From the Unité de Réhabilitation Chirurgicale Mini-Invasive Robotisée de l'Audition (H.J., R.T., Y.N., D.D.S., E.F., O.S., D.B., I.M.), Sorbonne Universités, Université Pierre et Marie Curie Paris 6, Institut National de la Santé et de la Recherche Médicale, Paris, France.
Otologie, Implants Auditifs et Chirurgie de la Base du Crane (H.J., Y.N., D.D.S., E.F., O.S., D.B., I.M.), Paris Assistance Publique, GHU Pitié-Salpêtrière, Service ORL, Paris, France.
AJNR Am J Neuroradiol. 2018 Apr;39(4):768-774. doi: 10.3174/ajnr.A5567. Epub 2018 Feb 22.
Intraoperative conebeam CT has been introduced into the operating room and provides quick radiologic feedback. This study aimed to investigate its utility in the assessment of the positioning of the electrode array after cochlear implantation.
This was a retrospective study of 51 patients (65 ears) with intraoperative imaging by conebeam CT (O-arm) after cochlear implantation between 2013 and 2017. Correct placement into the cochlea was immediately identified. Positioning assessments were later analyzed with OsiriX software.
Intraoperative imaging was quickly performed in all cases. No misplacement into the vestibule or semicircular canals was found. A foldover of the implanted array was identified in 1 patient. Secondary analysis by 2 raters showed excellent agreement on insertion depth angle (intraclass correlation = 0.96, < .001) and length of insertion of the electrode array (intraclass correlation coefficient = 0.93, = .04) measurements. The evaluation of the number of extracochlear electrodes was identical between the 2 raters in 78% of cases (Cohen κ = 0.55, < .001). The scalar position was inconsistent between raters. When we compared O-arm and high-resolution CT images in 14 cases, the agreement was excellent for insertion depth angle (intraclass correlation coefficient = 0.97, < .001) and insertion length (intraclass correlation coefficient = 0.98, < .001), good for the number of extracochlear electrodes (Cohen κ = 0.63, = .01), but moderate for the scalar position (Cohen κ = 0.59, = .02).
Intraoperative conebeam CT using the O-arm is a safe, rapid, easy, and reliable procedure to immediately identify a misplacement or foldover of an electrode array. The insertion depth angle, insertion length, and number of electrodes inserted can be accurately assessed.
术中锥形束 CT 已引入手术室，并提供快速的放射学反馈。本研究旨在探讨其在评估人工耳蜗植入后电极阵列定位中的应用。
这是一项回顾性研究，纳入 2013 年至 2017 年期间行术中锥形束 CT（O 臂）成像的 51 例（65 耳）患者。立即确认电极阵列正确植入耳蜗。随后使用 OsiriX 软件分析定位评估。
所有病例均快速进行术中成像。未发现电极阵列错误植入前庭或半规管。1 例患者发现电极阵列折叠。2 位评估者的二次分析显示，插入深度角度（组内相关系数 = 0.96， <.001）和电极阵列插入长度（组内相关系数 = 0.93， =.04）测量具有极好的一致性。在 78%的情况下，2 位评估者对额外耳蜗电极的数量评估完全一致（Cohen κ = 0.55， <.001）。标度位置在评估者之间不一致。当我们在 14 例病例中将 O 臂和高分辨率 CT 图像进行比较时，插入深度角度（组内相关系数 = 0.97， <.001）和插入长度（组内相关系数 = 0.98， <.001）的一致性极好，额外耳蜗电极数量（Cohen κ = 0.63， =.01）的一致性好，但标度位置（Cohen κ = 0.59， =.02）的一致性为中等。
使用 O 臂的术中锥形束 CT 是一种安全、快速、简便、可靠的方法，可以立即识别电极阵列的错位或折叠。可以准确评估插入深度角度、插入长度和插入的电极数量。
