The use of a surgical planning tool for evaluating the optimal surgical accessibility to the stapedius muscle via a retrofacial approach during cochlear implant surgery: a feasibility study.
The use of a surgical planning tool for evaluating the optimal surgical accessibility to the stapedius muscle via a retrofacial approach during cochlear implant surgery: a feasibility study.
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使用手术计划工具评估人工耳蜗植入手术中经面后入路到达镫骨肌的最佳手术可及性：可行性研究。
DOI：
10.1007/s11548-020-02288-8
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发表时间：
2021-03
影响因子：
3
通讯作者：
Guntinas-Lichius O
中科院分区：
文献类型：
--
作者：
Marquez P;Volk GF;Maule F;Korth D;Bitter T;Koscielny S;Aschenbach R;Guntinas-Lichius O
在耳蜗植入（CI）手术期间，通过CI电诱发的镫骨肌腱运动的镫骨肌反射的视觉检测是确认系统功能的标准测量。镫骨肌（SM）运动的方向可视化可能更可靠，但尚未定义安全进入小SM的方法。现在评价了一种新的手术计划工具，用于通过面后入路进行人工耳蜗植入（CI）期间对镫骨肌（SM）的可及性进行术前评价。 在MATLAB中使用图像处理算法开发了手术规划工具，以评估钻孔可行性。使用平板计算机断层扫描（CT），结合旋转血管造影C形臂装置和平板探测器（Dyna-CT）。总共有30个基于Dyna-CT的3D颞骨重建通过自动化算法进行了评估，生成了一系列轨迹，并比较了它们通过面后入路到达SM的可行性和安全性。在5名患者中测试了手术计划工具结果的可预测性。 手术计划工具显示，在25/30例病例中，面后进入SM是可行的。此外，在5例CI手术期间使用手术计划工具获得的结果的可预测性评价证实了该结果。手术计划工具和CI期间经面后入路SM可达性的结果均表明，只有SM暴露面积> 25%，SM与面神经之间的距离> 0.8 mm，手术通道直径> 3 mm时，这是安全可行的。手术计划工具似乎有助于通过面后入路进行CI手术期间对SM的可及性进行术前评价。需要进一步的前瞻性研究来验证更大队列的结果。本文的在线版本（10.1007/s11548-020-02288-8）包含补充材料，可供授权用户使用。
During cochlear implant (CI) surgery, visual detection of the stapedius reflex as movements of the stapes tendon, electrically elicited via the CI, is a standard measure to confirm the system's functionality. Direction visualization of the stapedius muscle (SM) movements might be more reliable, but a safe access to the small SM is not defined. A new surgical planning tool for pre-operative evaluation of the accessibility to the stapedius muscle (SM) during a cochlear implantation (CI) via a retrofacial approach was now evaluated. A surgical planning tool was developed in MATLAB using an image processing algorithm to evaluate drilling feasibility. A flat-panel computed tomography (CT) combining a rotational angiographic C-arm units with flat-panel detectors (Dyna-CT) was used. In total, 30 3D Dyna-CT-based temporal bone reconstructions were evaluated by automatized algorithms, generating a series of trajectories and comparing their feasibility and safety to reach the SM via a retrofacial approach. The predictability of the surgical planning tool results was tested in 5 patients. The surgical planning tool showed that a retrofacial access to the SM would be feasible in 25/30 cases. Moreover, the evaluation of the predictability of the results obtained with the surgical planning tool conducted during 5 CI surgeries confirmed the results. Both the surgical planning tool and the results on SM accessibility via retrofacial approach during CI showed that this is safe and feasible only when the SM-exposed area was > 25% of its total, the distance between the SM and the facial nerve was > 0.8 mm, and the surgical corridor diameter was > 3 mm. The surgical planning tool seems to be useful for the pre-operative evaluation of the accessibility to the SM during a CI surgery via a retrofacial approach. Further prospective studies are needed to validate the results in larger cohorts. The online version of this article (10.1007/s11548-020-02288-8) contains supplementary material, which is available to authorized users.
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影响因子：
1.2
作者：
Wojciechowski, Tomasz;Skadorwa, Tymon;Niemczyk, Kazimierz
通讯作者：
Niemczyk, Kazimierz
影响因子：
25
作者：
Weber, Stefan;Gavaghan, Kate;Caversaccio, Marco
通讯作者：
Caversaccio, Marco
影响因子：
2.6
作者：
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通讯作者：
Buchman, Craig A.
影响因子：
3
作者：
Chiu, TTW;Lo, SK
通讯作者：
Lo, SK
影响因子：
3.7
作者：
Caversaccio, Marco;Wimmer, Wilhelm;Weber, Stefan
通讯作者：
Weber, Stefan