Forces and trauma associated with minimally invasive image-guided cochlear implantation
Creators: name: Rohani, Pooyan
name: Pile, Jason
name: Kahrs, Lüder Alexander
name: Balachandran, Ramya
name: Blachon, Gregoire S.
name: Simaan, Nabil
name: Labadie, Robert F.
Publisher: name: London : SAGE Publications Ltd.
Year: 2014
Subjects: subject: cochlear electrode
subject: cochlear histology
subject: cochlear implantation
subject: insertion forces
subject: minimally invasive surgery
subject: stiffener
subject: bone drill
subject: cadaver
subject: cochlea injury
subject: cochlea prosthesis
subject: computer assisted tomography
subject: conference paper
subject: controlled study
subject: electrode
subject: force
subject: histology
subject: human
subject: human tissue
subject: implantation
subject: microdissection
subject: minimally invasive image guided cochlear implantation
subject: scala vestibuli
subject: sensor
subject: surgical technique
subject: temporal bone
subject: Biopsy, Needle
subject: Cadaver
subject: Cochlear Implantation
subject: Cochlear Implants
subject: Electrodes, Implanted
subject: Fiducial Markers
subject: Humans
subject: Imaging, Three-Dimensional
subject: Immunohistochemistry
subject: Sensitivity and Specificity
subject: Stress, Mechanical
subject: Surgery, Computer-Assisted
subject: Surgical Procedures, Minimally Invasive
subject: Temporal Bone
subject: Tomography, X-Ray Computed
subject: Wounds and Injuries
subject: Dewey Decimal Classification::600 | Technik::610 | Medizin, Gesundheit

description: Objective. Minimally invasive image-guided cochlear implantation (CI) utilizes a patient-customized microstereotactic frame to access the cochlea via a single drill-pass. We investigate the average force and trauma associated with the insertion of lateral wall CI electrodes using this technique. Study Design. Assessment using cadaveric temporal bones. Setting. Laboratory setup. Subjects and Methods. Microstereotactic frames for 6 fresh cadaveric temporal bones were built using CT scans to determine an optimal drill path following which drilling was performed. CI electrodes were inserted using surgical forceps to manually advance the CI electrode array, via the drilled tunnel, into the cochlea. Forces were recorded using a 6-axis load sensor placed under the temporal bone during the insertion of lateral wall electrode arrays (2 each of Nucleus CI422, MED-EL standard, and modified MED-EL electrodes with stiffeners). Tissue histology was performed by microdissection of the otic capsule and apical photo documentation of electrode position and intracochlear tissue. Results. After drilling, CT scanning demonstrated successful access to cochlea in all 6 bones. Average insertion forces ranged from 0.009 to 0.078 N. Peak forces were in the range of 0.056 to 0.469 N. Tissue histology showed complete scala tympani insertion in 5 specimens and scala vestibuli insertion in the remaining specimen with depth of insertion ranging from 360° to 600°. No intracochlear trauma was identified. Conclusion. The use of lateral wall electrodes with the minimally invasive image-guided CI approach was associated with insertion forces comparable to traditional CI surgery. Deep insertions were obtained without identifiable trauma. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2014.