Álvarez de Linera-Alperi Marta, Sismono Fergio, Sluydts Morgana, de Foer Bert, Manrique-Huarte Raquel, Ramos Macias Ángel, Manrique Manuel, Zarowski Andrzej
Otorhinolaryngology Department, University of Navarra Clinic, Pamplona, Spain.
European Institute for ORL-HNS, Sint-Augustinus Hospital, Antwerp, Belgium.
Audiol Neurootol. 2025 Jul 4:1-13. doi: 10.1159/000547032.
Balance disorders are a major challenge today as they greatly affect people's quality of life. Although medical treatment and vestibular rehabilitation are insufficient in many cases, significant improvements in the treatment of vestibular pathologies have been achieved in recent decades. New trends toward minimally invasive procedures have led to the study of direct treatment at the vestibular level, such as the use of vestibular implants. Great efforts have been made to acquire a thorough knowledge of these organs. However, the surgical anatomy and exact spatial orientation of the vestibular end organs remain partially unknown. The aim of this study was to evaluate in three-dimensional (3D) reconstructions the feasibility of new minimally traumatic surgical approaches to the vestibule.
In order to plan and explore new surgical approaches to the vestibular end organs, a methodology based on 3D models of the inner ear has been developed. This methodology is tested on human temporal bones treated with vestibular implants to analyze possible new minimally traumatic approaches to the vestibular system. Pre- and post-implantation cone-beam computed tomography (CBCT) images were acquired. Image segmentation of the vestibular end organs was performed on the pre-implantation CBCT scan. An already validated, freely and openly available anatomical atlas of the inner ear, IE-Map, was used as a reference template for the anatomy. Alignment of the IE-Map with the CBCT images was achieved using the MATLAB image processing toolbox. Interactive 3D models were visualized with the non-commercial version of Dragonfly 2021.1 software.
Image segmentation of the vestibular end organs and their 3D reconstructions were successfully performed in all cases. The 3D images showed reasonably realistic estimation of the location of the electrode within the vestibule and their relationships with respect to the different ampullary and otolithic receptors.
3D reconstruction by segmentation of the inner ear with superposition of CT images and an anatomical model is feasible and offers valuable morphological insight into the complex anatomy of the inner ear. This technique is particularly useful for exploring potential new surgical approaches to access the vestibule and shows promising results in the context of future local drug delivery and/or direct electrical stimulation at the vestibular level. Three such approaches were proposed and preliminarily assessed.
平衡障碍是当今的一项重大挑战，因为它们极大地影响人们的生活质量。尽管在许多情况下药物治疗和前庭康复并不充分，但近几十年来前庭疾病的治疗已取得显著进展。微创程序的新趋势促使人们研究在前庭水平进行直接治疗，例如使用前庭植入物。人们已付出巨大努力来全面了解这些器官。然而，前庭终器的手术解剖结构和确切空间定位仍部分未知。本研究的目的是通过三维（3D）重建评估新的微创前庭手术方法的可行性。
为了规划和探索前庭终器的新手术方法，已开发出一种基于内耳3D模型的方法。该方法在接受前庭植入物治疗的人类颞骨上进行测试，以分析可能的新的微创前庭系统手术方法。采集植入前和植入后的锥形束计算机断层扫描（CBCT）图像。在前庭植入前的CBCT扫描上对前庭终器进行图像分割。使用已验证的、免费且开放获取的内耳解剖图谱IE-Map作为解剖学参考模板。使用MATLAB图像处理工具箱将IE-Map与CBCT图像对齐。使用非商业版的Dragonfly 2021.1软件可视化交互式3D模型。
所有病例均成功完成前庭终器的图像分割及其3D重建。3D图像显示对电极在前庭内位置及其与不同壶腹和耳石感受器关系的估计较为逼真。
通过CT图像叠加和解剖模型对内耳进行分割来进行3D重建是可行的，并为内耳复杂的解剖结构提供了有价值的形态学见解。该技术对于探索进入前庭的潜在新手术方法特别有用，并且在未来前庭局部给药和/或直接电刺激方面显示出有希望的结果。提出并初步评估了三种此类方法。
