Custom mastoid-fitting templates to improve cochlear implant electrode insertion trajectory.
Custom mastoid-fitting templates to improve cochlear implant electrode insertion trajectory.
复制标题
DOI：
10.1007/s11548-020-02193-0
复制
发表时间：
2020-10
影响因子：
3
通讯作者：
Labadie RF
中科院分区：
文献类型：
--
作者：
Morrel WG;Riojas KE;Webster RJ 3rd;Noble JH;Labadie RF
植入轨迹会影响人工耳蜗术中的最终定位，但术中有关理想轨迹的信息有限。我们试图使用自定义模板来指定插入轨迹，以改善CI电极在卵泡内的定位。三维重建是通过对三具身体的颞骨进行计算机断层扫描而建立的。与耳蜗底转直段共平面的轨迹被认为是理想的。模板被设计成与钻过的乳突表面相匹配，并通过一个中空圆柱体传递这种引导轨迹。使用立体平版印刷术对模板进行3D打印。行乳突切除术。通过测量四个模板的目标配准误差(TRE)来测试模板的准确性。一种新颖的基于辊子的插入工具(设计用于安装在模板圆柱体内)将插入约束到预期的轨迹。用MED-EL标准电极在3块骨骼上进行3种情况的植入：用插入工具引导轨迹，用插入工具非引导轨迹，用外科手术钳引导轨迹。对于最后一种情况，使用模板标记乳突以传递轨迹。当电极发生屈曲时，停止插入。TRE为0.23~0.73 mm。平均TRE±标准差为0.55±0.19 mm。与非引导轨迹相比，沿引导轨迹插入的电极平均更多(9、8、8比7、7、8)，角插入深度(AID)更大(377°、341°、320°比278°、302°、290°)。以模板为导向的钳夹置入术也取得了良好的效果(髓内电极：10、7、8；AID：478°、318°、333°)。未发生移位。定制的乳突配合模板可靠地指定了预期的插入轨迹，并提供了足够的信息，用于在模板移除后通过手动插入来重建该轨迹。该模板能准确定位颞骨内结构，TRE为0.55±0.19 mm。我们的基于滚轮的插入工具达到了与使用外科钳子手动插入相当的效果。
Insertion trajectory affects final intracochlear cochlear implant (CI) positioning, but limited information is available intraoperatively regarding ideal trajectory. We sought to improve intracochlear positioning CI electrodes using custom templates to specify insertion trajectory. 3D reconstructions were created from computed tomography of three cadaveric temporal bones. Trajectories co-planar with the straight segment of the cochlea’s basal turn were considered ideal. Templates were designed to fit against the drilled mastoid’s surface and convey this guided trajectory via a hollow cylinder. Templates were 3D-printed using stereolithography. Mastoidectomy was performed. Template accuracy was tested by measuring target registration error (TRE) for four templates. A novel, roller-based insertion tool (designed to fit within the template cylinder) constrained insertions to intended trajectories. Insertions were performed with MED-EL Standard electrodes in three bones with three conditions: guided trajectory with insertion tool, non-guided trajectory with insertion tool, and guided trajectory with surgical forceps. For the final condition, the template was used to mark the mastoid to convey trajectory. Insertion was stopped when electrode buckling occurred. TRE ranged from 0.23 mm to 0.73 mm. Mean TRE ± standard deviation was 0.55 ± 0.19 mm. Insertions along guided vs. non-guided trajectories averaged more intracochlear electrodes (9, 8, 8 vs. 7, 7, 8) and greater angular insertion depths (AID) (377°, 341°, 320° vs. 278°, 302°, 290°). Insertions performed with forceps using templates as a guide also achieved excellent results (intracochlear electrodes: 10, 7, 8; AID: 478°, 318°, 333°). No translocations occurred. Custom mastoid-fitting templates reliably specify intended insertion trajectory and provide sufficient information for recreation of that trajectory with manual insertion after template removal. The templates can accurately target structures within the temporal bone with a TRE of 0.55 ± 0.19 mm. Our roller-based insertion tool achieves results comparable to manual insertion using surgical forceps.
登录
查看更多内容
影响因子：
2.1
作者：
Boyer, Eric;Karkas, Alexandre;Schmerber, Sebastien
通讯作者：
Schmerber, Sebastien
影响因子：
2.6
作者：
Schuman, Theodore A.;Noble, Jack H.;Labadie, Robert F.
通讯作者：
Labadie, Robert F.
影响因子：
3.7
作者：
Holden LK;Finley CC;Firszt JB;Holden TA;Brenner C;Potts LG;Gotter BD;Vanderhoof SS;Mispagel K;Heydebrand G;Skinner MW
通讯作者：
Skinner MW
影响因子：
2.1
作者：
Carlson, Matthew L.;Sladen, Douglas P.;Driscoll, Colin L.
通讯作者：
Driscoll, Colin L.
DOI：
10.1007/s11548-009-0292-3
发表时间：
2009-05
影响因子：
3
作者：
Labadie, Robert F.;Mitchell, Jason;Balachandran, Ramya;Fitzpatrick, J. Michael
通讯作者：
Fitzpatrick, J. Michael