title: Semiautomatic cochleostomy target and insertion trajectory planning for minimally invasive cochlear implantation.
abstract: A major component of minimally invasive cochlear implantation is atraumatic scala tympani (ST) placement of the electrode array. This work reports on a semiautomatic planning paradigm that uses anatomical landmarks and cochlear surface models for cochleostomy target and insertion trajectory computation. The method was validated in a human whole head cadaver model (n = 10 ears). Cochleostomy targets were generated from an automated script and used for consecutive planning of a direct cochlear access (DCA) drill trajectory from the mastoid surface to the inner ear. An image-guided robotic system was used to perform both, DCA and cochleostomy drilling. Nine of 10 implanted specimens showed complete ST placement. One case of scala vestibuli insertion occurred due to a registration/drilling error of 0.79 mm. The presented approach indicates that a safe cochleostomy target and insertion trajectory can be planned using conventional clinical imaging modalities, which lack sufficient resolution to identify the basilar membrane.
authors.affiliation: ARTORG Center for Biomedical Engineering Research, University of Bern, 3010 Bern, Switzerland ; Department of ENT, Head and Neck Surgery, Inselspital, University of Bern, 3010 Bern, Switzerland.
authors.forename: Wilhelm
authors.identifier: 0000-0001-5392-2074
authors.initials: W
authors.lastname: Wimmer
authors.affiliation: Otology and Neurotology Department, University Hospital of Montpellier, 34961 Montpellier, France ; Institute for Neurosciences of Montpellier, INSERM U1051, 34091 Montpellier, France.
authors.forename: Frederic
authors.identifier: 0000-0001-9919-2126
authors.initials: F
authors.lastname: Venail
authors.affiliation: ARTORG Center for Biomedical Engineering Research, University of Bern, 3010 Bern, Switzerland.
authors.forename: Tom
authors.identifier: 0000-0001-7986-1302
authors.initials: T
authors.lastname: Williamson
authors.affiliation: Otology and Neurotology Department, University Hospital of Montpellier, 34961 Montpellier, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Akkari
authors.affiliation: ARTORG Center for Biomedical Engineering Research, University of Bern, 3010 Bern, Switzerland.
authors.forename: Nicolas
authors.identifier: 0000-0003-0308-699X
authors.initials: N
authors.lastname: Gerber
authors.affiliation: ARTORG Center for Biomedical Engineering Research, University of Bern, 3010 Bern, Switzerland.
authors.forename: Stefan
authors.identifier: 0000-0002-0395-7102
authors.initials: S
authors.lastname: Weber
authors.affiliation: ARTORG Center for Biomedical Engineering Research, University of Bern, 3010 Bern, Switzerland ; Department of ENT, Head and Neck Surgery, Inselspital, University of Bern, 3010 Bern, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Caversaccio
authors.affiliation: Otology and Neurotology Department, University Hospital of Montpellier, 34961 Montpellier, France ; Institute for Neurosciences of Montpellier, INSERM U1051, 34091 Montpellier, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Uziel
authors.affiliation: ARTORG Center for Biomedical Engineering Research, University of Bern, 3010 Bern, Switzerland.
authors.forename: Brett
authors.identifier: 0000-0003-2264-0589
authors.initials: B
authors.lastname: Bell
mesh_terms: D001489:Basilar Membrane / Q000473:pathology / Q000601:surgery; D003051:Cochlea / Q000473:pathology / Q000601:surgery*; D019929:Cochlear Implantation / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012984:Software; D025321:Surgery, Computer-Assisted / Q000379:methods*
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