Neuromonitoring During Robotic Cochlear Implantation: Initial Clinical Experience

Area of Science:

• Neurosurgery
• Medical Engineering
• Otolaryngology

Background:

• Robotic cochlear implantation requires precise drill trajectories near the facial nerve.
• Current neuromonitoring lacks submillimeter facial nerve proximity discrimination.
• Ensuring facial nerve preservation is critical during temporal bone surgery.

Purpose of the Study:

• To clinically validate a novel stimulation threshold-based system for intraoperative facial nerve proximity assessment.
• To integrate this system into an image-guided platform for robotic cochlear implantation safety.
• To determine the system's efficacy in maintaining safe surgical margins.

Main Methods:

• Clinical validation of a previously developed monopolar and bipolar stimulation threshold protocol.
• Integration of automated nerve proximity analysis into an image-guided system.
• Intraoperative measurement of stimulation thresholds at preoperatively defined distances from the facial nerve.

Main Results:

• The system successfully validated stimulation thresholds and nerve proximity values from an animal model in a first-in-man clinical trial.
• Automated measurements correctly identified safe drill trajectories (> 0.4 mm) in all robotic cochlear implantation cases.
• The system demonstrated accurate discrimination of facial nerve proximity within critical submillimeter ranges.

Conclusions:

• The validated stimulation protocol and integrated system provide a reliable intraoperative safety mechanism for robotic cochlear implantation.
• This approach enhances facial nerve preservation by enabling precise submillimeter proximity monitoring.
• The system shows significant potential for improving surgical safety in complex head and neck procedures.