McRackan Theodore R, Balachandran Ramya, Blachon Grégoire S, Mitchell Jason E, Noble Jack H, Wright Charles G, Fitzpatrick J Michael, Dawant Benoit M, Labadie Robert F
Department of Otolaryngology, Vanderbilt University, 7209 Medical Center East, South Tower, 1215 21st Avenue South, Nashville, TN, 37232, USA.
Int J Comput Assist Radiol Surg. 2013 Nov;8(6):989-95. doi: 10.1007/s11548-013-0842-6. Epub 2013 Apr 30.
Validation of a novel minimally invasive, image-guided approach to implant electrodes from three FDA-approved manufacturers-Medel, Cochlear, and Advanced Bionics-in the cochlea via a linear tunnel from the lateral cranium through the facial recess to the cochlea.
Custom microstereotactic frames that mount on bone-implanted fiducial markers and constrain the drill along the desired path were utilized on seven cadaver specimens. A linear tunnel was drilled from the lateral skull to the cochlea followed by a marginal, round window cochleostomy and insertion of the electrode array into the cochlea through the drilled tunnel. Post-insertion CT scan and histological analysis were used to analyze the results.
All specimens ([Formula: see text]) were successfully implanted without visible injury to the facial nerve. The Medel electrodes ([Formula: see text]) had minimal intracochlear trauma with 8, 8, and 10 (out of 12) electrodes intracochlear. The Cochlear lateral wall electrodes (straight research arrays) ([Formula: see text]) had minimal trauma with 20 and 21 of 22 electrodes intracochlear. The Advanced Bionics electrodes ([Formula: see text]) were inserted using their insertion tool; one had minimal insertion trauma and 14 of 16 electrodes intracochlear, while the other had violation of the basilar membrane just deep to the cochleostomy following which it remained in scala vestibuli with 13 of 16 electrodes intracochlear.
Minimally invasive, image-guided cochlear implantation is possible using electrodes from the three FDA-approved manufacturers. Lateral wall electrodes were associated with less intracochlear trauma suggesting that they may be better suited for this surgical technique.
验证一种新型的微创、图像引导方法，该方法可通过从侧颅经面隐窝至耳蜗的线性隧道，将来自三家美国食品药品监督管理局（FDA）批准的制造商——梅德尔（Medel）、科利耳（Cochlear）和先进生物电子学公司（Advanced Bionics）的电极植入耳蜗。
在七个尸体标本上使用定制的微型立体定向框架，该框架安装在植入骨的基准标记上，并沿着所需路径约束钻头。从侧颅骨向耳蜗钻一个线性隧道，随后进行边缘性圆窗耳蜗造孔，并通过钻出的隧道将电极阵列插入耳蜗。插入后进行CT扫描和组织学分析以分析结果。
所有标本（[公式：见正文]）均成功植入，面神经未见明显损伤。梅德尔电极（[公式：见正文]）在耳蜗内的创伤最小，12个电极中有8个、8个和10个位于耳蜗内。科利耳侧壁电极（直的研究阵列，[公式：见正文]）创伤最小，22个电极中有20个和21个位于耳蜗内。先进生物电子学公司的电极（[公式：见正文]）使用其插入工具插入；一个插入创伤最小，16个电极中有14个位于耳蜗内，而另一个在耳蜗造孔稍深处基底膜受损，之后其留在前庭阶，16个电极中有13个位于耳蜗内。
使用三家FDA批准制造商的电极进行微创、图像引导的耳蜗植入是可行的。侧壁电极与较少的耳蜗内创伤相关，表明它们可能更适合这种手术技术。
