Surgical planning and evaluation of implanting a penetrating cochlear nerve implant in human temporal bones using microcomputed tomography.
OBJECTIVE
To develop a transmastoid-posterior tympanotomy approach for the implantation of a penetrating auditory prosthesis in the most distal portion of the cochlear nerve.


BACKGROUND
Animal studies suggest that penetrating cochlear nerve implants may overcome limitations of current cochlear implant systems. One step toward human implantation is the development of a suitable surgical approach.


METHODS
In computer-rendered 3-dimensional (3-D) models (based on micro-CT scans of 10 human temporal bones), we simulated trajectories through the most basal part of the cochlea that gave access to the most distal portion of the cochlear nerve with minimal damage to intracochlear structures. We determined their vectors with respect to the mid-modiolar axis and posterior round window edge and assessed if they intersected the chorda tympani nerve.


RESULTS
The typical vector obtained with these 3-D models ran in an anterosuperior direction, through the inferior part of the facial recess and anterior round window edge. In 7 of 10 temporal bones, this trajectory intersected the chorda tympani nerve. Based on the vectors, dummy probes were implanted in 3 of 10 temporal bones, and the need for chorda tympani removal was confirmed in accordance with the 3-D models. Postoperative micro-CT scans revealed that all probes were successfully implanted in the cochlear nerve, whereas the osseous spiral lamina and basilar membrane were preserved.


CONCLUSIONS
The vector for drilling and implantation found in this study can be used as a guideline for real-life surgery and, therefore, is another step toward the clinical implementation of cochlear nerve implants.
Department of Otolaryngology and Head and Neck Surgery, Radboud University Nijmegen Medical Centre, The Netherlands. h.theunisse@kno.umcn.nl
Henricus Johannes
HJ
Theunisse
Martin
M
Gotthardt
Emmanuel A M
EA
Mylanus
D001489:Basilar Membrane / Q000473:pathology; D002102:Cadaver; D002814:Chorda Tympani Nerve / Q000033:anatomy & histology; D003051:Cochlea / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D019929:Cochlear Implantation / Q000379:methods*; D003056:Cochlear Nerve / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008953:Models, Anatomic; D058117:Neural Prostheses; D010347:Patient Care Planning; D049268:Positron-Emission Tomography; D013137:Spiral Lamina / Q000033:anatomy & histology; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D055114:X-Ray Microtomography