Minimally invasive image‐guided cochlear implantation surgery: First report of clinical implementation

Labadie, Robert F.; Balachandran, Ramya; Noble, Jack H.; Blachon, Grégoire S.; Mitchell, Jason E.; Reda, Fitsum A.; Dawant, Benoît M.; Fitzpatrick, J. Michael

doi:10.1002/lary.24520

Cited by 112 publications

(116 citation statements)

References 28 publications

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“…By the application of robotic systems, ideal trajectories may be determined preoperatively, along which for example drilling is performed from the mastoid surface to the cochlea [38]. The cochlea can be opened through this drill canal and the electrode is securely inserted by means of special insertion tools ( Figure 24).…”

Section: Robotic or Minimally Invasive Surgerymentioning

confidence: 99%

Cochlear Implant – State of the Art

2017

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Cochlear implants are the treatment of choice for auditory rehabilitation of patients with sensory deafness. They restore the missing function of Thomas Lenarz 1 inner hair cells by transforming the acoustic signal into electrical stimuli in the majority of patients including the use of the telephone. Children can achieve a near to normal speech and language development provided their deafness is detected early after onset and implantation is performed quickly thereafter. The diagnostic procedure as well as the surgical technique have been standardized and can be adapted to the individual anatomical and physiological needs both in children and adults. Special cases such as cochlear obliteration might require special measures and re-implantation, which can be done in most cases in a straight forward way. Technology upgrades count for better performance. Future developments will focus on better electrode-nerve interfaces by improving electrode technology. An increased number of electrical contacts as well as the biological treatment with regeneration of the dendrites growing onto the electrode will increase the number of electrical channels. This will give room for improved speech coding strategies in order to create the bionic ear, i.e. to restore the process of natural hearing by means of technology. The robot-assisted surgery will allow for high precision surgery and reliable hearing preservation. Biological therapies will support the bionic ear. Methods are bio-hybrid electrodes, which are coded by stem cells transplanted into the inner ear to enhance auto-production of neurotrophins. Local drug delivery will focus on suppression of trauma reaction and local regeneration. Gene therapy by nanoparticles will hopefully lead to the preservation of residual hearing in patients being affected by genetic hearing loss. Overall the cochlear implant is a very powerful tool to rehabilitate patients with sensory deafness. More than 1 million of candidates in Germany today could benefit from this high technology auditory implant. Only 50,000 are implanted so far. In the future, the procedure can be done under local anesthesia, will be minimally invasive and straight forward. Hearing preservation will be routine.Keywords: cochlear implant, sensory deafness, diagnostics, surgical procedure, results, complications, future developments SummaryCochlear implants are electronical stimulus prostheses for the functional replacement of the inner ear. Because of the rapid technical development and the good results, they could be established as standard therapy for sensory deafness. Cochlear implantation requires an interdisciplinary team and a quality-controlled concepts that reaches from the indication to the life-long control and that is fixed in the AWMF guideline on cochlear implant [1]. Current cochlear implant systems are partially implantable and equipped with a multitude of additional functions similar to hearing aids for sound pre-processing and noise elimination. The intracochlear position of the electrode allows fo...

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Section: Robotic or Minimally Invasive Surgerymentioning

confidence: 99%

Cochlear Implant – State of the Art

2017

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“…Microstereotactic frames [21] as well as surgical robot systems [22]-which could fulfil that task-are currently under development; however they still have to prove their clinical suitability.…”

Section: Outlook On Further Researchmentioning

confidence: 99%

Toward steerable electrodes. An overview of concepts and current research.

Rau

Hügl

Lenarz

et al. 2017

Current Directions in Biomedical Engineering

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Abstract:Restoration of hearing is a demanding surgical task which requires the insertion of a cochlear implant electrode array into the inner ear while preserving the delicate basilar membrane inside the cochlea for an atraumatic insertion. Already shortly after the first clinical success with early versions of cochlear implants the desire for a controlled insertion of the electrode array arose. Such a steerable electrode should be in its shape adaptable to the individual path of the helical inner ear in order to avoid any contact between the implant and the surrounding tissue. This article provides a short overview of concepts and actuator mechanisms investigated in the past and present with the objective of developing a steerable electrode array for an individualized insertion process. Although none of these concepts has reached clinical implementation, there are promising experimental results indicating that insertion forces can be reduced up to 60% compared to straight and not steerable electrodes. Finally, related research topics are listed which require considerable further improvements until steerable electrodes will reach clinical applicability.

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“…[3][4][5] Since drilling is performed in highly sensitive areas inside the human head during these operations -crucial structures like the facial nerve, chorda tympani etc. can be damaged -research is highly advisable to ensure atraumatic drilling precision control.…”

Section: Introductionmentioning

confidence: 99%

Panorama imaging for image-to-physical registration of narrow drill holes inside spongy bones

et al. 2017

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Image-to-physical registration based on volumetric data like computed tomography on the one side and intraoperative endoscopic images on the other side is an important method for various surgical applications. In this contribution, we present methods to generate panoramic views from endoscopic recordings for image-to-physical registration of narrow drill holes inside spongy bone. One core application is the registration of drill poses inside the mastoid during minimally invasive cochlear implantations. Besides the development of image processing software for registration, investigations are performed on a miniaturized optical system, achieving 360°radial imaging with one shot by extending a conventional, small, rigid, rod lens endoscope. A reflective cone geometry is used to deflect radially incoming light rays into the endoscope optics. Therefore, a cone mirror is mounted in front of a conventional 0°endoscope. Furthermore, panoramic images of inner drill hole surfaces in artificial bone material are created. Prior to drilling, cone beam computed tomography data is acquired from this artificial bone and simulated endoscopic views are generated from this data. A qualitative and quantitative image comparison of resulting views in terms of image-to-image registration is performed. First results show that downsizing of panoramic optics to a diameter of 3 mm is possible. Conventional rigid rod lens endoscopes can be extended to produce suitable panoramic one-shot image data. Using unrolling and stitching methods, images of the inner drill hole surface similar to computed tomography image data of the same surface were created. Registration is performed on ten perturbations of the search space and results in target registration errors of (0.487 ± 0.438) mm at the entry point and (0.957 ± 0.948) mm at the exit as well as an angular error of (1.763 ± 1.536)°. The results show suitability of this image data for image-to-image registration. Analysis of the error components in different directions reveals a strong influence of the pattern structure, meaning higher diversity results into smaller errors.

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Minimally invasive image‐guided cochlear implantation surgery: First report of clinical implementation

Cited by 112 publications

References 28 publications

Cochlear Implant – State of the Art

Cochlear Implant – State of the Art

Toward steerable electrodes. An overview of concepts and current research.

Panorama imaging for image-to-physical registration of narrow drill holes inside spongy bones

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