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Enhancing Electrode Location Assessment in Cochlear Implantation via Computed Tomography Image Fusion
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Custom mastoid-fitting templates to improve cochlear implant electrode insertion trajectory.

William G Morrel1, Katherine E Riojas2, Robert J Webster2

  • 1Department of Otolaryngology, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 7209, Nashville, TN, 37232-8605, USA. will.morrel@vumc.org.

International Journal of Computer Assisted Radiology and Surgery
|May 16, 2020
PubMed
Summary

Custom surgical templates improve cochlear implant (CI) electrode placement by guiding insertion trajectory. This novel method enhances accuracy, leading to better intracochlear positioning and potentially improved hearing outcomes.

Keywords:
Cochlear implantationImage-guided surgeryOtologySurgical template

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Area of Science:

  • Neurosurgery
  • Biomedical Engineering
  • Otolaryngology

Background:

  • Accurate cochlear implant (CI) electrode insertion is crucial for optimal hearing outcomes.
  • Intraoperative guidance for insertion trajectory is limited, impacting final CI positioning.
  • Custom templates offer a potential solution for improving trajectory control.

Purpose of the Study:

  • To develop and evaluate custom-fit templates for specifying cochlear implant electrode insertion trajectory.
  • To improve the precision of intracochlear electrode positioning during CI surgery.

Main Methods:

  • 3D CT reconstructions of cadaveric temporal bones were used to define ideal cochlear trajectories.
  • Custom templates were designed, 3D-printed, and tested for accuracy (Target Registration Error: 0.55 ± 0.19 mm).
  • Insertions were performed using a novel roller-based tool and surgical forceps with guided and non-guided trajectories.

Main Results:

  • Guided trajectories resulted in more intracochlear electrodes placed (average 8-9) and greater angular insertion depths (up to 377°).
  • Manual insertions using templates as guides also yielded excellent results (up to 10 intracochlear electrodes, 478° AID).
  • No electrode translocations were observed in any insertion condition.

Conclusions:

  • Custom mastoid-fitting templates reliably guide CI electrode insertion trajectory.
  • Templates provide accurate targeting within the temporal bone, with a mean TRE of 0.55 ± 0.19 mm.
  • The developed insertion tool and template system achieve results comparable to manual insertion techniques.