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Cochlear implantation via the middle fossa: surgical and electrode array considerations
1Temporal Bone Laboratory, Emory University, Atlanta GA, USA. ntodd@emory.edu
Cochlear Implants International
|May 8, 2007
Summary
The middle cranial fossa approach for cochlear implantation offers safe access to the cochlea without opening the middle ear. Further research is needed on specialized electrode arrays for this technique.
Area of Science:
- Neurosurgery
- Otolaryngology
- Cochlear Implant Technology
Background:
- Cochlear implantation via the middle cranial fossa (MCF) approach bypasses the middle ear.
- Safety and electrode array design are key concerns for this implantation route.
Purpose of the Study:
- To measure the depth to the superior portion of the basal turn (SPBT) of the cochlea.
- To determine distances from the SPBT to critical nerves (facial and greater petrosal).
- To explore electrode array designs for the MCF approach.
Main Methods:
- Operative dissection of 41 adult human crania (82 temporal bones).
- X-ray assessment of mastoid size.
- Insertion of commercially available MED-EL split electrode arrays.
Main Results:
- Depth to SPBT ranged from 0.5 mm to 4.2 mm, correlating with mastoid size.
- Distances to facial nerve, geniculate ganglion, and greater petrosal nerve were measured.
- Electrode insertion reached the vestibule and a median depth of 12 mm towards the cochlear apex.
Conclusions:
- The MCF approach appears safe for cochlear implantation.
- It provides electrode access to most of the cochlea's length.
- Specialized electrode arrays and comparative outcome studies are necessary for this approach.
