Clinical validation study of percutaneous cochlear access using patient-customized microstereotactic frames.

Labadie RF, Balachandran R, Mitchell JE, Noble JH, Majdani O, Haynes DS, Bennett ML, Dawant BM, Fitzpatrick JM
Otol Neurotol. 2010 31 (1): 94-9

PMID: 20019561 · PMCID: PMC2845321 · DOI:10.1097/MAO.0b013e3181c2f81a

OBJECTIVE - Percutaneous cochlear implant (PCI) surgery consists of drilling a single trough from the lateral cranium to the cochlea avoiding vital anatomy. To accomplish PCI, we use a patient-customized microstereotactic frame, which we call a "microtable" because it consists of a small tabletop sitting on legs. The orientation of the legs controls the alignment of the tabletop such that it is perpendicular to a specified trajectory.

STUDY DESIGN - Prospective.

SETTING - Tertiary referral center.

PATIENTS - Thirteen patients (18 ears) undergoing traditional cochlear implant surgery.

INTERVENTIONS - With institutional review board approval, each patient had 3 fiducial markers implanted in bone surrounding the ear. Temporal bone computed tomographic scans were obtained, and the markers were localized, as was vital anatomy. A linear trajectory from the lateral cranium through the facial recess to the cochlea was planned. A microtable was fabricated to follow the specified trajectory.

MAIN OUTCOME MEASURES - After mastoidectomy and posterior tympanotomy, accuracy of trajectories was validated by mounting the microtables on the bone-implanted markers and then passing sham drill bits across the facial recess to the cochlea. The distance from the drill to vital anatomy was measured.

RESULTS - Microtables were constructed on a computer-numeric-control milling machine in less than 5 minutes each. Successful access across the facial recess to the cochlea was achieved in all 18 cases. The mean +/- SD distance was 1.20 +/- 0.36 mm from midportion of the drill to the facial nerve and 1.25 +/- 0.33 mm from the chorda tympani.

CONCLUSION - These results demonstrate the feasibility of PCI access using customized microstereotactic frames.

MeSH Terms (19)

Adolescent Adult Aged Aged, 80 and over Cochlear Implantation Cochlear Implants Ear, Inner Equipment Design Female Hearing Loss Humans Male Middle Aged Monitoring, Intraoperative Patient Selection Prospective Studies Radiography Stereotaxic Techniques Treatment Outcome

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