title: The temporalis pocket technique for cochlear implantation: an anatomic and clinical study.
abstract: OBJECTIVE
  To describe the surgical anatomy and clinical outcomes of a technique for securing cochlear implant receiver/stimulators (R/S). Receiver/stimulators are generally secured by drilling a custom-fit seat and suture-retaining holes in the skull. However, rare intracranial complications and R/S migration have been reported with this standard method. Newer R/S designs feature a low profile and larger, rigid flat bottoms in which drilling a seat may be less appropriate. We report a technique for securing the R/S without drilling bone.
  
  
  METHODS
  Anatomic: Forty-eight half-heads were studied. Digital photography and morphometric analysis demonstrated anatomic boundaries of the subpericranial pocket (t-pocket). Clinical: Retrospective series of 227 consecutive Cochlear implant recipients implanted during a 2-year period using either the t-pocket or standard technique. The main outcome measures were rates of R/S migration and intracranial complications. Minimum follow-up was 12 months.
  
  
  RESULTS
  The t-pocket is limited anteriorly by dense condensations of pericranium anteriorly at the temporal-parietal suture, posteroinferiorly at the lamdoid suture, and anteroinferiorly by the bony ridge of the squamous suture. One hundred seventy-one subjects were implanted using the t-pocket technique and 56 using the standard technique, with a minimum follow-up of 12 months. There were no cases of migration or intracranial complications in either group.
  
  
  CONCLUSIONS
  The t-pocket secures the R/S with anatomically consistent strong points of fixation while precluding dural complications. There were no cases of migration or intracranial complication noted. Further trials and device-specific training with this technique are necessary before it is widely adopted.
authors.affiliation: University of Miami Ear Institute Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA. tbalkany@miami.edu
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Balkany
authors.forename: Matthew
authors.initials: M
authors.lastname: Whitley
authors.forename: Yisgav
authors.initials: Y
authors.lastname: Shapira
authors.forename: Simon I
authors.initials: SI
authors.lastname: Angeli
authors.forename: Kevin
authors.initials: K
authors.lastname: Brown
authors.forename: Elias
authors.initials: E
authors.lastname: Eter
authors.forename: Thomas
authors.initials: T
authors.lastname: Van De Water
authors.forename: Fred F
authors.initials: FF
authors.lastname: Telischi
authors.forename: Adrien A
authors.initials: AA
authors.lastname: Eshraghi
authors.forename: Adrien E
authors.initials: AE
authors.lastname: Eshrahgi
authors.forename: Claudiu
authors.initials: C
authors.lastname: Treaba
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000379:methods*; D003054:Cochlear Implants; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology; D034381:Hearing Loss / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013701:Temporal Bone / Q000601:surgery*; D016896:Treatment Outcome