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Individual Optimization of the Insertion of a Preformed Cochlear Implant Electrode Array.

Rau TS, Lenarz T, Majdani O - Int J Otolaryngol (2015)

Bottom Line: Conclusion.This finding leads to the conclusion that, in general, consideration of the specific curling behaviour of a CI electrode array is beneficial in terms of less traumatic insertion.Therefore, these results highlight an entirely novel aspect of clinical application of preformed perimodiolar electrode arrays in general.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.

ABSTRACT
Purpose. The aim of this study was to show that individual adjustment of the curling behaviour of a preformed cochlear implant (CI) electrode array to the patient-specific shape of the cochlea can improve the insertion process in terms of reduced risk of insertion trauma. Methods. Geometry and curling behaviour of preformed, commercially available electrode arrays were modelled. Additionally, the anatomy of each small, medium-sized, and large human cochlea was modelled to consider anatomical variations. Finally, using a custom-made simulation tool, three different insertion strategies (conventional Advanced Off-Stylet (AOS) insertion technique, an automated implementation of the AOS technique, and a manually optimized insertion process) were simulated and compared with respect to the risk of insertion-related trauma. The risk of trauma was evaluated using a newly developed "trauma risk" rating scale. Results. Using this simulation-based approach, it was shown that an individually optimized insertion procedure is advantageous compared with the AOS insertion technique. Conclusion. This finding leads to the conclusion that, in general, consideration of the specific curling behaviour of a CI electrode array is beneficial in terms of less traumatic insertion. Therefore, these results highlight an entirely novel aspect of clinical application of preformed perimodiolar electrode arrays in general.

No MeSH data available.


Related in: MedlinePlus

Schematic illustration of the Advanced Off-Stylet (AOS) technique. (a) The electrode array is inserted into the inner ear with the stylet inside until a marker is at the level of the cochleostomy site. (b) The stylet is kept stationary and the implant is advanced further into the cochlea until full insertion depth is achieved (image provided by courtesy of Karl STORZ, Tuttlingen, Germany).
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fig2: Schematic illustration of the Advanced Off-Stylet (AOS) technique. (a) The electrode array is inserted into the inner ear with the stylet inside until a marker is at the level of the cochleostomy site. (b) The stylet is kept stationary and the implant is advanced further into the cochlea until full insertion depth is achieved (image provided by courtesy of Karl STORZ, Tuttlingen, Germany).

Mentions: However, the integrated curling mechanism provides the opportunity to modify not only the pose but also the shape of the electrode array with regard to the individual anatomy. This entails the replacement of a uniform insertion technique (such as the Advanced Off-Stylet (AOS) technique; see Section 2.2.2 and Figure 2) by a patient-specific one. This is, of course, possible only on a limited scale as the commercially available perimodiolar implants are not developed and designed for this purpose, and additional intraoperative surgical assistance devices are necessary because an individually optimized insertion process can no longer be performed manually. Nevertheless, thanks to recent advances in surgical master-slave systems [12], and especially in robot-assisted devices for CI surgery [13–18], as well as in automated insertion tools [11, 19–25], it seems to be only a question of time until accurate assistance devices can be used intraoperatively for electrode insertion.


Individual Optimization of the Insertion of a Preformed Cochlear Implant Electrode Array.

Rau TS, Lenarz T, Majdani O - Int J Otolaryngol (2015)

Schematic illustration of the Advanced Off-Stylet (AOS) technique. (a) The electrode array is inserted into the inner ear with the stylet inside until a marker is at the level of the cochleostomy site. (b) The stylet is kept stationary and the implant is advanced further into the cochlea until full insertion depth is achieved (image provided by courtesy of Karl STORZ, Tuttlingen, Germany).
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4581552&req=5

fig2: Schematic illustration of the Advanced Off-Stylet (AOS) technique. (a) The electrode array is inserted into the inner ear with the stylet inside until a marker is at the level of the cochleostomy site. (b) The stylet is kept stationary and the implant is advanced further into the cochlea until full insertion depth is achieved (image provided by courtesy of Karl STORZ, Tuttlingen, Germany).
Mentions: However, the integrated curling mechanism provides the opportunity to modify not only the pose but also the shape of the electrode array with regard to the individual anatomy. This entails the replacement of a uniform insertion technique (such as the Advanced Off-Stylet (AOS) technique; see Section 2.2.2 and Figure 2) by a patient-specific one. This is, of course, possible only on a limited scale as the commercially available perimodiolar implants are not developed and designed for this purpose, and additional intraoperative surgical assistance devices are necessary because an individually optimized insertion process can no longer be performed manually. Nevertheless, thanks to recent advances in surgical master-slave systems [12], and especially in robot-assisted devices for CI surgery [13–18], as well as in automated insertion tools [11, 19–25], it seems to be only a question of time until accurate assistance devices can be used intraoperatively for electrode insertion.

Bottom Line: Conclusion.This finding leads to the conclusion that, in general, consideration of the specific curling behaviour of a CI electrode array is beneficial in terms of less traumatic insertion.Therefore, these results highlight an entirely novel aspect of clinical application of preformed perimodiolar electrode arrays in general.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.

ABSTRACT
Purpose. The aim of this study was to show that individual adjustment of the curling behaviour of a preformed cochlear implant (CI) electrode array to the patient-specific shape of the cochlea can improve the insertion process in terms of reduced risk of insertion trauma. Methods. Geometry and curling behaviour of preformed, commercially available electrode arrays were modelled. Additionally, the anatomy of each small, medium-sized, and large human cochlea was modelled to consider anatomical variations. Finally, using a custom-made simulation tool, three different insertion strategies (conventional Advanced Off-Stylet (AOS) insertion technique, an automated implementation of the AOS technique, and a manually optimized insertion process) were simulated and compared with respect to the risk of insertion-related trauma. The risk of trauma was evaluated using a newly developed "trauma risk" rating scale. Results. Using this simulation-based approach, it was shown that an individually optimized insertion procedure is advantageous compared with the AOS insertion technique. Conclusion. This finding leads to the conclusion that, in general, consideration of the specific curling behaviour of a CI electrode array is beneficial in terms of less traumatic insertion. Therefore, these results highlight an entirely novel aspect of clinical application of preformed perimodiolar electrode arrays in general.

No MeSH data available.


Related in: MedlinePlus