The use of a surgical planning tool for evaluating the optimal surgical accessibility to the stapedius muscle via a retrofacial approach during cochlear implant surgery: a feasibility study.
3D reconstruction
Cochlear implantation
Dyna-computed tomography
Electrically elicited stapedius reflex
Segmentation
Temporal bone
Journal
International journal of computer assisted radiology and surgery
ISSN: 1861-6429
Titre abrégé: Int J Comput Assist Radiol Surg
Pays: Germany
ID NLM: 101499225
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
16
05
2020
accepted:
28
10
2020
pubmed:
14
11
2020
medline:
8
6
2021
entrez:
13
11
2020
Statut:
ppublish
Résumé
During cochlear implant (CI) surgery, visual detection of the stapedius reflex as movements of the stapes tendon, electrically elicited via the CI, is a standard measure to confirm the system's functionality. Direction visualization of the stapedius muscle (SM) movements might be more reliable, but a safe access to the small SM is not defined. A new surgical planning tool for pre-operative evaluation of the accessibility to the stapedius muscle (SM) during a cochlear implantation (CI) via a retrofacial approach was now evaluated. A surgical planning tool was developed in MATLAB using an image processing algorithm to evaluate drilling feasibility. A flat-panel computed tomography (CT) combining a rotational angiographic C-arm units with flat-panel detectors (Dyna-CT) was used. In total, 30 3D Dyna-CT-based temporal bone reconstructions were evaluated by automatized algorithms, generating a series of trajectories and comparing their feasibility and safety to reach the SM via a retrofacial approach. The predictability of the surgical planning tool results was tested in 5 patients. The surgical planning tool showed that a retrofacial access to the SM would be feasible in 25/30 cases. Moreover, the evaluation of the predictability of the results obtained with the surgical planning tool conducted during 5 CI surgeries confirmed the results. Both the surgical planning tool and the results on SM accessibility via retrofacial approach during CI showed that this is safe and feasible only when the SM-exposed area was > 25% of its total, the distance between the SM and the facial nerve was > 0.8 mm, and the surgical corridor diameter was > 3 mm. The surgical planning tool seems to be useful for the pre-operative evaluation of the accessibility to the SM during a CI surgery via a retrofacial approach. Further prospective studies are needed to validate the results in larger cohorts.
Identifiants
pubmed: 33185757
doi: 10.1007/s11548-020-02288-8
pii: 10.1007/s11548-020-02288-8
pmc: PMC7880982
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
331-343Références
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