Fluoroscopy guided electrode-array insertion for cochlear implantation with straight electrode-arrays: a valuable...

Area of Science:

• Otolaryngology
• Neurosurgery
• Medical Imaging

Background:

• Cochlear implantation is a complex procedure requiring precise electrode-array (EA) insertion.
• Real-time imaging guidance can potentially improve surgical outcomes and safety.

Purpose of the Study:

• To evaluate the benefits of real-time fluoroscopy-guided electrode-array (EA) insertion (FGI) in cochlear implant surgery.
• To assess the efficacy of FGI across different patient groups and surgical scenarios.

Main Methods:

• Surgical procedures utilized a robotic C-arm cone beam device for intraoperative 2D FGI and postoperative 3D imaging.
• Patients were categorized into three groups: anatomical concerns (ANAT), residual hearing (HP), and no particular reason (NPR).
• EA insertion angles were measured, hearing was compared pre- and post-operatively in the HP group, and radiation doses were recorded.

Main Results:

• FGI aided EA insertion in 61.5% of ANAT cases and ensured controlled insertion in the HP group, preserving hearing with a mean drop of 30 dB.
• In NPR cases, FGI confirmed insertion quality and identified issues like misrouting or stuck EAs in 17.8% of patients.
• Radiation exposure was comparable to less than four digital subtract radiographs.

Conclusions:

• Fluoroscopy-guided insertion is a valuable tool in cochlear implantation, particularly for complex cases and hearing preservation.
• FGI offers significant advantages even in routine procedures, providing critical intraoperative feedback with low radiation doses.