Iso-Mustajärvi Matti, Matikka Hanna, Risi Frank, Sipari Sini, Koski Teemu, Willberg Tytti, Lehtimäki Antti, Tervaniemi Jyrki, Löppönen Heikki, Dietz Aarno
*Department of Otorhinolaryngology †Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland ‡Cochlear Ltd Sydney, Sydney, Australia §Cochlear Nordic Ab, Gothenburg, Sweden ||University of Eastern Finland, Kuopio, Finland.
Otol Neurotol. 2017 Oct;38(9):e327-e334. doi: 10.1097/MAO.0000000000001542.
To explore the results of a new slim modiolar electrode array (SMA) with respect to intracochlear placement and trauma evaluated by detailed radiologic imaging and histology.
Hearing and structure preservation is the goal of cochlear implantation for advanced hearing outcomes. Currently, this is most consistently achieved with thin lateral wall electrodes. Modiolar electrodes are located nearer the modiolus and may provide some electrophysiological advantages, but have a greater tendency for causing insertion trauma.
The SMA was implanted in 20 fresh-frozen human temporal bones (TB). All TBs were scanned pre- and postoperatively with cone beam computed tomography. For atraumatic insertion, the round window approach was preferred. Scalar localization and trauma were analyzed by three-dimensional image fusion reconstructions of the pre- and postimplant scans. The TBs underwent histologic examination to validate the radiologic findings.
Insertion through the round window was performed in 19 TBs and through a cochleostomy in one TB. In one TB trauma in the form of scala translocation was identified radiologically and histologically. In the remaining TBs there was no insertion trauma. Adequate modiolar localization of the SMA was found in 19 of 20 TBs. The mean angular insertion depth was 400 degrees without correlation to cochlea size. There was no significant statistical difference between the radiological and histological measurements of electrode localization.
The SMA showed consistent and atraumatic insertion results in TBs. Pre- and postimplant cone beam computed tomography with image fusion was shown to be very accurate for the assessment of electrode position and insertion trauma.
通过详细的放射影像学和组织学评估，探讨新型纤细蜗轴电极阵列（SMA）在耳蜗内植入及创伤方面的结果。
听力和结构保留是人工耳蜗植入实现高级听力结果的目标。目前，使用薄侧壁电极最能始终如一地实现这一目标。蜗轴电极更靠近蜗轴，可能具有一些电生理优势，但更容易造成插入创伤。
将SMA植入20个新鲜冷冻的人颞骨（TB）中。所有颞骨在术前和术后均采用锥形束计算机断层扫描。为实现无创伤插入，首选圆窗入路。通过植入前后扫描的三维图像融合重建分析蜗管定位和创伤情况。对颞骨进行组织学检查以验证放射学结果。
19个颞骨通过圆窗插入，1个颞骨通过耳蜗造口术插入。在1个颞骨中，通过放射学和组织学鉴定出存在蜗管移位形式的创伤。在其余颞骨中未发现插入创伤。在20个颞骨中的19个中发现SMA在蜗轴的定位良好。平均角插入深度为400度，与耳蜗大小无关。电极定位的放射学测量和组织学测量之间无显著统计学差异。
SMA在颞骨中显示出一致且无创伤的插入结果。植入前后的锥形束计算机断层扫描及图像融合对于评估电极位置和插入创伤非常准确。
