Robotic cochlear implantation in post-meningitis ossified cochlea

Area of Science:

• Otolaryngology
• Medical Robotics
• Neurosurgery

Background:

• Labyrinthitis ossificans presents a significant challenge for cochlear implantation due to intra-cochlear bone growth.
• Traditional cochlear implant surgery can be difficult in cases with ossified cochleas, potentially leading to incomplete electrode insertion or trauma.

Purpose of the Study:

• To detail the use of an image-guided, navigation-based robotic arm as an assistive surgical tool.
• To evaluate the efficacy of Robotic Assisted Cochlear Implant Surgery (RACIS) in a patient with labyrinthitis ossificans.

Main Methods:

• A 55-year-old male patient with bilateral profound sensorineural hearing loss secondary to childhood meningitis and subsequent labyrinthitis ossificans was treated.
• Robotic Assisted Cochlear Implant Surgery (RACIS) was performed using a straight, flexible lateral wall electrode via a facial recess approach.
• The robotic system facilitated autonomous inner ear access, enabling full insertion of the cochlear implant array.

Main Results:

• The robotic system enabled precise navigation and drilling, overcoming the ossified labyrinth.
• Full insertion of the flexible straight cochlear implant array was achieved.
• The procedure demonstrated safe and effective access to the inner ear despite the ossification.

Conclusions:

• Intra-cochlear ossifications are a major hurdle in cochlear implantation, impacting electrode insertion.
• Image-guided robotic assistance, utilizing radiological image computations and navigation, provides an efficient method for accessing the inner ear in complex cases.
• RACIS shows promise for improving outcomes in cochlear implantation complicated by labyrinthitis ossificans.