Vranken Brecht, Schoovaerts Maarten, Geerardyn Alexander, Kerkhofs Lore, Devos Johannes, Hermans Robert, Putzeys Tristan, Verhaert Nicolas
Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven Belgium.
ExpORL, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
Heliyon. 2024 Aug 14;10(16):e36335. doi: 10.1016/j.heliyon.2024.e36335. eCollection 2024 Aug 30.
Robotic devices have recently enhanced cochlear implantation by improving precision resulting in reduced intracochlear damage during electrode insertion. This study aimed to gain first insights into the expected dimensions of the cone-like workspace from the posterior tympanotomy towards the round window membrane. This retrospective chart review analyzed ten postoperative CT scans of adult patients who were implanted with a CI in the past ten years. The dimensions of the cone-like workspace were determined using four landmarks (P1-P4). In the anteroposterior range, P1 and P2 were defined on the edge of the bony layer over the facial nerve and chorda tympani nerve, respectively. In the inferosuperior range, P3 was defined on the bony edge of the incus buttress and P4 was obtained at a distance of 0.45 mm between the facial nerve and the chorda tympani nerve. After selecting the landmarks, the calculations of the dimensions of the surgical access space were done in a standardized coordinate system and presented using descriptive statistics. The cone-like space is limited by two maximal angles, and . The average angle of 19.84 (±3.55) degrees defines the angle towards the round window membrane between P1 and P2. The second average angle of 53.56 (±10.29) degrees defines the angle towards the round window membrane between P3 and P4. Based on the angles the mean anteroposterior range of 2.25 (±0.42) mm and mean inferosuperior range of 6.73 (±2.42) mm. The distance from the posterior tympanotomy to the round window membrane was estimated at 6.05 (±0.71) mm. These findings present data on the hypothetical maximum workspace in which a future robotically steered insertion tool can be positioned for an optimal automated electrode insertion. A larger sample size is necessary before generalizing these dimensions to a population. Further research including preoperative CT scans is needed for planning robotic-steered cochlear implantation.
机器人设备最近通过提高精度增强了人工耳蜗植入，从而在电极插入过程中减少了耳蜗内损伤。本研究旨在首次深入了解从后鼓室切开术到圆窗膜的锥形工作空间的预期尺寸。这项回顾性图表审查分析了过去十年中接受人工耳蜗植入的成年患者的十份术后CT扫描。使用四个标志点（P1 - P4）确定锥形工作空间的尺寸。在前后范围内，P1和P2分别定义在面神经和鼓索神经上方骨层的边缘。在上下范围内，P3定义在砧骨支柱的骨边缘，P4在面神经和鼓索神经之间0.45毫米处获得。选择标志点后，在标准化坐标系中进行手术入路空间尺寸的计算，并使用描述性统计进行呈现。锥形空间由两个最大角度限制，即 和 。平均角度 为19.84（±3.55）度，定义了P1和P2之间朝向圆窗膜的角度。第二个平均角度 为53.56（±10.29）度，定义了P3和P4之间朝向圆窗膜的角度。基于这些角度，平均前后范围为2.25（±0.42）毫米，平均上下范围为6.73（±2.42）毫米。从后鼓室切开术到圆窗膜的距离估计为6.05（±0.71）毫米。这些发现提供了关于假设的最大工作空间的数据，在该空间中，未来的机器人导向插入工具可被定位以实现最佳的自动电极插入。在将这些尺寸推广到人群之前，需要更大的样本量。需要包括术前CT扫描在内的进一步研究来规划机器人导向的人工耳蜗植入。
