Minimally invasive, image-guided, facial-recess approach to the middle ear: demonstration of the concept of percutaneous cochlear access in vitro.
OBJECTIVE
Image-guided surgery will permit accurate access to the middle ear via the facial recess using a single drill hole from the lateral aspect of the mastoid cortex.


BACKGROUND
The widespread use of image-guided methods in otologic surgery has been limited by the need for a system that achieves the necessary level of accuracy with an easy-to-use, noninvasive fiducial marker system. We have developed and recently reported such a system (accuracy within the temporal bone = 0.76 +/- 0.23 mm; n = 234 measurements). With this system, image-guided otologic surgery is feasible.


METHODS
Skulls (n = 2) were fitted with a dental bite-block affixed fiducial frame and scanned by computed tomography using standard temporal-bone algorithms. The frame was removed and replaced with an infrared emitter used to track the skull during dissection. Tracking was accomplished using an infrared tracker and commercially available software. Using this system in conjunction with a tracked otologic drill, the middle ear was approached via the facial recess using a single drill hole from the lateral aspect of the mastoid cortex. The path of the drill was verified by subsequently performing a traditional temporal bone dissection, preserving the tunnel of bone through which the drill pass had been made.


RESULTS
An accurate approach to the middle ear via the facial recess was achieved without violating the canal of the facial nerve, the horizontal semicircular canal, or the external auditory canal.


CONCLUSIONS
Image-guided otologic surgery provides access to the cochlea via the facial recess in a minimally invasive, percutaneous fashion. While the present study was confined to in vitro demonstration, these exciting results warrant in vivo testing, which may lead to clinically applicable access.
Labadie
Robert F
RF
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-8605, USA. robert.labadie@vanderbilt.edu
Chodhury
Pallavi
P
Cetinkaya
Ebru
E
Balachandran
Ramya
R
Haynes
David S
DS
Fenlon
Micahel R
MR
Jusczyzck
Andrzej S
AS
Fitzpatrick
J Michael
JM
D003051:Cochlea / Q000601:surgery*; D004432:Ear, Middle / Q000601:surgery*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D013506:Otologic Surgical Procedures; D025321:Surgery, Computer-Assisted