scholarly journals Atraumatic Insertion of a Cochlear Implant Pre-Curved Electrode Array by a Robot-Automated Alignment with the Coiling Direction of the Scala Tympani

2021 ◽  
pp. 1-8
Author(s):  
Renato Torres ◽  
Baptiste Hochet ◽  
Hannah Daoudi ◽  
Fabienne Carré ◽  
Isabelle Mosnier ◽  
...  
Keyword(s):  
Navigation System ◽  
Electrode Array ◽  
Automated System ◽  
Cone Beam ◽  
Scala Tympani ◽  
Basal Turn ◽  
Coiling Direction ◽  
Grinding Technique ◽  
Temporal Bones ◽  
Automated Alignment

<b><i>Introduction:</i></b> Electrode array translocation is an unpredictable event with all types of arrays, even using a teleoperated robot in a clinical scenario. We aimed to compare the intracochlear trauma produced by the HiFocus™ Mid-Scala (MS) electrode array (Advanced Bionics, Valencia, CA, USA) using a teleoperated robot, with an automated robot connected to a navigation system to align the pre-curved tip of the electrode array with the coiling direction of the scala tympani (ST). <b><i>Methods:</i></b> Fifteen freshly frozen temporal bones were implanted with the MS array using the RobOtol® (Collin, Bagneux, France). In the first group (<i>n</i> = 10), the robot was teleoperated to insert the electrode array into the basal turn of the ST under stereomicroscopic vision, and then the array was driven by a slow-speed hydraulic insertion technique with an estimated placement of the pre-curved electrode tip. In the second group (<i>n</i> = 5), 3 points were obtained from the preoperative cone-beam computed tomography: the 2 first defining the ST insertion axis of the basal turn and a third one at the center of the ST at 270°. They provided the information to the automated system (RobOtol® connected with a navigation system) to automatically align the electrode array with the ST insertion axis and to aim the pre-curved tip toward the subsequent coiling of the ST. After this, the electrode array was manually advanced. Finally, the cochleae were obtained and fixed in a crystal resin, and the position of each electrode was determined by a micro-grinding technique. <b><i>Results:</i></b> In all cases, the electrode array was fully inserted into the cochlea and the depth of insertion was similar using both techniques. With the teleoperated robotic technique, translocations of the array were observed in 7/10 insertions (70%), but neither trauma nor array translocation occurred with automated robotic insertion. <b><i>Conclusion:</i></b> We have successfully tested an automated insertion system (robot + navigation) that could accurately align a pre-curved electrode array to the axis of the basal turn of the ST and its subsequent coiling, which reduced intracochlear insertion trauma and translocation.

Pathology of labyrinthine ossification

1991 ◽  
Vol 105 (8) ◽  
pp. 621-624 ◽  
Author(s):  
Christopher deSouza ◽  
Michael M. Paparella ◽  
Pat Schachern ◽  
Tae H. Yoon
Keyword(s):  
Inner Ear ◽  
Otitis Media ◽  
Osseous Tissue ◽  
Scala Tympani ◽  
Fabry’S Disease ◽  
Fabry's Disease ◽  
Basal Turn ◽  
Vascular Compromise ◽  
Temporal Bones

AbstractOssification of the inner ear is the result of multifactorial pathogeneses, such as infection or malignant infiltration, and otosclerosis. Ossification of the innerear spaces is a well documented sequela of suppurative labyrinthitis. In this study of human temporal bones, sections from 14 patients (28 temporal bones)were studied. In additionto the osseous tissue within the inner ear, findings included neoplasms, otosclerosis, otitis media, trauma, and Fabry's disease. We have attempted to correlate these conditions and their influence on the formation of osseous tissue within the spaces of the inner ear. Tympanogenic infection and vascular compromise were found to play an important role in ossification. The scala tympani ofthe basal turn of the cochlea was frequently the site involved.

scholarly journals A Surgical Navigation System for Guiding Exact Cochleostomy Using Auditory Feedback: A Clinical Feasibility Study

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Byunghyun Cho ◽  
Nozomu Matsumoto ◽  
Shizuo Komune ◽  
Makoto Hashizume
Keyword(s):  
Feasibility Study ◽  
Navigation System ◽  
Auditory Feedback ◽  
Surgical Navigation ◽  
Complex Structure ◽  
Electrode Array ◽  
Scala Tympani ◽  
Correct Placement ◽  
Surgical Navigation System ◽  
The Common

In cochlear implantation (CI), the insertion of the electrode array into the appropriate compartment of the cochlea, the scala tympani, is important for an optimal hearing outcome. The current surgical technique for CI depends primarily on the surgeon’s skills and experience level to achieve the correct placement of the electrode array, and the surgeon needs to confirm that the exact placement is achieved prior to completing the procedure. Thus, a surgical navigation system can help the surgeon to access the scala tympani without injuring important organs in the complex structure of the temporal bone. However, the use of a surgical microscope has restricted the effectiveness of the surgical navigation because it has been difficult to deliver the navigational information to the surgeon from outside of the surgeon’s visual attention. We herein present a clinical feasibility study of an auditory feedback function developed as a computer-surgeon interface that can guide the surgeon to the preset cochleostomy location. As a result, the surgeon could confirm that the drilling point was correct, while keeping his or her eyes focused on the microscope. The proposed interface reduced the common frustration that surgeons experience when using surgical navigation during otologic surgeries.

Evaluation of the HiFocus® electrode array with positioner in human temporal bones

2003 ◽  
Vol 117 (7) ◽  
pp. 527-531 ◽  
Author(s):  
Antje Aschendorff ◽  
Thomas Klenzner ◽  
Bernhard Richter ◽  
Ralf Kubalek ◽  
Heiner Nagursky ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Electrode Array ◽  
Scala Tympani ◽  
X Ray ◽  
Temporal Bones ◽  
Scala Vestibuli

The aim of the study presented was to assess the insertion mode and possible intracochlear trauma after implantation of the HiFocus® electrode with positioner in human temporal bones. The study was performed in five freshly frozen temporal bones. The position of electrodes was evaluated using conventional X-ray analysis, rotational tomography and histomorphological analysis. Insertion of the HiFocus® electrode with positioner resulted in considerable trauma to fine cochlear structures including fracture of the osseous spiral lamina, dislocation of the electrode array from the scala tympani into the scala vestibuli and fracture of the modiolus close to the cochleostomy. The implication of the results regarding clinical outcome will be discussed.

Cochlear and Vestibular Lesions in Capsular Otosclerosis as Seen in Microdissection

1978 ◽  
Vol 87 (2_suppl2) ◽  
pp. 1-40 ◽  
Author(s):  
Lars-Göran Johnsson ◽  
Joseph E. Hawkins ◽  
Fred H. Linthicum
Keyword(s):  
Hair Cells ◽  
Round Window ◽  
Organ Of Corti ◽  
Otic Capsule ◽  
Scala Tympani ◽  
Toxic Factor ◽  
Basal Turn ◽  
Vestibular Pathology ◽  
Temporal Bones ◽  
State Of Activity

In 24 temporal bones from patients with otosclerosis prepared by the method of microdissection and surface preparations, otosclerotic foci could be clearly seen during removal of the otic capsule. The state of activity of each focus was estimated on the basis of its consistency and vascularity. Small anterior foci constituted the most common form of involvement of the otic capsule. All were judged to be inactive, and none of them appeared to have caused obvious sensorineural degeneration. No cases of “pure cochlear otosclerosis” were seen. Sensorineural degeneration was associated with large anterior foci which reached the upper basal turn. One specimen displayed a circumscribed sensorineural degeneration in the upper basal turn, with an almost exact correspondence between the location and extent of the cochlear lesion and the site of invasion by the otosclerotic process in the bone and endosteum bordering on scala media and scala tympani. It is postulated that a toxic factor had diffused from the focus and acted directly on the organ of Corti. When multiple foci were present they were usually poorly defined. The otosclerotic process involved the round window, with new lamellar bone formation in the scala tympani of the lower half of the basal turn. The most extensive sensorineural degeneration in the entire material was seen in this group. One specimen also had severe cochlear hydrops. In three specimens large shunts were observed to connect the otosclerotic foci with the cochlear vasculature, which was severely dilated. Where otosclerosis involved the endosteum of the scala tympani, loss of vessels was observed. One specimen with extensive active capsular otosclerosis had severe sensorineural degeneration of the vestibular system. Vestibular pathology in fenestrated ears is also described. In a specimen from a patient with no caloric reaction, numerous hair cells were present in the macular organs.

Comparative Measurements of Cochlear Apparatus

1968 ◽  
Vol 11 (2) ◽  
pp. 229-235 ◽  
Author(s):  
Makoto Igarashi ◽  
Robert G. Mahon ◽  
Shizuo Konishi
Keyword(s):  
Cross Section ◽  
Basilar Membrane ◽  
Stria Vascularis ◽  
The Other ◽  
Tectorial Membrane ◽  
Spiral Ligament ◽  
Scala Tympani ◽  
Basal Turn ◽  
Temporal Bones ◽  
Scala Vestibuli

Micromeasurements of horizontal midmodiolar sections of temporal bones were performed to obtain the dimensions of the different cochlear partitions in the squirrel monkey, the cat, and the rat. The width of the basilar membrane and the tectorial membrane were larger in the apical turn than in the basal turn in all three species. The thickness of the spiral ligament, the width of Reissner’s membrane, and the width of the stria vascularis were larger in the basal turn than in the apical turn. The cross-section areas of scala vestibuli and scala tympani in the three species were larger in the basal turn than in the other turns.

An Optimized Robot-Based Technique for Cochlear Implantation to Reduce Array Insertion Trauma

2018 ◽  
Vol 159 (5) ◽  
pp. 900-907 ◽  
Author(s):  
Renato Torres ◽  
Huan Jia ◽  
Mylène Drouillard ◽  
Jean-Loup Bensimon ◽  
Olivier Sterkers ◽  
...  
Keyword(s):  
Analysis Of Variance ◽  
Tracking System ◽  
Electrode Array ◽  
Electrode Position ◽  
Scala Tympani ◽  
Insertion Technique ◽  
Insertion Depth ◽  
Insertion Tool ◽  
Temporal Bones ◽  
Section Analysis

Objective To compare the intracochlear trauma induced by optimized robot-based and manual techniques with a straight electrode array prototype inserted at different lengths. Study Design Experimental study. Setting Robot-based otologic surgery laboratory. Subjects and Methods A prototype array was inserted at different insertion lengths (21 and 25 mm) in 20 temporal bones. The manual insertion was performed with a microforceps. The optimized approach consisted of an optimal axis insertion provided by a robot-based arm controlled by a tracking system, with a constant speed of insertion (0.25 mm/s) achieved by a motorized insertion tool. The electrode position was determined at the level of each electrode by stereomicroscopic cochlea section analysis. Results A higher number of electrodes correctly located in the scala tympani was associated with the optimized approach ( P = .03, 2-way analysis of variance). Regardless of the insertion technique used, the array inserted at 25 mm allowed complete insertion of the active stimulating portion of the array in all cases. Insertion depth was greater when the array was inserted to 25 mm versus 21 mm ( P < .001, 2-way analysis of variance). The optimized insertion was associated with less trauma than that from manual insertion regardless the length of the inserted array ( P = .04, 2-way analysis of variance). Conclusion Compared with a manual insertion, intracochlear trauma could be reduced with array insertion performed on an optimal axis by using motorized insertion and by applying a constant insertion speed.

Insertion characteristics and placement of the Mid-Scala electrode array in human temporal bones using detailed cone beam computed tomography

2016 ◽  
Vol 273 (12) ◽  
pp. 4135-4143 ◽  
Author(s):  
Aarno Dietz ◽  
Dzemal Gazibegovic ◽  
Jyrki Tervaniemi ◽  
Veli-Matti Vartiainen ◽  
Heikki Löppönen
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Electrode Array ◽  
Cone Beam ◽  
Temporal Bones

Cone beam computed tomography and histological evaluations of a straight electrode array positioning in temporal bones

2016 ◽  
Vol 137 (3) ◽  
pp. 229-234 ◽  
Author(s):  
Isabelle Mosnier ◽  
Charlotte Célérier ◽  
Jean-Loup Bensimon ◽  
Daniele de Seta ◽  
Olivier Sterkers ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Electrode Array ◽  
Cone Beam ◽  
Temporal Bones

Electron Microscopic Findings in Presbycusic Degeneration of the Basal Turn of the Human Cochlea

1979 ◽  
Vol 87 (6) ◽  
pp. 818-836 ◽  
Author(s):  
Joseph B. Nadol
Keyword(s):  
Light Microscopy ◽  
Hair Cells ◽  
Basilar Membrane ◽  
Ganglion Cells ◽  
Nerve Fibers ◽  
Degenerative Changes ◽  
Supporting Cells ◽  
Neural Degeneration ◽  
Basal Turn ◽  
Temporal Bones

Three human temporal bones with presbycusis affecting the basal turn of the cochlea were studied by light and electron microscopy. Conditions in two ears examined by light microscopy were typical of primary neural degeneration, with a descending audiometric pattern, loss of cochlear neurons in the basal turn, and preservation of the organ of Corti. Ultrastructural analysis revealed normal hair cells and marked degenerative changes of the remaining neural fibers, especially in the basal turn. These changes included a decrease in the number of synapses at the base of hair cells, accumulation of cellular debris in the spiral bundles, abnormalities of the dendritic fibers and their sheaths in the osseous spiral lamina, and degenerative changes in the spiral ganglion cells and axons. These changes were interpreted as an intermediate stage of degeneration prior to total loss of nerve fibers and ganglion cells as visualized by light microscopy. In the third ear the changes observed were typical of primary degeneration of hair and supporting cells in the basal turn with secondary neural degeneration. Additional observations at an ultrastructural level included maintenance of the tight junctions of the scala media despite loss of both hair and supporting cells, suggesting a capacity for cellular “healing” in the inner ear. Degenerative changes were found in the remaining neural fibers in the osseous spiral lamina. In addition, there was marked thickening of the basilar membrane in the basal turn, which consisted of an increased number of fibrils and an accumulation of amorphous osmiophilic material in the basilar membrane. This finding supports the concept that mechanical alterations may occur in presbycusis of the basal turn.

Sign in / Sign up

Export Citation Format

Share Document