Percutaneous cochlear access using bone-mounted, customized drill guides: Demonstration of concept in vitro
Percutaneous cochlear access using bone-mounted, customized drill guides: Demonstration of concept in vitro
复制标题
DOI：
10.1097/01.mao.0000253287.86737.2e
复制
发表时间：
2007-04-01
影响因子：
2.1
通讯作者：
Labadie, Robert F.
中科院分区：
文献类型：
--
作者：
Warren, Frank M.;Balachandran, Ramya;Labadie, Robert F.
假设：经皮耳蜗通路可以使用基于干预前计算机断层扫描定制的骨装钻导板进行。背景：我们之前已经证明了使用基于基准标记的图像引导在体外获得经皮耳蜗通路的能力。一种更简单的方法，应用误差的空间要小得多，是使用钻导向器限制钻头的路径，使其按预定轨迹通过。方法：尸体颞骨标本（n = 8）贴有三个骨植入基准标记。获得颞骨计算机断层扫描，并用于规划从乳突表面到耳蜗的直线轨迹，而不违反面凹的边界，即鼓索、砧骨支撑和面神经。这些手术计划用于通过快速原型制作（MicroTargeting Platform；FHC Inc.；Bowdoinham，ME，U.S.A.）制造定制钻导向器，该钻导向器安装到先前用于安装基准标记的锚定销上。然后对样本进行传统的乳突切除术和面部隐窝切除术。安装钻导向器，并将 1 毫米钻头穿过导向器，穿过乳突和面部凹陷。拍摄并测量了钻头的行程及其与面部隐窝边界的关系。结果：八具尸体标本接受了研究方案。在八个样本中的七个中，钻头轨迹是准确的；它从外侧皮层传递到耳蜗的侧壁，而没有损害任何关键结构。在一个标本中，实现了进入中耳，但砧骨被钻头击中。从钻头边缘到面部隐窝边界的平均最短距离标准偏差为 0.78 +/- 0.56 mm（鼓索）、2.00 +/- 1.06 mm（砧骨支撑）和 1.27 +/- 0.54 mm（面神经）。 结论：我们的研究表明，使用基于干预前放射线照相研究。
Hypothesis: Percutaneous cochlear access can be performed using bone-mounted drill guides that are custom made on the basis of preintervention computed tomographic scans.Background: We have previously demonstrated the ability to use image guidance based on fiducial markers to obtain percutaneous cochlear access in vitro. A simpler approach that has far less room for application error is to constrict the path of the drill to pass in a predetermined trajectory using a drill guide.Methods: Cadaveric temporal bone specimens (n = 8) were affixed with three bone-implanted fiducial markers. The temporal bone computed tomographic scans were obtained and used in planning a straight trajectory from the mastoid surface to the cochlea without violating the boundaries of the facial recess, namely, the chorda tympani, the incus buttress, and the facial nerve. These surgical plans were used to manufacture a customized drill guide by means of rapid prototyping (MicroTargeting Platform; FHC Inc.; Bowdoinham, ME, U.S.A.) that mounts onto anchor pins previously used to mount fiducial markers. The specimens then underwent traditional mastoidectomy with facial recess. The drill guide was mounted, and a 1-mm drill bit was passed through the guide across the mastoid and the facial recess. The course of the drill bit and its relationship to the boundaries of the facial recess were photographed and measured.Results: Eight cadaveric specimens were subjected to the study protocol. In seven of eight specimens, the drill bit trajectory was accurate; it passed from the lateral cortex to the lateral wall of the cochlea without compromise of any critical structures. In one specimen, the access to the middle ear was achieved, but the incus was hit by the drill. The average shortest distance standard deviation from the edge of the drill bit to the boundaries of the facial recess was 0.78 +/- 0.56 mm (chorda tympani), 2.00 +/- 1.06 mm (incus buttress), and 1.27 +/- 0.54 mm (facial nerve).Conclusion: Our study demonstrates the ability to obtain percutaneous cochlear access in vitro using customized drill guides manufactured on the basis of preintervention radiographic studies.