear implantation. Measurements performed automatically at preoperatively defined distances from the facial nerve were used to determine safety of the drill trajectory intraoperatively. The presented system and automated analysis correctly determined sufficient safety distance margins (> 0.4 mm) to the facial nerve in all cases.
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Affiliation(s)
- Juan Ansó
- ARTORG Center for Biomedical Engineering, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
| | | | - Wilhelm Wimmer
- ARTORG Center for Biomedical Engineering, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland. .,Department of Head and Neck Surgery, Inselspital, University of Bern, Bern, Switzerland.
| | - Kate Gavaghan
- ARTORG Center for Biomedical Engineering, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
| | - Nicolas Gerber
- ARTORG Center for Biomedical Engineering, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
| | - Daniel Schneider
- ARTORG Center for Biomedical Engineering, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
| | - Jan Hermann
- ARTORG Center for Biomedical Engineering, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
| | - Christoph Rathgeb
- ARTORG Center for Biomedical Engineering, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
| | - Cilgia Dür
- ARTORG Center for Biomedical Engineering, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland.,Department of Head and Neck Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Kai Michael Rösler
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- ARTORG Center for Biomedical Engineering, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland.,Department of Head and Neck Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- ARTORG Center for Biomedical Engineering, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland.,Department of Head and Neck Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Weber
- ARTORG Center for Biomedical Engineering, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
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Characterization of the electrical conductivity of bone and its correlation to osseous structure. Sci Rep 2018; 8:8601. [PMID: 29872230 PMCID: PMC5988654 DOI: 10.1038/s41598-018-26836-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 05/21/2018] [Indexed: 11/16/2022] Open
Abstract
The interaction of osseous tissue with electric fields is an important subject. The electrical stimulation of bone promotes osteogenesis, while bone impedance has been proposed as a measure of osteoporosis, to follow fracture healing, or as a method to improve safety of surgical procedures. However, a deeper understanding of the electrical properties of bone and their relation to the architecture of osseous tissue is required to extend the range of use of electrical measurements to clinical studies. In this paper we apply electrical impedance spectroscopy to study the conductivity of fresh bovine tibia and we correlate the measured conductivities with its structural properties. Impedance was measured using a custom-made cell and a potentiostat. Bone conductivity was determined at 100 kHz, where the phase shift was negligible. A good agreement (R2 = 0.83) was found between the measured conductivity and the bone volume fraction, determined on microCT images. Based on this relationship, an equivalent circuit model was created for bone samples. The results of this ex-vivo study are comparable to previous in-vivo observations reporting bone resistivity as a function of bone density. This information can be used to construct a map of the tissue resistivity directly derived from clinical images.
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Dahroug B, Tamadazte B, Weber S, Tavernier L, Andreff N. Review on Otological Robotic Systems: Toward Microrobot-Assisted Cholesteatoma Surgery. IEEE Rev Biomed Eng 2018; 11:125-142. [PMID: 29994589 DOI: 10.1109/rbme.2018.2810605] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Otologic surgical procedures over time have become minimally invasive due to the development of medicine, microtechniques, and robotics. This trend then provides an expected reduction in the patient's recovery time and improvement in the accuracy of diagnosis and treatment. One of the most challenging difficulties that such techniques face are precise control of the instrument and supply of an ergonomic system to the surgeon. The objective of this literature review is to present requirements and guidelines for a surgical robotic system dedicated to middle ear surgery. This review is particularly focused on cholesteatoma surgery (diagnosis and surgical tools), which is one of the most frequent pathologies that urge for an enhanced treatment. This review also presents the current robotic systems that are implemented for otologic applications.
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Yoo MH, Lee HS, Yang CJ, Lee SH, Lim H, Lee S, Yi BJ, Chung JW. A cadaver study of mastoidectomy using an image-guided human-robot collaborative control system. Laryngoscope Investig Otolaryngol 2017; 2:208-214. [PMID: 29094065 PMCID: PMC5655553 DOI: 10.1002/lio2.111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/09/2017] [Accepted: 08/16/2017] [Indexed: 11/21/2022] Open
Abstract
Objective Surgical precision would be better achieved with the development of an anatomical monitoring and controlling robot system than by traditional surgery techniques alone. We evaluated the feasibility of robot‐assisted mastoidectomy in terms of duration, precision, and safety. Study Design Human cadaveric study. Materials and Methods We developed a multi‐degree‐of‐freedom robot system for a surgical drill with a balancing arm. The drill system is manipulated by the surgeon, the motion of the drill burr is monitored by the image‐guided system, and the brake is controlled by the robotic system. The system also includes an alarm as well as the brake to help avoid unexpected damage to vital structures. Experimental mastoidectomy was performed in 11 temporal bones of six cadavers. Parameters including duration and safety were assessed, as well as intraoperative damage, which was judged via pre‐ and post‐operative computed tomography. Results The duration of mastoidectomy in our study was comparable with that required for chronic otitis media patients. Although minor damage, such as dura exposure without tearing, was noted, no critical damage to the facial nerve or other important structures was observed. When the brake system was set to 1 mm from the facial nerve, the postoperative average bone thicknesses of the facial nerve was 1.39, 1.41, 1.22, 1.41, and 1.55 mm in the lateral, posterior pyramidal and anterior, lateral, and posterior mastoid portions, respectively. Conclusion Mastoidectomy can be successfully performed using our robot‐assisted system while maintaining a pre‐set limit of 1 mm in most cases. This system may thus be useful for more inexperienced surgeons. Level of Evidence NA.
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Affiliation(s)
- Myung Hoon Yoo
- Department of Otorhinolaryngology-Head and Neck Surgery School of Medicine, Kyungpook National University Daegu Republic of Korea
| | - Hwan Seo Lee
- Department of Otorhinolaryngology-Head & Neck Surgery Asan Medical Center, University of Ulsan, College of Medicine Seoul Republic of Korea
| | - Chan Joo Yang
- Department of Otorhinolaryngology-Head & Neck Surgery Asan Medical Center, University of Ulsan, College of Medicine Seoul Republic of Korea
| | - Seung Hwan Lee
- Department of Otorhinolaryngology School of Medicine, Hanyang University Seoul Republic of Korea
| | - Hoon Lim
- Department of Electronic Systems Engineering Hanyang University Ansan Republic of Korea
| | - Seongpung Lee
- Department of Robotics Engineering DGIST Daegu Republic of Korea
| | - Byung-Ju Yi
- Department of Electronic Systems Engineering Hanyang University Ansan Republic of Korea
| | - Jong Woo Chung
- Department of Otorhinolaryngology-Head & Neck Surgery Asan Medical Center, University of Ulsan, College of Medicine Seoul Republic of Korea
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Torres R, Nguyen Y, Vanier A, Smail M, Ferrary E, Sterkers O, Kalamarides M, Bernardeschi D. Multivariate Analysis of Factors Influencing Facial Nerve Outcome following Microsurgical Resection of Vestibular Schwannoma. Otolaryngol Head Neck Surg 2016; 156:525-533. [PMID: 28248607 DOI: 10.1177/0194599816677711] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To assess through multivariate analysis the clinical pre- and intraoperative factors of facial nerve outcomes at day 8 and 1-year recovery of facial palsy, as compared with day 8 status among patients who underwent total resection of unilateral vestibular schwannoma. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods This study included 229 patients with preoperative normal facial function and anatomic preservation of the facial nerve. Clinical, radiologic, and intraoperative factors were assessed according to facial nerve function at day 8 and 1 year. Results We observed that 74% and 84% of patients had good facial function (House-Brackmann [HB] I-II) at day 8 and 1 year, respectively. Of 60 patients, 26 (43%) who had impaired facial function (HB III-VI) at day 8 recovered good facial function (HB I-II) 1 year after surgery. A structured equation model showed that advanced tumor stage and strong facial nerve adhesion were independently associated with facial nerve conduction block at day 8. No predictive factor of impaired facial function recovery was seen at 1 year. In terms of the extracanalicular diameter of the tumor, the cutoff point to minimize the risk of impaired facial function was 16 mm. Conclusion At day 8 after vestibular schwannoma resection, facial function was impaired in the case of large tumors or strong facial nerve adhesion to the tumor. After 1 year, less than half of the patients recovered good facial function, and no predictive factor was found to be associated with this possible recovery.
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Affiliation(s)
- Renato Torres
- 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,2 Sorbonne Universities, UPMC Univ, France.,3 "Minimally Invasive Robot-based Hearing Rehabilitation", Inserm, UMR S-1159, Paris, France
| | - Yann Nguyen
- 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,2 Sorbonne Universities, UPMC Univ, France.,3 "Minimally Invasive Robot-based Hearing Rehabilitation", Inserm, UMR S-1159, Paris, France
| | - Antoine Vanier
- 2 Sorbonne Universities, UPMC Univ, France.,4 Biostatistics Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Mustapha Smail
- 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Evelyne Ferrary
- 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,2 Sorbonne Universities, UPMC Univ, France.,3 "Minimally Invasive Robot-based Hearing Rehabilitation", Inserm, UMR S-1159, Paris, France
| | - Olivier Sterkers
- 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,2 Sorbonne Universities, UPMC Univ, France.,3 "Minimally Invasive Robot-based Hearing Rehabilitation", Inserm, UMR S-1159, Paris, France
| | - Michel Kalamarides
- 2 Sorbonne Universities, UPMC Univ, France.,5 Neurosurgery Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Daniele Bernardeschi
- 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,2 Sorbonne Universities, UPMC Univ, France.,3 "Minimally Invasive Robot-based Hearing Rehabilitation", Inserm, UMR S-1159, Paris, France
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In-Vivo Electrical Impedance Measurement in Mastoid Bone. Ann Biomed Eng 2016; 45:1122-1132. [PMID: 27830489 DOI: 10.1007/s10439-016-1758-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Abstract
Nerve monitoring is a safety mechanism to detect the proximity between surgical instruments and important nerves during surgical bone preparation. In temporal bone, this technique is highly specific and sensitive at distances below 0.1 mm, but remains unreliable for distances above this threshold. A deeper understanding of the patient-specific bone electric properties is required to improve this range of detection. A sheep animal model has been used to characterize bone properties in vivo. Impedance measurements have been performed at low frequencies (<1 kHz) between two electrodes placed inside holes drilled into the sheep mastoid bone. An electric circuit composed of a resistor and a Fricke constant phase element was able to accurately describe the experimental measurements. Bone resistivity was shown to be linearly dependent on the inter-electrode distance and the local bone density. Based on this model, the amount of bone material between the electrodes could be predicted with an error of 0.7 mm. Our results indicate that bone could be described as an ideal resistor while the electrochemical processes at the electrode-tissue interface are characterized by a constant phase element. These results should help increasing the safety of surgical drilling procedures by better predicting the distance to critical nerve structures.
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Torres R, Kazmitcheff G, De Seta D, Ferrary E, Sterkers O, Nguyen Y. Improvement of the insertion axis for cochlear implantation with a robot-based system. Eur Arch Otorhinolaryngol 2016; 274:715-721. [DOI: 10.1007/s00405-016-4329-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/28/2016] [Indexed: 11/28/2022]
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12
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A Neuromonitoring Approach to Facial Nerve Preservation During Image-guided Robotic Cochlear Implantation. Otol Neurotol 2016; 37:89-98. [DOI: 10.1097/mao.0000000000000914] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Mechatronic feasibility of minimally invasive, atraumatic cochleostomy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:181624. [PMID: 25110661 PMCID: PMC4109217 DOI: 10.1155/2014/181624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/29/2014] [Indexed: 11/17/2022]
Abstract
Robotic assistance in the context of lateral skull base surgery, particularly during cochlear implantation procedures, has been the subject of considerable research over the last decade. The use of robotics during these procedures has the potential to provide significant benefits to the patient by reducing invasiveness when gaining access to the cochlea, as well as reducing intracochlear trauma when performing a cochleostomy. Presented herein is preliminary work on the combination of two robotic systems for reducing invasiveness and trauma in cochlear implantation procedures. A robotic system for minimally invasive inner ear access was combined with a smart drilling tool for robust and safe cochleostomy; evaluation was completed on a single human cadaver specimen. Access to the middle ear was successfully achieved through the facial recess without damage to surrounding anatomical structures; cochleostomy was completed at the planned position with the endosteum remaining intact after drilling as confirmed by microscope evaluation.
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