Abstract
Objectives:
Minimally-invasive, image-guided cochlear implantation (CI) involves accessing the cochlea via a linear path from the lateral skull to the cochlea avoiding vital structures, including the facial nerve. Herein, we describe and demonstrate the feasibility of the technique for pediatric patients.
Methods:
Thirteen pediatric patients (1.5 to 8 years) undergoing traditional CI in a children’s hospital participated in this institutional review board-approved study. Three fiducial markers were bone-implanted surrounding the ear, and a computed tomography (CT) scan was acquired. The CT scan was processed to identify the marker locations and critical structures of the temporal bone. A safe linear path was then determined to target the cochlea, avoiding damage to vital structures. A custom microstereotactic frame was then fabricated that would mount on the fiducial markers and constrain a tool to the desired trajectory. After traditional mastoidectomy and prior to cochleostomy, the custom microstereotactic frame was mounted on the bone-implanted markers to confirm that the achieved trajectory is safe and accurately accesses the cochlea.
Results:
For all the 13 patients, it was possible to determine a safe trajectory to the cochlea. Custom microstereotactic frames were fabricated for the desired trajectory and validated successfully on nine patients. Two of these patients had inner ear malformation, and this technique helped the surgeon identify the location for cochleostomy. For patients with normal anatomy, the closest distance of the trajectory to facial nerve and chorda tympani were 1.26 ± 0.32 mm and 0.97 ± 0.40 mm, respectively.
Conclusions:
Minimally-invasive, image-guided cochlear implantation is feasible for pediatric patients.
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