Department of Otolaryngology-Head and Neck Surgery.
ImVia Research Laboratory, Université Bourgogne-Franche-Comté.
Otol Neurotol. 2020 Apr;41(4):e441-e448. doi: 10.1097/MAO.0000000000002577.
The objective of this work was to study the feasibility of minimally invasive cochlear implantation under intraoperative computerized tomography-scan coupled to navigation.
Five human resin temporal bones (two adults and three children) were used. Initially, a temporal bone imaging was obtained by the intraoperative CT-scan coupled to the navigation (O-ARM). The navigation-assisted drilling began at the mastoid surface creating a conical tunnel (4-2 mm in diameter) through the facial recess and down to the round window. A cochleostomy was performed based on the navigation. A sham electrode array was inserted in the drilled tunnel and into the cochlea.Postoperative CT-scan and dissection were performed to evaluate the trajectory, and possible injury to the external auditory canal, ossicles, or facial nerve.
The mean duration of the procedure was 24.4 ± 3.79 minutes (range, 15-35). Cochleostomy was possible in all cases without injury to other structures. The sham array was inside the cochlea in all cases. The mean distance between the drilled canal and the mastoid portion of the facial nerve was 1.2 ± 0.07 mm (range, 1.08-1.38). The mean tracking error was 0.6 ± 0.26 mm (range, 0.20-0.72) at the entry point, 0.6 ± 0.33 mm (range, 0.2-1.02) at the facial nerve and 0.4 ± 0.07 mm (range, 0.36-0.51) at the cochleostomy.
Cochlear implantation through a minimally invasive approach assisted by intraoperative imaging combined with navigation was feasible in operating room environment and experimental conditions.
本研究旨在探讨术中计算机断层扫描（CT）扫描与导航相结合引导下微创耳蜗植入的可行性。
本研究共使用 5 个人工颞骨（2 例成人和 3 例儿童）。首先，通过术中 CT 扫描与导航（O-ARM）获取颞骨图像。在导航辅助下，从乳突表面开始，沿面神经隐窝向下至圆窗，钻制一个锥形隧道（直径 4-2mm）。基于导航进行镫骨钻孔。将假电极阵列插入钻制的隧道并进入耳蜗。术后行 CT 扫描和解剖以评估轨迹，以及对外耳道、听小骨或面神经可能造成的损伤。
该手术的平均时间为 24.4±3.79 分钟（15-35 分钟）。所有病例均成功完成镫骨钻孔，未损伤其他结构。所有情况下，假电极阵列均位于耳蜗内。钻孔隧道与面神经乳突段之间的平均距离为 1.2±0.07mm（1.08-1.38mm）。入口处的平均跟踪误差为 0.6±0.26mm（0.20-0.72mm），面神经处为 0.6±0.33mm（0.2-1.02mm），耳蜗造孔处为 0.4±0.07mm（0.36-0.51mm）。
在手术室环境和实验条件下，术中成像与导航辅助的微创耳蜗植入是可行的。
