Use of intraoperative CT scanning for quality control assessment of cochlear implant electrode array placement*

Abstract

Background: Imaging of cochlear implant (CI) electrode arrays (EAs) consists of intraoperative fluoroscopy to rule out tip fold-over and/or post-operative computerized tomography (CT) if concern exists regarding extrusion or misplacement of the EA. Intraoperative CT (iCT) can satisfy these current needs and enables specification of final intracochlear position.

Aims/objectives: To describe iCT scanning of CI recipients at an academic medical center.

Materials and methods: iCT was used to scan CI recipients within the operating room before recovering from general anesthesia.

Results: In fiscal year 2019, 301 CI were placed (83 children, 218 adult). One hundred, seventy-five iCTs were performed (58% of total CIs) of which 52 were children (63% of pediatric CIs) and 123 were adult (57% of adult CIs). Of 7 CI surgeons, use of iCT ranged from 14% to 100% (mean 60%). Four tip fold-overs were identified and corrected intraoperatively. Surgeons reported using the images to improve technique (i.e. pulling back precurved EAs to improve perimodiolar positioning).

Conclusion and significance: The current standard of care for CI is to insert EAs without feedback as to final location. iCT provides surgeons with rapid post-insertion feedback which allows detection and correction of suboptimally placed EAs as well as refinement of surgical technique.

Chinese abstract

背景：人工耳蜗植入（CI）电极阵列成像术包括术中透视以排除尖端折叠和/或术后计算机断层扫描（CT）, 如果担心对阵列的挤压或错位。术中CT（iCT）可以满足这些需求, 并能确定最终耳蜗内位置。

目的：描述在学术医疗中心对CI接受者进行iCT扫描的情况。

材料与方法：在手术室内, 采用iCT对CI接受者进行全身麻醉恢复前的扫描。

结果：在2019财政年度, 共植入301个CI（83名儿童, 218名成人）。共进行了175例iCT（占总CIs的58%）, 其中儿童52例（占儿童CIs的63%）, 成人123例（占成人CIs的57%）。在7名CI外科医生中, iCT的使用率从13.5%到100%（平均60%）。术中发现并纠正了四个叶尖折叠。外科医生报告使用这些图像可以改进技术（即拉回预弯电极以改善近蜗轴定位）。

结论及意义：目前CI的护理标准是在没有关于最终位置的反馈的情况下插入电极阵列。iCT为外科医生提供了快速的插入后反馈, 允许检测和纠正放置欠佳的EA, 并改进手术技术。

Keywords:

• Cochlear implantation
• computerized tomography
• intraoperative imaging
• quality control

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Research reported in this publication was supported by the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health under award numbers R01DC008408 (PI – RFL) and R01DC014462 (PI – BD). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.