Clinical validation study of percutaneous cochlear access using patient-customized microstereotactic frames.
Clinical validation study of percutaneous cochlear access using patient-customized microstereotactic frames.
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DOI：
10.1097/mao.0b013e3181c2f81a
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发表时间：
2010-01
期刊：
影响因子：
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通讯作者：
Fitzpatrick JM
中科院分区：
文献类型：
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作者：
Labadie RF;Balachandran R;Mitchell JE;Noble JH;Majdani O;Haynes DS;Bennett ML;Dawant BM;Fitzpatrick JM
经皮耳蜗植入术（PCI）包括从侧颅到耳蜗钻一个槽，避开重要解剖结构。为了完成PCI，我们使用患者定制的微型立体定向框架，我们称之为“微型手术台”，因为它由一个放在腿上的小桌面组成。腿的方向控制床面的对齐，使其垂直于指定的轨迹。有前途。三级转诊中心。13例患者（18耳）接受传统CI手术。经IRB批准，每名患者在耳周围的骨中植入三个基准标记。获得颞骨CT扫描，并定位标记物以及重要解剖结构。计划从侧颅通过面神经隐窝到耳蜗的线性轨迹。制作了一个微型工作台，以遵循指定的轨迹。在乳突切除术和后鼓室切开术后，通过将微型表安装在骨植入标记上，然后将假钻头穿过面神经窝到达耳蜗，验证轨迹的准确性。测量钻头到重要解剖结构的距离。每个微型台在CNC铣床上在5分钟内构建。18例均成功经面隐窝进入耳蜗。从钻头中部到面神经的平均值±标准差为1.20 ± 0.36 mm，从鼓索到面神经的平均值±标准差为1.25 ± 0.33 mm。这些结果证明了使用定制的微立体定向框架进行PCI入路的可行性。
Percutaneous cochlear implant (PCI) surgery consists of drilling a single trough from the lateral skull to the cochlea avoiding vital anatomy. To accomplish PCI, we utilize a patient-customized, micro-stereotactic frame, which we call a “microtable” because it consists of a small tabletop sitting on legs. The orientation of the legs controls the alignment of the tabletop such that it is perpendicular to a specified trajectory. Prospective. Tertiary referral center. Thirteen patients (eighteen ears) undergoing traditional CI surgery. With IRB approval, each patient had three fiducial markers implanted in bone surrounding the ear. Temporal bone CT scans were obtained and the markers were localized, as was vital anatomy. A linear trajectory from the lateral skull through the facial recess to the cochlea was planned. A microtable was fabricated to follow the specified trajectory. After mastoidectomy and posterior tympanotomy, accuracy of trajectories was validated by mounting microtables on bone-implanted markers and then passing sham drill bits across the facial recess to the cochlea. Distance from the drill to vital anatomy was measured. Microtables were constructed on a CNC milling machine in under 5 minutes each. Successful access across the facial recess to the cochlea was achieved in all 18 cases. The mean ± standard deviation from mid-portion of the drill to the facial nerve was 1.20 ± 0.36 mm and from the chorda tympani was 1.25 ± 0.33 mm. These results demonstrate the feasibility of PCI access using customized, micro-stereotactic frames.