Surgery of the ear and the lateral skull base: pitfalls and complications

Schick, Bernhard; Dlugaiczyk, Julia

doi:10.3205/cto000097

Cited by 15 publications

(5 citation statements)

References 383 publications

(646 reference statements)

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“…For example, semicircular canal injury from cholesteatoma removal can lead to severe sensorineural hearing loss, 1 while accidental contact with middle ear ossicles can cause conductive hearing loss from ossicular chain dislocation. 2 Even in patients with normal anatomy, an estimated 1.6% of patients reported permanent changes in taste after cochlear implantation at the end of their follow-up period. 3-5 In more rare cases, patients are at risk for facial paralysis from accidental damage to the facial nerve or cerebrospinal fluid leakage from penetration of the surrounding dura.…”

mentioning

confidence: 99%

Automated Registration‐Based Temporal Bone Computed Tomography Segmentation for Applications in Neurotologic Surgery

Ding¹,

Lu²,

et al. 2021

Otolaryngol.--head neck surg.

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Objective This study investigates the accuracy of an automated method to rapidly segment relevant temporal bone anatomy from cone beam computed tomography (CT) images. Implementation of this segmentation pipeline has potential to improve surgical safety and decrease operative time by augmenting preoperative planning and interfacing with image-guided robotic surgical systems. Study Design Descriptive study of predicted segmentations. Setting Academic institution. Methods We have developed a computational pipeline based on the symmetric normalization registration method that predicts segmentations of anatomic structures in temporal bone CT scans using a labeled atlas. To evaluate accuracy, we created a data set by manually labeling relevant anatomic structures (eg, ossicles, labyrinth, facial nerve, external auditory canal, dura) for 16 deidentified high-resolution cone beam temporal bone CT images. Automated segmentations from this pipeline were compared against ground-truth manual segmentations by using modified Hausdorff distances and Dice scores. Runtimes were documented to determine the computational requirements of this method. Results Modified Hausdorff distances and Dice scores between predicted and ground-truth labels were as follows: malleus (0.100 ± 0.054 mm; Dice, 0.827 ± 0.068), incus (0.100 ± 0.033 mm; Dice, 0.837 ± 0.068), stapes (0.157 ± 0.048 mm; Dice, 0.358 ± 0.100), labyrinth (0.169 ± 0.100 mm; Dice, 0.838 ± 0.060), and facial nerve (0.522 ± 0.278 mm; Dice, 0.567 ± 0.130). A quad-core 16GB RAM workstation completed this segmentation pipeline in 10 minutes. Conclusions We demonstrated submillimeter accuracy for automated segmentation of temporal bone anatomy when compared against hand-segmented ground truth using our template registration pipeline. This method is not dependent on the training data volume that plagues many complex deep learning models. Favorable runtime and low computational requirements underscore this method’s translational potential.

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mentioning

confidence: 99%

Automated Registration‐Based Temporal Bone Computed Tomography Segmentation for Applications in Neurotologic Surgery

Ding¹,

Lu²,

et al. 2021

Otolaryngol.--head neck surg.

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“… 5 Accidental opening of the inner ear during the surgery jeopardizes its function and often leads to hearing loss even after intense sealing of the defect. 6 24 High variability and inconsistency of the arcuate eminence limits its reliability as a surgical landmark in hearing preserving operations on the inner ear.…”

Section: Discussionmentioning

confidence: 99%

Phenotypical Variability of the Internal Acoustic Canal in the Middle Cranial Fossa Surgery

Al-Fauri

Kelly

Lee

et al. 2022

J Neurol Surg B Skull Base

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Introduction: The wide range of anatomical variability of the structures of the middle cranial fossa and the lack of reliable surgical landmarks contribute to a high level of complications in the surgical treatment of vestibular schwannomas. We hypothesized that the cranial phenotype influences the shape of the middle cranial fossa, the orientation of the pyramid of the temporal bone, and the relative topography of the internal acoustic canal. Materials and Methods: The skull base structures were studied on 54 embalmed cadavers and 60 MR images of the head and neck by photo modeling, dissection, and 3D analysis techniques. By the value of the cranial index, all specimens were subdivided into dolichocephalic, mesocephalic, and brachycephalic groups for comparison of variables. Results: The length of the superior border of the temporal pyramid, the apex to squama distance, and the width of the middle cranial fossa all peaked in the brachycephalic group. The value of the angle between the superior border of the pyramid and the axis of the acoustic canal varied from 33 to 58 º; it peaked in the dolichocephalic group and showed its smaller value in the brachycephalic one. The pyramid to squama angle had reversed distribution and dominated in the brachycephalic group. Conclusions: The cranial phenotype influences the shape of the middle cranial fossa, temporal pyramid, and internal acoustic canal. Presented in this paper data help specialists operating on the vestibular schwannoma to localize the internal acoustic canal based on the individual shape of a skull.

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“…Furthermore, revision surgeries may be required in cases where infections persist, where recurrent or residual cholesteatoma is detected or suspicious, or to correct a failed ossicular reconstruction [ 6 ]. Cases requiring multiple surgeries are likely to impart significant time and financial burden on the healthcare system [ 7 ] and are also associated with risks and complications [ 8 ]. It is estimated that around 30% of patients do not receive a substantial hearing improvement following middle ear surgery [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Healthcare consumption among subjects with otitis media undergoing middle ear surgery—analysis of cost drivers

Lewis¹,

Backous

Choi

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose To map healthcare utilized by subjects with chronic otitis media, with or without cholesteatoma and perform a cost analysis to determine key drivers of healthcare expenditure. Methods A registry study of 656 adult subjects with chronic otitis media that underwent a middle ear surgery between 2014 and 2018. Healthcare contacts related to all publicly funded specialist ENT care, audiological care and primary care for a disease of the ear and mastoid process were extracted. The data are extracted from the Swedish National Patient Registry on subjects that reside in western Sweden. Results Subjects made 13,782 healthcare contacts at a total cost 61.1 million SEK (6.0 million EUR) between 2014 and 2018. The mean cost per subject was 93,075 SEK (9071 EUR) and ranged between 3971 SEK (387 EUR) and 468,711 SEK (45,683 EUR) per individual. In the most expensive quartile of subjects, mean cost was 192,353 SEK (18,747 EUR) over the 5-year period. These subjects made 3227 ENT contacts (roughly four each year) and 60% of total costs were associated with in-patient ENT care. Conclusion Patients with chronic otitis media are associated with high ENT resource utilization that does not diminish after surgical intervention and the disease places a long-term burden on healthcare systems. Significant costs are attributed to revision surgeries, indicating that these patients could be managed more effectively. In many such cases, reoperation cannot be avoided, especially due to recurrence of cholesteatoma. However, in some patients, when the indication for subsequent surgery is only hearing improvement, alternative options, such as hearing aids or implants, should also be considered. This is especially true in difficult cases, where revision ossiculoplasty is likely.

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Surgery of the ear and the lateral skull base: pitfalls and complications

Cited by 15 publications

References 383 publications

Automated Registration‐Based Temporal Bone Computed Tomography Segmentation for Applications in Neurotologic Surgery

Automated Registration‐Based Temporal Bone Computed Tomography Segmentation for Applications in Neurotologic Surgery

Phenotypical Variability of the Internal Acoustic Canal in the Middle Cranial Fossa Surgery

Healthcare consumption among subjects with otitis media undergoing middle ear surgery—analysis of cost drivers

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