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Published on: June 21, 2024
Minimally invasive image-guided cochlear implantation for pediatric patients: clinical feasibility study
Ramya Balachandran1, Fitsum A Reda, Jack H Noble
1Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, USA.
Insights
Minimally invasive image-guided cochlear implantation (CI) is a feasible technique for pediatric patients. This method uses a custom frame to create a safe trajectory to the cochlea, avoiding critical nerves.
Area of Science:
- Neurosurgery
- Otolaryngology
- Medical Imaging
Background:
- Cochlear implantation (CI) is a surgical procedure to improve hearing in deaf individuals.
- Minimally invasive techniques aim to reduce surgical trauma and improve outcomes.
- Pediatric CI presents unique challenges due to smaller anatomy and the need to avoid developing structures.
Purpose of the Study:
- To describe and demonstrate the feasibility of a minimally invasive, image-guided cochlear implantation technique in pediatric patients.
- To evaluate the safety and accuracy of a custom microstereotactic frame for guiding CI surgery in children.
Main Methods:
- A prospective study involving 13 pediatric patients (1.5-8 years) undergoing traditional CI.
- Three fiducial markers were implanted, followed by CT imaging to plan a safe trajectory to the cochlea.
- A custom microstereotactic frame was fabricated and mounted on markers to guide the surgical tool.
Main Results:
- A safe trajectory to the cochlea was determined for all 13 patients.
- The custom microstereotactic frame was successfully validated on 9 patients.
- For patients with normal anatomy, the trajectory was an average of 1.1 mm from the facial nerve and 1.2 mm from the chorda tympani.
Conclusions:
- Minimally invasive image-guided cochlear implantation is feasible and safe for pediatric patients.
- This technique can aid surgeons in identifying optimal cochleostomy locations, even in cases of inner ear malformations.
Objective:
Minimally invasive image-guided cochlear implantation (CI) involves accessing the cochlea via a linear path from the lateral skull to the cochlea avoiding vital structures including the facial nerve. Herein, we describe and demonstrate the feasibility of the technique for pediatric patients.
Study Design:
Prospective.
Setting:
Children's Hospital.
Subjects And Methods:
Thirteen pediatric patients (1.5 to 8 years) undergoing traditional CI participated in this Institutional Review Board-approved study. Three fiducial markers were bone-implanted surrounding the ear, and a CT scan was acquired. The CT scan was processed to identify the marker locations and critical structures of the temporal bone. A safe linear path was determined to target the cochlea avoiding damage to vital structures. A custom microstereotactic frame was fabricated that would mount on the fiducial markers and constrain a tool to the desired trajectory. After traditional mastoidectomy and prior to cochleostomy, the custom microstereotactic frame was mounted on the bone-implanted markers to confirm that the achieved trajectory was safe and accurately accessed the cochlea.
Results:
For all the 13 patients, it was possible to determine a safe trajectory to the cochlea. Custom microstereotactic frames were validated successfully on 9 patients. Two of these patients had inner ear malformations, and this technique helped the surgeon confirm ideal location for cochleostomy. For patients with normal anatomy, the mean and standard deviation of the closest distance of the trajectory to facial nerve and chorda tympani were 1.1 ± 0.3 mm and 1.2 ± 0.5 mm, respectively.
Conclusion:
Minimally invasive image-guided CI is feasible for pediatric patients.
