scholarly journals A Manual Insertion Mechanism for Percutaneous Cochlear Implantation

2010 ◽  
Vol 4 (2) ◽  
Author(s):  
Daniel Schurzig ◽  
Zachariah W. Smith ◽  
D. Caleb Rucker ◽  
Robert F. Labadie ◽  
Robert J. Webster
Keyword(s):  
Minimally Invasive ◽  
Cochlear Implant ◽  
Cochlear Implantation ◽  
Image Guidance ◽  
Electrode Array ◽  
Narrow Channel ◽  
Invasive Technique ◽  
Custom Made ◽  
Insertion Mechanism ◽  
Insertion Tool

Percutaneous cochlear implantation (PCI) is a recently developed minimally invasive technique that utilizes image guidance and a custom-made microstereotactic frame to guide a drill directly to the cochlea. It enables cochlear access through a single drill port, reducing invasiveness in comparison to mastoidectomy. With the reduction in invasiveness, PCI enables a corresponding reduction in visualization and space in which to work at the cochlear entry point. This precludes standard cochlear implant deployment techniques and necessitates a new insertion tool that can deploy a cochlear implant into the cochlea while working down a deep, narrow channel. In this paper, we describe a manual insertion tool that we have developed for this purpose. The tool is capable of inserting an electrode array into the cochlea using the advance off-stylet technique, using simple manual controls on its handle.

A Simple Manual Roller Wheel Insertion Tool for Electrode Array Insertion in Minimally Invasive Cochlear Implant Surgery

2019 ◽  
Author(s):  
Narendran Narasimhan ◽  
Katherine E. Riojas ◽  
Trevor L. Bruns ◽  
Jason E. Mitchell ◽  
Robert J. Webster ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Cochlear Implant ◽  
Electrode Array ◽  
Invasive Procedure ◽  
Narrow Channel ◽  
Wide Field ◽  
Implant Surgery ◽  
Stereotactic Frame ◽  
Cochlear Implant Surgery ◽  
Insertion Tool

Image-guided, minimally-invasive cochlear implant surgery is a novel “keyhole” surgical approach for placing a cochlear implant electrode array eliminating the need for a wide-field mastoidectomy approach. Image guidance is used for path planning which is followed by the construction of a customized micro-stereotactic frame to drill a narrow channel from the skull surface to the cochlea. Herein, we present an insertion tool that uses roller wheels to advance the electrode array through the narrow tunnel and into the cochlea. Testing in a phantom revealed that when compared to insertions with surgical forceps, the new insertion tool was on average 26s faster, produced complete insertions more often (i.e. in 6/6 trials, vs. 1/6), and reduced array buckling (0/6 trials vs. 5/6). The tool provides a viable solution to complete the last step of this novel, minimally-invasive procedure. It also provides the advantage over previously developed manual insertion tools of enabling the surgeon to blindly actuate the roller wheel tool to advance the electrode into the tunnel. This allows the surgeon to visualize and guide insertion into the cochlea from a more advantageous visual perspective.

scholarly journals Extra- and Intracochlear Electrocochleography in Cochlear Implant Recipients

2015 ◽  
Vol 20 (5) ◽  
pp. 339-348 ◽  
Author(s):  
Adrian Dalbert ◽  
Flurin Pfiffner ◽  
Christof Röösli ◽  
Konrad Thoele ◽  
Jae Hoon Sim ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Middle Ear ◽  
Cochlear Implantation ◽  
Low Frequency ◽  
Electrode Array ◽  
Postoperative Phase ◽  
Residual Hearing ◽  
Middle Ear Effusion ◽  
Cochlear Function ◽  
Ear Effusion

Objective: To monitor cochlear function by extra- and intracochlear electrocochleography (ECoG) during and after cochlear implantation and thereby to enhance the understanding of changes in cochlear function following cochlear implantation surgery. Methods: ECoG responses to acoustic stimuli of 250, 500 and 1,000 Hz were recorded in 9 cochlear implant recipients with presurgical residual hearing. During surgery extracochlear ECoG recordings were performed before and after insertion of the cochlear implant electrode array. After insertion of the electrode array, intracochlear ECoG recordings were conducted using intracochlear electrode contacts as recording electrodes. Intracochlear ECoG recordings were performed up to 6 months after implantation. ECoG findings were correlated with findings from audiometric tests. Results: Extra- and intracochlear ECoG responses could be recorded in all subjects. Extracochlear ECoG recordings during surgery showed moderate changes. Loss or reduction of the ECoG signal at all three frequencies did not occur during cochlear implantation. During the first week following surgery, conductive hearing loss, due to middle ear effusion, led to a decrease in intracochlear ECoG signal amplitudes. This was not attributable to changes of cochlear function. All persistent reductions in ECoG response magnitude after normalization of the tympanogram occurred during the first week following implantation. Thresholds of ECoG signals were at or below hearing thresholds in all cases. Conclusion: Gross intracochlear trauma during surgery appears to be rare. In the early postoperative phase the ability to assess cochlear status by ECoG recordings was limited due to the regular occurrence of middle ear effusion. Still, intracochlear ECoG along with tympanogram recordings suggests that any changes of low-frequency cochlear function occur mainly during the first week after cochlear implantation. ECoG seems to be a promising tool to objectively assess changes in cochlear function in cochlear implant recipients and may allow further insight into the mechanisms underlying the loss of residual hearing.

Robotic Insertion Aid for Self-Coiling Cochlear Implants

MRS Advances ◽  
2016 ◽  
Vol 1 (1) ◽  
pp. 51-56
Author(s):  
Hans Ajieren ◽  
Radu Reit ◽  
Roxanne Lee ◽  
Tiffany Pham ◽  
Dongmei Shao ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Shape Memory ◽  
Cochlear Implants ◽  
Histological Analysis ◽  
Electrode Array ◽  
Shape Memory Polymers ◽  
The Self ◽  
Cochlear Duct ◽  
Future Studies ◽  
Insertion Tool

ABSTRACTThis study investigates the use of shape memory polymers (SMPs) as a substrate for a self-coiling cochlear implant electrode array and investigates the self-coiling ability of a sham probe micromachined atop such a substrate. Through the use of a self-coiling cochlear implant, the capability to avoid contact with the tissue of the cochlear duct is investigated via the insertion of a dummy device into a model cochlea heated to an ambient 34 °C. Finally, a prototype straightening and insertion tool is developed for automated retraction and locking of the coiled shape into a bar geometry. Preliminary demonstration of the deployment of self-coiling cochlear implants is shown and paves the way for future studies focused on using histological analysis of the cochlear wall tissue to compare the degree of trauma resulting from linear cochlear implant arrays versus the self-coiling, non-contact probes demonstrated herein.

Image-Guided Surgery for Treatment of Unruptured Middle Cerebral Artery Aneurysms

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONS266-ONS272 ◽  
Author(s):  
Young-Je Son ◽  
Dae Hee Han ◽  
Jeong Eun Kim
Keyword(s):  
Minimally Invasive ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Image Guidance ◽  
Invasive Technique ◽  
Surgical Clipping ◽  
Guided Surgery ◽  
Image Guided ◽  
Mca Aneurysm ◽  
Middle Cerebral Artery Aneurysms

Abstract Objective: Direct surgical clipping appears to be an efficient means for managing unruptured middle cerebral artery (MCA) aneurysms, owing to several angioanatomic features. Here, we present a minimally invasive technique that uses navigation guidance for the treatment of unruptured MCA aneurysms. Methods: Between July of 2003 and June of 2005, we used image-guidance navigation to operate on 24 patients who were diagnosed with unruptured MCA aneurysm. Five men and 19 women were included in the study, and their ages ranged from 43 to 70 years (mean, 58 yr). We predetermined the transsylvian trajectory toward the aneurysm and planned a tailored craniotomy for each patient. Results: All aneurysms were readily identified and successfully clipped via craniotomies of less than 3 cm in diameter. We experienced no surgical complications, and each patient had an uneventful postoperative course. Conclusion: With the aid of navigation, we were able to easily locate MCA aneurysms and perform minimally invasive surgeries such as mini-craniotomies, tailored sylvian dissections, and successful clippings of unruptured MCA aneurysms. In addition, we obtained satisfactory cosmetic results.

scholarly journals A Manually Operated, Advance Off-Stylet Insertion Tool for Minimally Invasive Cochlear Implantation Surgery

2012 ◽  
Vol 59 (10) ◽  
pp. 2792-2800 ◽  
Author(s):  
L. B. Kratchman ◽  
D. Schurzig ◽  
T. R. McRackan ◽  
R. Balachandran ◽  
J. H. Noble ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Cochlear Implantation ◽  
Insertion Tool

scholarly journals Cochlear Implant Surgical Technique: Our Experience

2018 ◽  
Vol 01 (01) ◽  
pp. 007-010
Author(s):  
Milind Kirtane ◽  
Kashmira Chavan
Keyword(s):  
Surgical Technique ◽  
Cochlear Implant ◽  
Cochlear Implantation ◽  
Electrode Array ◽  
Surgical Approaches ◽  
Implant Surgery ◽  
Original Technique ◽  
Cortical Mastoidectomy ◽  
Cochlear Implant Surgery ◽  
Posterior Tympanotomy

Abstract Introduction Different surgical approaches have been adopted for cochlear implantation, with cortical mastoidectomy–posterior tympanotomy being the most commonly followed technique. Method In this article, we describe the surgical technique for cochlear implant followed at our center, which has been successfully implemented in more than 2,500 cochlear implant surgeries. Cochlear implant surgery using the cortical mastoidectomy–posterior tympanotomy technique has been performed in more than 2,500 cases with some modifications to the original technique over a period of time. Results In spite of not using tie-down holes and securing down the receiver–stimulator with sutures, no cases of receiver–stimulator displacement or outward electrode migration have been noted with the current technique of creating a snug-fitting subperiosteal pocket along with a hook for the electrode array. Conclusion Adhering to a strict intraoperative surgical protocol plays an extremely important role in carrying out successful cochlear implant surgeries with minimal complications.

Another reason for intra-operative imaging during cochlear implantation

2008 ◽  
Vol 122 (4) ◽  
Author(s):  
M Viccaro ◽  
E De Seta ◽  
E Covelli ◽  
V Marvaso ◽  
R Filipo
Keyword(s):  
Cochlear Implant ◽  
Semicircular Canal ◽  
Cochlear Implantation ◽  
Electrode Array ◽  
Neural Response ◽  
Radiological Assessment ◽  
Implant Surgery ◽  
Stimulation Intensity ◽  
Cochlear Implant Surgery ◽  
The Right

AbstractObjective:We report a case of a rare cochlear implant complication: the introduction of the electrode array into the superior semicircular canal, with intra-operative measurements of neural response reactions suggesting reasonable functioning of the implant.Case report:A two-year old patient affected by congenital, profound, sensorineural deafness underwent bilateral cochlear implantation at the ENT clinic of the ‘La Sapienza’ University of Rome. Two Clarion 90k devices were implanted, and electrophysiological and radiological checks were performed. After the introduction of the array in the right side, neural response imaging was performed, and a neural potential was found only on two apical electrodes, at a stimulation intensity of 431 clinical units. The situation differed on the left side, where neural response imaging was present at a stimulation intensity of 300 clinical units on the two electrodes tested (one apical electrode (number three), and one middle electrode (number nine)). Intra-operative radiological assessment with a transorbital plain films was performed as usual in order to assess the position of the electrodes inside the cochlea. This radiography showed the electrode array to be in the superior semicircular canal in the right ear.Conclusion:Intra-operative monitoring tests during cochlear implant surgery play different roles; measurement of impedances and neural response imaging can evaluate the integrity of implant electrodes and the status of the electrode–cochlea interface, but it must not be the sole way in which correct positioning of the array is confirmed. In our opinion, intra-operative radiological assessment is mandatory during cochlear implant surgery.

scholarly journals Individual Optimization of the Insertion of a Preformed Cochlear Implant Electrode Array

2015 ◽  
Vol 2015 ◽  
pp. 1-22 ◽  
Author(s):  
Thomas S. Rau ◽  
Thomas Lenarz ◽  
Omid Majdani
Keyword(s):  
Cochlear Implant ◽  
Rating Scale ◽  
Electrode Array ◽  
Anatomical Variations ◽  
Patient Specific ◽  
Electrode Arrays ◽  
Insertion Technique ◽  
Custom Made ◽  
Specific Shape ◽  
Insertion Process

Purpose. The aim of this study was to show that individual adjustment of the curling behaviour of a preformed cochlear implant (CI) electrode array to the patient-specific shape of the cochlea can improve the insertion process in terms of reduced risk of insertion trauma.Methods. Geometry and curling behaviour of preformed, commercially available electrode arrays were modelled. Additionally, the anatomy of each small, medium-sized, and large human cochlea was modelled to consider anatomical variations. Finally, using a custom-made simulation tool, three different insertion strategies (conventional Advanced Off-Stylet (AOS) insertion technique, an automated implementation of the AOS technique, and a manually optimized insertion process) were simulated and compared with respect to the risk of insertion-related trauma. The risk of trauma was evaluated using a newly developed “trauma risk” rating scale.Results. Using this simulation-based approach, it was shown that an individually optimized insertion procedure is advantageous compared with the AOS insertion technique.Conclusion. This finding leads to the conclusion that, in general, consideration of the specific curling behaviour of a CI electrode array is beneficial in terms of less traumatic insertion. Therefore, these results highlight an entirely novel aspect of clinical application of preformed perimodiolar electrode arrays in general.

Cochlear implantation at King Abdulaziz University Hospital, Riyadh, Saudi Arabia: a 12-year experience

2009 ◽  
Vol 123 (11) ◽  
Author(s):  
H S Al-Muhaimeed ◽  
F Al-Anazy ◽  
M S Attallah ◽  
O Hamed
Keyword(s):  
Hearing Loss ◽  
Saudi Arabia ◽  
Minimally Invasive ◽  
Cochlear Implant ◽  
Cochlear Implantation ◽  
University Hospital ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
King Abdulaziz University ◽  
Post Implantation

AbstractObjective:This paper aims to report our experience with different multichannel cochlear implant devices, and to discuss the outcomes of our cochlear implant programme, together with the problems encountered.Setting:Cochlear implantation was undertaken in 117 patients (35 post-lingual and 82 pre-lingual cases; 70 males and 47 females) over a 12-year period. Three cochlear implant systems were used: Nucleus (22 and 24), Med-El and Advanced Bionics Clarion. An extended endaural incision was used in 78 cases and a minimally invasive approach in 39 cases.Results:Complications occurred in 16.2 per cent of patients. All patients showed a significant post-implantation improvement in their perception and discrimination of sound and speech. Better results were noted in pre-lingual patients under the age of six years. The cause of hearing loss was unknown in 81 per cent of patients.Conclusion:The outcomes of our cochlear implantation series are comparable to previous reports. The possibility of an abnormally rotated cochlea should be borne in mind when difficulty is encountered during cochleostomy.

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