Intraoperative Conebeam CT for Assessment of Intracochlear Positioning of Electrode Arrays in Adult Recipients of Cochlear Implants

Abstract

Intraoperative conebeam CT using the O-arm is a safe, rapid, easy, and reliable procedure to immediately identify a misplacement or foldover of an electrode array. The insertion depth angle, insertion length, and number of electrodes inserted can be accurately assessed.

Review on cochlear implant electrode array tip fold-over and scalar deviation

“…(2018)23 (CT)–MS (23)–2Gabrielpillai et al. (2018)1722 (CT) No info on brand segments 7 (CA), 6 (SM), 2(SS)Jia et al. (2018)65 (Intra-op CT)(Contains 3 electrodes from Oticon)CA (12), SM (1), SS (31)1J (2), MS (3)F28 (13)1 (SM)Sabban et al.…”

“…Electrode scalar deviation is another important and the most traumatic event that could happen inside the cochlea during electrode placement. A total of 26 peer-reviewed publications were found reporting on intra-cochlear electrode array scalar deviation in patient cases with the current commercially available electrode types (McJunkin et al., 2018; Mittmann et al., 2017; Koka et al., 2018; Dirr et al., 2013; Sipari et al., 2018; Jia et al., 2018; Aschendorff et al., 2017; Fischer et al., 2015; Shaul et al., 2018; Ketterer et al., 2017; An et al., 2017; O'Connell et al., 2017a; O'Connell et al., 2017b; Lathuillière et al., 2017; O'Connell et al., 2016a; O'Connell et al., 2016b; Wanna et al., 2015; Nordfalk et al., 2016; Mittmann et al., 2015a; Mittmann et al., 2015b; Mittmann et al., 2015c; Boyer et al., 2015; Wanna et al., 2014; Nordfalk et al., 2014; Aschendorff et al., 2011; Wanna et al., 2011; Lane et al., 2007) and were summarized in Table 2.…”

“…(2018)23Imaging–MS (23)––5 (22%)–Koka et al. (2018)32Imaging/EcochG–MS (32)––7 (22%)–Jia et al. (2018)65ImagingCA (12), SM(1), SS (31)1J (2), MS (3)F28 (16),1 (8%)1 (20%)–McJunkin et al.…”

“…Grade 1 and 2 degree of trauma cannot be detected conclusively by the clinical CT due to the image artefact but grade 3 and 4 can be conclusively detected. There is enough number of publications since 2007 that reported on electrode tip fold-over (McJunkin et al., 2018; Sabban et al., 2018; Dirr et al., 2013; Timm et al.; Sipari et al., 2018; Gabrielpillai et al., 2018; Jia et al., 2018; Garaycochea et al., 2017; Aschendorff et al., 2017; Zuniga et al., 2017; Fischer et al., 2015; Cosetti et al., 2012; Grolman et al., 2009) and electrode scalar deviation (McJunkin et al., 2018; Mittmann et al., 2017; Koka et al., 2018; Dirr et al., 2013; Sipari et al., 2018; Jia et al., 2018; Aschendorff et al., 2017; Shaul et al., 2018; Ketterer et al., 2017; An et al., 2017; O'Connell et al., 2017a; O'Connell et al., 2017b; Lathuillière et al., 2017; O'Connell et al., 2016a; O'Connell et al., 2016b; Wanna et al., 2015; Nordfalk et al., 2016; Mittmann et al., 2015a; Mittmann et al., 2015b; Mittmann et al., 2015c; Boyer et al., 2015; Wanna et al., 2014; Nordfalk et al., 2014; Aschendorff et al., 2011; Wanna et al., 2011; Lane et al., 2007) detected with x-ray, clinical CT, NRT and ECochG methods. All the commercially available CI electrodes vary in its size, shape and the method of insertion, the operating surgeon should be well informed about all these variation before the surgery.…”

Simpler and effective radiological evaluations for modiolar proximity of a slim modiolar cochlear implant electrode

“…With the advent of cone-beam CT based on flat-panel volumetric technology, significantly better image quality enables clear delineation of the intracochlear electrode array with more definition of the fine osseous structures surrounding the temporal bone 26 , 27 . Although a previous ex vivo study showed that the average electrode-to-modiolus distance value measured by two imaging modalities (conventional CT vs. cone-beam CT) was not different 28 , measurement of electrode-to-modiolus distance using conventional CT is not feasible due to metal artifacts blurring the region of interest.…”