Automatic determination of optimal linear drilling trajectories for cochlear access accounting for drill-positioning error.

Noble JH, Majdani O, Labadie RF, Dawant B, Fitzpatrick JM
Int J Med Robot. 2010 6 (3): 281-90

PMID: 20812268 · PMCID: PMC2933923 · DOI:10.1002/rcs.330

BACKGROUND - Cochlear implantation is a surgical procedure in which an electrode array is permanently implanted into the cochlea to stimulate the auditory nerve and allow deaf people to hear. Percutaneous cochlear access, a new minimally invasive implantation approach, requires drilling a single linear channel from the skull surface to the cochlea. The focus of this paper addresses a major challenge with this approach, which is the ability to determine, in a pre-operative CT, a safe and effective drilling trajectory.

METHODS - A measure of the safety and effectiveness of a given trajectory relative to sensitive structures is derived using a Monte Carlo approach. The drilling trajectory that maximizes this measure is found using an optimization algorithm.

RESULTS - In tests on 13 ears, the technique was shown to find approximately twice as many acceptable trajectories as those found manually by an experienced surgeon.

CONCLUSIONS - Using this method, safe trajectories can be automatically determined quickly and consistently.

Copyright 2010 John Wiley & Sons, Ltd.

MeSH Terms (15)

Automation Cochlea Cochlear Implantation Deafness Ear Electrodes Equipment Design Humans Patient Positioning Probability Robotics Safety Temporal Bone Tomography, X-Ray Computed Treatment Outcome

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