title: Cone beam and micro-computed tomography validation of manual array insertion for minimally invasive cochlear implantation.
abstract: Delivering cochlear implants through a minimally invasive tunnel (1.8 mm in diameter) from the mastoid surface to the inner ear is referred to as direct cochlear access (DCA). Based on cone beam as well as micro-computed tomography imaging, this in vitro study evaluates the feasibility and efficacy of manual cochlear electrode array insertions via DCA. Free-fitting electrode arrays were inserted in 8 temporal bone specimens with previously drilled DCA tunnels. The insertion depth angle, procedural time, tunnel alignment as well as the inserted scala and intracochlear trauma were assessed. Seven of the 8 insertions were full insertions, with insertion depth angles higher than 520°. Three cases of atraumatic scala tympani insertion, 3 cases of probable basilar membrane rupture and 1 case of dislocation into the scala vestibuli were observed (1 specimen was damaged during extraction). Manual electrode array insertion following a DCA procedure seems to be feasible and safe and is a further step toward clinical application of image-guided otological microsurgery.
authors.affiliation: ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Wimmer
authors.forename: Brett
authors.initials: B
authors.lastname: Bell
authors.forename: Markus E
authors.initials: ME
authors.lastname: Huth
authors.forename: Christian
authors.initials: C
authors.lastname: Weisstanner
authors.forename: Nicolas
authors.initials: N
authors.lastname: Gerber
authors.forename: Martin
authors.initials: M
authors.lastname: Kompis
authors.forename: Stefan
authors.initials: S
authors.lastname: Weber
authors.forename: Marco
authors.initials: M
authors.lastname: Caversaccio
mesh_terms: D019929:Cochlear Implantation / Q000379:methods*; D054893:Cone-Beam Computed Tomography; D006801:Humans; D008416:Mastoid / Q000000981:diagnostic imaging / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D055114:X-Ray Microtomography