Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center.
Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee.
Otol Neurotol. 2018 Aug;39(7):922-928. doi: 10.1097/MAO.0000000000001850.
Using patient-customized cochlear measurements obtained from preoperative computed tomography (CT) scans to guide insertion of cochlear implant (CI) electrode arrays will lead to more optimal intracochlear positioning.
Cochlear duct length is highly variable ranging from 25.26 to 35.46 mm, yet CI electrode arrays are treated as one size fits most. We sought to investigate the impact of patient-customized insertion plans on final location of electrode arrays.
Twenty cadaveric temporal bone specimens were CT scanned and randomly divided into groups A and B. Group A specimens had an optimal customized insertion plan generated including entry site (e.g., round window versus extended round window), entry vector based on anatomical landmarks (e.g., hug posterior aspect of facial recess and angle 1 mm inferior to stapes), depth to begin advancing off stylet, and final insertion depth. Suboptimal plans were chosen for group B by selecting an approach that was normal yet predicted to result in poor final electrode location. One surgeon, blinded as to group, carried out the CI insertions following which the electrode array was fixed using superglue and the specimen CT scanned to allow assessment of final electrode location.
Average perimodiolar distances for groups A and B were 0.51 and 0.60 mm, respectively. For group A, full scala tympani insertion was achieved in all specimens while in group B, 4 of 10 specimens had scalar translocation.
Patient customized cochlear implant insertion techniques achieved better positioning of electrode arrays in this study and have potential for improving electrode positioning in patients.
使用术前计算机断层扫描 (CT) 扫描获得的患者定制的耳蜗测量值来指导耳蜗植入 (CI) 电极阵列的插入，将导致更优化的耳蜗内定位。
耳蜗管长度变化很大，范围从 25.26 到 35.46 毫米，但 CI 电极阵列被视为一种大小适合大多数人。我们试图研究患者定制的插入计划对电极阵列最终位置的影响。
对 20 个尸体颞骨标本进行 CT 扫描，并随机分为 A 组和 B 组。A 组标本生成了最佳的定制插入计划，包括入口部位（例如，圆窗 versus 扩展圆窗）、基于解剖标志的入口向量（例如，紧贴面神经隐窝的后侧面并距镫骨 1 毫米）、开始脱离导丝的深度和最终插入深度。B 组选择了一种正常但预计会导致电极最终位置不佳的方法来选择次优计划。一位外科医生在不知道分组的情况下进行了 CI 插入，然后使用超级胶水固定电极阵列，并对标本进行 CT 扫描，以评估最终电极位置。
A 组和 B 组的平均围内电极距离分别为 0.51 和 0.60 毫米。在 A 组中，所有标本均实现了全耳蜗插入，而在 B 组中，有 4 个标本出现了耳蜗移位。
在这项研究中，患者定制的耳蜗植入插入技术实现了电极阵列更好的定位，并有可能改善患者的电极定位。
