Fluoroscopically assisted cochlear implantation.
OBJECTIVE
Real-time intraoperative fluoroscopy is a useful adjunct to cochlear implantation in selected cases. The advantages include the avoidance of complications such as extracochlear array placement, intrameatal array insertion, and avoidance of significant bending or kinking. This is particularly useful when implanting a severely abnormal cochlea.


BACKGROUND
The technique was initially developed for laboratory study of electrode prototypes in cadaver temporal bones to evaluate insertion dynamics and mechanisms of intracochlear trauma. The technique was subsequently adapted for use in live surgeries.


METHODS
Live surgeries were performed using fluoroscopic guidance on nine patients.


RESULTS
Five patients were implanted with the Nucleus 24 RCS during preclinical trials. Two patients with severe cochlear malformations were implanted with a Nucleus CI24M straight array. Two patients with severe cochlear ossification were implanted with the Nucleus CI24 double array. Appropriate insertions were achieved without electrode damage in all cases.


CONCLUSIONS
Intraoperative fluoroscopy is a useful adjunct to cochlear implantation, which can be performed with minimum risk to the patient and operating room staff if the outlined precautions are taken. Intraoperative fluoroscopy is indicated in cases where the intracochlear behavior of the electrode array cannot be predicted, a condition encountered when implanting new electrode designs, cases with severely malformed inner ears, or cases of severe intraluminal obstruction requiring a double-array insertion.
Department of Otolaryngology, New York University Medical Center, New York, New York 10016, USA. andrew.fishman@med.nyu.edu
Andrew J
AJ
Fishman
J Thomas
JT
Roland
George
G
Alexiades
Jozef
J
Mierzwinski
Noel L
NL
Cohen
D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000379:methods*; D003638:Deafness / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy; D006801:Humans