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Scheunemann CWD, Taeger J, Brecht SV, Neun T, Hagen R, Lueth TC, Rak KJ. Concept and first Implementation of an intracochlearly navigated Electrode Array for Cochlear Implantation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:2560-2564. [PMID: 36085908 DOI: 10.1109/embc48229.2022.9871850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Cochlear implants (CI) are an established treatment for people with deafness or severe hearing loss. To restore patients' hearing an electrode array (EA) of the CI is inserted into the cochlea to stimulate the auditory nerve. Thereby, the exact positioning and gentle insertion of the EA is crucial for optimal hearing perception outcome. Currently, only microscopic vision is available for entering the cochlea, but the critical intracochlear process during EA insertion is like a "black box" and the surgeon has to rely on haptic feedback. Methods for visualizing the insertion process during surgery are inaccurate or not suitable for routine use due to radiation exposure. To address this problem, we developed a computer-assisted and image-guided cochlear implantation system with an exact real-time visualization of the EA position during the insertion process. The system is based on an electromagnetic tracking system that measures the position and orientation of a sensor integrated into the tip of a EA prototype and visualizes it in presurgical image data. A first experiment with our system showed that a EA prototype could be inserted into a cochlea of a human temporal bone and placed with an accuracy of [Formula: see text]. A maximum insertion angle of 120° was achieved.
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Robotics, automation, active electrode arrays, and new devices for cochlear implantation: A contemporary review. Hear Res 2022; 414:108425. [PMID: 34979455 DOI: 10.1016/j.heares.2021.108425] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 12/16/2021] [Accepted: 12/23/2021] [Indexed: 01/14/2023]
Abstract
In the last two decades, cochlear implant surgery has evolved into a minimally invasive, hearing preservation surgical technique. The devices used during surgery have benefited from technological advances that have allowed modification and possible improvement of the surgical technique. Robotics has recently gained popularity in otology as an effective tool to overcome the surgeon's limitations such as tremor, drift and accurate force control feedback in laboratory testing. Cochlear implantation benefits from robotic assistance in several steps during the surgical procedure: (i) during the approach to the middle ear by automated mastoidectomy and posterior tympanotomy or through a tunnel from the postauricular skin to the middle ear (i.e. direct cochlear access); (ii) a minimally invasive cochleostomy by a robot-assisted drilling tool; (iii) alignment of the correct insertion axis on the basal cochlear turn; (iv) insertion of the electrode array with a motorized insertion tool. In recent years, the development of bone-attached parallel robots and image-guided surgical robotic systems has allowed the first successful cochlear implantation procedures in patients via a single hole drilled tunnel. Several other robotic systems, new materials, sensing technologies applied to the electrodes, and smart devices have been developed, tested in experimental models and finally some have been used in patients with the aim of reducing trauma in cochleostomy, and permitting slow and more accurate insertion of the electrodes. Despite the promising results in laboratory tests in terms of minimal invasiveness, reduced trauma and better hearing preservation, so far, no clinical benefits on residual hearing preservation or better speech performance have been demonstrated. Before these devices can become the standard approach for cochlear implantation, several points still need to be addressed, primarily cost and duration of the procedure. One can hope that improvement in the cost/benefit ratio will expand the technology to every cochlear implantation procedure. Laboratory research and clinical studies on patients should continue with the aim of making intracochlear implant insertion an atraumatic and reversible gesture for total preservation of the inner ear structure and physiology.
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Martin MJ, Spitzmaul G, Lassalle V. Novel insights and perspectives for the diagnosis and treatment of hearing loss through the implementation of magnetic nanotheranostics. ChemMedChem 2022; 17:e202100685. [PMID: 34978134 DOI: 10.1002/cmdc.202100685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/29/2021] [Indexed: 11/06/2022]
Abstract
Hearing loss (HL) is a sensory disability that affects 5% of the world's population. HL predominantly involves damage and death to the cochlear cells. Currently, there is no cure or specific medications for HL. Furthermore, the arrival of therapeutic molecules to the inner ear represents a challenge due to the limited blood supply to the sensory cells and the poor penetration of the blood-cochlear barrier. Superparamagnetic iron oxide nanoparticles (SPIONs) perfectly coordinate with the requirements for controlled drug delivery along with magnetic resonance imaging (MRI) diagnostic and monitoring capabilities. Besides, they are suitable tools to be applied to HL, expecting to be more effective and non-invasive. So far, the published literature only refers to some preclinical studies of SPIONs for HL management. This contribution aims to provide an integrated view of the best options and strategies that can be considered for future research punctually in the field of magnetic nanotechnology applied to HL.
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Affiliation(s)
- Maria Julia Martin
- INQUISUR: Instituto de Quimica del Sur, Departamento de Química, Universidad Nacional del Sur (CONICET-UNS), Alem 1253, 8000, Bahía Blanca, ARGENTINA
| | - Guillermo Spitzmaul
- Universidad Nacional del Sur Departamento de Biología Bioquímica y Farmacia: Universidad Nacional del Sur Departamento de Biologia Bioquimica y Farmacia, Departamento de Biología, Bioquímica Y farmacia, Camino La Carrindanga Km 7, 8000, Bahía Blanca, ARGENTINA
| | - Verónica Lassalle
- INQUISUR: Instituto de Quimica del Sur, Química, Av Alem 1253, 8000, Bahía Blanca, ARGENTINA
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Riojas KE, Tran ET, Freeman MH, Noble JH, Webster RJ, Labadie RF. Clinical Translation of an Insertion Tool for Minimally Invasive Cochlear Implant Surgery. J Med Device 2021; 15:031001. [PMID: 33995757 PMCID: PMC8086187 DOI: 10.1115/1.4050203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/22/2021] [Indexed: 11/08/2022] Open
Abstract
The objective of this paper is to describe the development of a minimally invasive cochlear implant surgery (MICIS) electrode array insertion tool concept to enable clinical translation. First, analysis of the geometric parameters of potential MICIS patients (N = 97) was performed to inform tool design, inform MICIS phantom model design, and provide further insight into MICIS candidacy. Design changes were made to the insertion tool based on clinical requirements and parameter analysis results. A MICIS phantom testing model was built to evaluate insertion force profiles in a clinically realistic manner, and the new tool design was evaluated in the model and in cadavers to test clinical viability. Finally, after regulatory approval, the tool was used for the first time in a clinical case. Results of this work included first, in the parameter analysis, approximately 20% of the population was not considered viable MICIS candidates. Additionally, one 3D printed tool could accommodate all viable candidates with polyimide sheath length adjustments accounting for interpatient variation. The insertion tool design was miniaturized out of clinical necessity and a disassembly method, necessary for removal around the cochlear implant, was developed and tested. Phantom model testing revealed that the force profile of the insertion tool was similar to that of traditional forceps insertion. Cadaver testing demonstrated that all clinical requirements (including complete disassembly) were achieved with the tool, and the new tool enabled 15% deeper insertions compared to the forceps approach. Finally, and most importantly, the tool helped achieve a full insertion in its first MICIS clinical case. In conclusion, the new insertion tool provides a clinically viable solution to one of the most difficult aspects of MICIS.
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Affiliation(s)
- Katherine E. Riojas
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212
| | - Emily T. Tran
- Department of Mechanical Engineering, The University of Tulsa, Tulsa, OK 74104
| | - Michael H. Freeman
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Jack H. Noble
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37212
| | - Robert J. Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212
| | - Robert F. Labadie
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN 37232
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Wang J, Liu H, Ke J, Hu L, Zhang S, Yang B, Sun S, Guo N, Ma F. Image-guided cochlear access by non-invasive registration: a cadaveric feasibility study. Sci Rep 2020; 10:18318. [PMID: 33110188 PMCID: PMC7591497 DOI: 10.1038/s41598-020-75530-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/15/2020] [Indexed: 11/09/2022] Open
Abstract
Image-guided cochlear implant surgery is expected to reduce volume of mastoidectomy, accelerate recovery, and improve safety. The purpose of this study was to investigate the safety and effectiveness of image-guided cochlear implant surgery by a non-invasive registration method, in a cadaveric study. We developed a visual positioning frame that can utilize the maxillary dentition as a registration tool and completed the tunnels experiment on 5 cadaver specimens (8 cases in total). The accuracy of the entry point and the target point were 0.471 ± 0.276 mm and 0.671 ± 0.268 mm, respectively. The shortest distance from the margin of the tunnel to the facial nerve and the ossicular chain were 0.790 ± 0.709 mm and 1.960 ± 0.630 mm, respectively. All facial nerves, tympanic membranes, and ossicular chains were completely preserved. Using this approach, high accuracy was achieved in this preliminary study, suggesting that the non-invasive registration method can meet the accuracy requirements for cochlear implant surgery. Based on the above accuracy, we speculate that our method can also be applied to neurosurgery, orbitofacial surgery, lateral skull base surgery, and anterior skull base surgery with satisfactory accuracy.
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Affiliation(s)
- Jiang Wang
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Hongsheng Liu
- The Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Jia Ke
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Lei Hu
- The Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Shaoxing Zhang
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Biao Yang
- The Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Shilong Sun
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Na Guo
- The Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Furong Ma
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
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Bruns TL, Riojas KE, Ropella DS, Cavilla MS, Petruska AJ, Freeman MH, Labadie RF, Abbott JJ, Webster RJ. Magnetically Steered Robotic Insertion of Cochlear-Implant Electrode Arrays: System Integration and First-In-Cadaver Results. IEEE Robot Autom Lett 2020; 5:2240-2247. [PMID: 34621979 DOI: 10.1109/lra.2020.2970978] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cochlear-implant electrode arrays (EAs) must be inserted accurately and precisely to avoid damaging the delicate anatomical structures of the inner ear. It has previously been shown on the benchtop that using magnetic fields to steer magnet-tipped EAs during insertion reduces insertion forces, which correlate with insertion errors and damage to internal cochlear structures. This paper presents several advancements toward the goal of deploying magnetic steering of cochlear-implant EAs in the operating room. In particular, we integrate image guidance with patient-specific insertion vectors, we incorporate a new nonmagnetic insertion tool, and we use an electromagnetic source, which provides programmable control over the generated field. The electromagnet is safer than prior permanent-magnet approaches in two ways: it eliminates motion of the field source relative to the patient's head and creates a field-free source in the power-off state. Using this system, we demonstrate system feasibility by magnetically steering EAs into a cadaver cochlea for the first time. We show that magnetic steering decreases average insertion forces, in comparison to manual insertions and to image-guided robotic insertions alone.
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Affiliation(s)
- Trevor L Bruns
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Katherine E Riojas
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Dominick S Ropella
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Matt S Cavilla
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Andrew J Petruska
- Department of Mechanical Engineering, Colorado School of Mines, Golden, CO, USA
| | - Michael H Freeman
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert F Labadie
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jake J Abbott
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Robert J Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
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Dillon NP, Mitchell JE, Geraldine Zuniga M, Webster RJ, Labadie RF. Design and Thermal Testing of an Automatic Drill Guide for Less Invasive Cochlear Implantation1. J Med Device 2016. [DOI: 10.1115/1.4033223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Neal P. Dillon
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235
| | - Jason E. Mitchell
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235
| | - M. Geraldine Zuniga
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37235
| | - Robert J. Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235
| | - Robert F. Labadie
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37235
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Shapiro B, Kulkarni S, Nacev A, Sarwar A, Preciado D, Depireux D. Shaping Magnetic Fields to Direct Therapy to Ears and Eyes. Annu Rev Biomed Eng 2014; 16:455-81. [DOI: 10.1146/annurev-bioeng-071813-105206] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- B. Shapiro
- Fischell Department of Bioengineering,
- The Institute for Systems Research (ISR), University of Maryland, College Park, Maryland 20742;
| | | | - A. Nacev
- Fischell Department of Bioengineering,
| | - A. Sarwar
- Fischell Department of Bioengineering,
| | - D. Preciado
- Otolaryngology, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC 20010
| | - D.A. Depireux
- The Institute for Systems Research (ISR), University of Maryland, College Park, Maryland 20742;
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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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Hassarati RT, Dueck WF, Tasche C, Carter PM, Poole-Warren LA, Green RA. Improving Cochlear Implant Properties Through Conductive Hydrogel Coatings. IEEE Trans Neural Syst Rehabil Eng 2014; 22:411-8. [DOI: 10.1109/tnsre.2014.2304559] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Rohani P, Pile J, Kahrs LA, Balachandran R, Blachon GS, Simaan N, Labadie RF. Forces and trauma associated with minimally invasive image-guided cochlear implantation. Otolaryngol Head Neck Surg 2014; 150:638-45. [PMID: 24468898 DOI: 10.1177/0194599813519747] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Minimally invasive image-guided cochlear implantation (CI) utilizes a patient-customized microstereotactic frame to access the cochlea via a single drill-pass. We investigate the average force and trauma associated with the insertion of lateral wall CI electrodes using this technique. STUDY DESIGN Assessment using cadaveric temporal bones. SETTING Laboratory setup. SUBJECTS AND METHODS Microstereotactic frames for 6 fresh cadaveric temporal bones were built using CT scans to determine an optimal drill path following which drilling was performed. CI electrodes were inserted using surgical forceps to manually advance the CI electrode array, via the drilled tunnel, into the cochlea. Forces were recorded using a 6-axis load sensor placed under the temporal bone during the insertion of lateral wall electrode arrays (2 each of Nucleus CI422, MED-EL standard, and modified MED-EL electrodes with stiffeners). Tissue histology was performed by microdissection of the otic capsule and apical photo documentation of electrode position and intracochlear tissue. RESULTS After drilling, CT scanning demonstrated successful access to cochlea in all 6 bones. Average insertion forces ranged from 0.009 to 0.078 N. Peak forces were in the range of 0.056 to 0.469 N. Tissue histology showed complete scala tympani insertion in 5 specimens and scala vestibuli insertion in the remaining specimen with depth of insertion ranging from 360° to 600°. No intracochlear trauma was identified. CONCLUSION The use of lateral wall electrodes with the minimally invasive image-guided CI approach was associated with insertion forces comparable to traditional CI surgery. Deep insertions were obtained without identifiable trauma.
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Affiliation(s)
- Pooyan Rohani
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Wimmer W, Bell B, Huth ME, Weisstanner C, Gerber N, Kompis M, Weber S, Caversaccio M. Cone Beam and Micro-Computed Tomography Validation of Manual Array Insertion for Minimally Invasive Cochlear Implantation. Audiol Neurootol 2013; 19:22-30. [DOI: 10.1159/000356165] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 09/23/2013] [Indexed: 11/19/2022] Open
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Semaan MT, Fredman ET, Shah JR, Fares SA, Murray GS, Megerian CA. Surgical duration of cochlear implantation in an academic university-based practice. Am J Otolaryngol 2013; 34:382-7. [PMID: 23415572 DOI: 10.1016/j.amjoto.2013.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 01/08/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Establish the time to safely and efficiently perform cochlear implantation (CI) in a university-based academic center. STUDY DESIGN Case series with chart review. SETTING Academic neurotologic referral center. PATIENTS 424 patients who underwent CI surgery between 2002 and 2010. INTERVENTION Unilateral, bilateral or revision CI using commercially available devices approved for use in the United States. MAIN OUTCOME MEASURES mean surgical duration (SD) and mean total operative room time (TORT). RESULTS Overall mean SD for all 424 patients was 83 ± 30 min (min) whereas the mean TORT was 135 ± 56 min. The mean SD for unilateral CI was 84 ± 18 min for the first implant and 82 ± 22 min for the second implant (p=0.55). The SD for primary and revision CI was 83 ± 18 min and 85 ± 36 min, respectively (p=0.51). The mean SD for pediatric and adult CI was 83 ± 21 min and 83 ± 18 min, respectively (p=0.92). The mean SD without resident assistance was 74 ± 14 min whereas with the assistance of a resident the mean SD was 84 ± 20 min (p=0.02). When ossification was encountered the mean SD was 90 ± 32 min compared to 82 ± 19 min when absent (p<0.001). An association was found between TORT or SD, and the year of surgery, presence of ossification and the involvement of an assistant. CONCLUSION In a university-based academic center, CI surgery can be safely and efficiently performed, supporting future cost-effectiveness analysis of its current practice.
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Affiliation(s)
- Maroun T Semaan
- Ear, Nose and Throat Institute, University Hospitals Case Medical Center, Cleveland, OH, USA.
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Validation of minimally invasive, image-guided cochlear implantation using Advanced Bionics, Cochlear, and Medel electrodes in a cadaver model. Int J Comput Assist Radiol Surg 2013; 8:989-95. [PMID: 23633113 DOI: 10.1007/s11548-013-0842-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Validation of a novel minimally invasive, image-guided approach to implant electrodes from three FDA-approved manufacturers-Medel, Cochlear, and Advanced Bionics-in the cochlea via a linear tunnel from the lateral cranium through the facial recess to the cochlea. METHODS Custom microstereotactic frames that mount on bone-implanted fiducial markers and constrain the drill along the desired path were utilized on seven cadaver specimens. A linear tunnel was drilled from the lateral skull to the cochlea followed by a marginal, round window cochleostomy and insertion of the electrode array into the cochlea through the drilled tunnel. Post-insertion CT scan and histological analysis were used to analyze the results. RESULTS All specimens ([Formula: see text]) were successfully implanted without visible injury to the facial nerve. The Medel electrodes ([Formula: see text]) had minimal intracochlear trauma with 8, 8, and 10 (out of 12) electrodes intracochlear. The Cochlear lateral wall electrodes (straight research arrays) ([Formula: see text]) had minimal trauma with 20 and 21 of 22 electrodes intracochlear. The Advanced Bionics electrodes ([Formula: see text]) were inserted using their insertion tool; one had minimal insertion trauma and 14 of 16 electrodes intracochlear, while the other had violation of the basilar membrane just deep to the cochleostomy following which it remained in scala vestibuli with 13 of 16 electrodes intracochlear. CONCLUSIONS Minimally invasive, image-guided cochlear implantation is possible using electrodes from the three FDA-approved manufacturers. Lateral wall electrodes were associated with less intracochlear trauma suggesting that they may be better suited for this surgical technique.
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