How we do it: using a surgical navigation system in the management of the ossified cochlea

The ossified cochlea poses both concerns and challenges to any implant team. One of the surgical aims is to implant as many of an implant system's electrodes into the cochlea as close to the modiolus as possible, thus facilitating stimulation of the surviving cell bodies in the spiral ganglion. Within the field of otorhinolaryngology various surgical navigation systems have been introduced to facilitate surgical orientation during endoscopic sinus and skull-base surgery. The principle behind such systems is that specialized software uses high-resolution computerized tomography and magnetic resonance imaging scans to create a 3D image of the patient's anatomy. This 'virtual patient model' is then 'registered' with the patient's anatomical landmarks. Surgical instruments registered into, or linked with, the system can then be tracked within the 3D model. This is the first time this system has been described for surgery of the inner ear, and we describe how the technique allows more precise control of the bur tip while drilling tunnels that approximate with the apical and distal parts of the basal coil of the ossified cochlea.