title: First use of flat-panel computed tomography during cochlear implant surgery : Perspectives for the use of advanced therapies in cochlear implantation.
abstract: BACKGROUND
  Cochlear implantation in routine cases with normal anatomy is commonly performed without intraoperative image guidance. Revision cochlear implantation as well as surgery in malformations require not only a precise understanding of the underlying complex anatomy, but surgeons need to transform two-dimensional computed tomography (2D CT) scans into the surgical field and use this information for intraoperative surgical navigation. So far, information about the exact position of the electrode during insertion cannot be provided to the surgeon. Here, we present our first operative experience with cochlear implant surgery supported by intraoperative Dyna-CT technology, providing the surgeon with detailed views of the electrode location.
  
  
  METHODS
  To prove the feasibility of the procedure, two cases of cochlear implantation were performed with intraoperative application of cone-beam CT acquired by a C-arm Dyna-CT system (Artis Zeego, Siemens Healthcare, Erlangen, Germany). Image reconstruction was performed intraoperatively in order to assess the correct positioning of the electrodes.
  
  
  RESULTS
  Intraoperative Dyna-CT enabled clear visualization of the surgical anatomy and intracochlear electrode position. Dyna-CT technology can be applied with acceptable additional time requirements without adding too much complexity to the surgical procedure.
  
  
  CONCLUSIONS
  Intraoperative data acquisition by Dyna-CT represents a suitable option for online surgical navigation during cochlear implant surgery. This imaging technology will push further advances in cochlear implant surgery and lateral skull base surgery, particularly if linked to intraoperative navigation.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany. nicole.rotter@uniklinik-ulm.de.
authors.forename: N
authors.initials: N
authors.lastname: Rotter
authors.affiliation: Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Schmitz
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Sommer
authors.affiliation: Department of Neurosurgery, Ulm University Medical Center, Ulm, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Röhrer
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany.
authors.forename: P J
authors.initials: PJ
authors.lastname: Schuler
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Bischof
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany.
authors.forename: M O
authors.initials: MO
authors.lastname: Scheithauer
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany.
authors.forename: T K
authors.initials: TK
authors.lastname: Hoffmann
mesh_terms: D000328:Adult; D019929:Cochlear Implantation / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods; D017755:Prosthesis Fitting / Q000295:instrumentation* / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome; D014963:X-Ray Intensifying Screens; D055815:Young Adult
keywords: Cochlear implantation; Cone-beam computed tomography; Electrodes; Preservation, structure