Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto.
Department of Otolaryngology-Head and Neck Surgery, Osaka Red Cross Hospital, Osaka.
Otol Neurotol. 2019 Feb;40(2):177-183. doi: 10.1097/MAO.0000000000002097.
To evaluate the electrode status during cochlear implantation (CI) using mobile cone-beam CT (mCBCT).
Retrospective case review.
Tertiary referral hospital.
Fifty-seven patients (7 bilateral surgeries, 64 ears) who underwent CI and who received intraoperative mCBCT imaging.
CI and CBCT during surgery.
Electrode location and angular insertion depth determined by intraoperative mCBCT images.
There were six cases with cochlear malformation where intraoperative mCBCT was useful to confirm electrode location. Of 58 ears with a normal cochlear morphology, perimodiolar, straight, and mid-scalar electrodes were used in 30 (cochleostomy; 14 advance off-stylet technique cases), 27 (26 round window [RW] insertion, 1 extended round window [ERW] insertion), and 1 (RW insertion) ears, respectively. Complete scala-tympani (ST) insertion was achieved in 35 ears (14 cochleostomy, 21 RW or ERW insertion). The complete ST-insertion rate was significantly higher with RW or ERW insertion than that for cochleostomy insertion (p = 0.03), although cochleostomy insertion using the advanced off-stylet technique had a similar rate to RW or ERW insertion. The angular insertion depth values (average ± standard deviation) for perimodiolar electrodes (354.4 ± 29.44 degrees) were significantly smaller than those for Flex24 (464.8 ± 43.09 degrees) and Flex28 (518.2 ± 61.91 degrees) electrodes (p < 0.05).
Evaluation of CI electrodes using intraoperative mCBCT was comparable to that with fan-beam CT or c-arm-based CBCT. Considering the low radiation dose of mCBCT and its availability in any operation room, mCBCT is the better modality for evaluating cochlear implant electrode arrays.
使用移动锥形束 CT（mCBCT）评估人工耳蜗植入（CI）过程中的电极状态。
回顾性病例研究。
三级转诊医院。
57 例（7 例双侧手术，64 耳）接受 CI 手术并接受术中 mCBCT 成像的患者。
CI 和手术中的 CBCT。
术中 mCBCT 图像确定的电极位置和角度插入深度。
6 例患者存在耳蜗畸形，术中 mCBCT 有助于确认电极位置。在 58 例具有正常耳蜗形态的耳朵中，使用了 30 个（耳蜗造口术；14 例使用导丝技术）、27 个（26 例圆窗 [RW] 插入术，1 例扩展圆窗 [ERW] 插入术）和 1 个（RW 插入术）的经皮电极，分别为 35 个（14 例耳蜗造口术，21 例 RW 或 ERW 插入术）实现了完全的鼓阶插入。RW 或 ERW 插入的完全 ST 插入率明显高于耳蜗造口术（p = 0.03），尽管使用先进的导丝技术进行耳蜗造口术与 RW 或 ERW 插入术具有相似的插入率。经皮电极的角度插入深度值（平均值±标准差）为 354.4±29.44 度，明显小于 Flex24（464.8±43.09 度）和 Flex28（518.2±61.91 度）电极（p < 0.05）。
使用术中 mCBCT 评估 CI 电极与使用扇形束 CT 或 C 臂 CBCT 相当。考虑到 mCBCT 的低辐射剂量及其在任何手术室中的可用性，mCBCT 是评估耳蜗植入电极阵列的更好方式。
