Minimally Invasive Cochlear Implant Surgery

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Minimally Invive Cochlear Implant Surgery

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Cochlear implantation h become a common method of rehabilitating severely to profoundly deaf children and adults. Standard cochlear implantation requires an extended postauricular and scalp incision and large flap, mastoidectomy, facial recess approach, cochleostomy, and insertion of an electrode into the scala tympani. The most common complications sociated with the standard approach to cochlear implantation include flap wn and electrode misplacement.

Limited data concerning minimally invive techniques have been desibed in the literature. Generally, such techniques involve a less-extensive incision and less-invive manner of securing the receiver/stimulator onto the skull or, more recently, the use of image-guided navigation for percutaneous drilling from the surface of the mtoid directly to the cochlea.

In recent years, the standard approach to cochlear implantation with a large incision h been challenged by successful implantation of cochlear im in numerous patients with a much smaller incision and a less-invive approach. In addition, CT-guided preoperative planning of the drilling path and intraoperative CT guidance appear promising, which could further reduce the inviveness of the procedure. However, this technique remains to be proven comparable in safety and efficacy the established minimally invive techniques in Technique.

The anatomy of the inner ear consists of the bony labyrinth (see the image below), a system of psages making up the following 2 main functional parts: (1) the cochlea, which is dedicated to hearing, and (2) the ibular system, which is dedicated to balance.

The cochlea is a bony, spiral-shaped chamber that contains the cochlear duct of the membranous labyrinth. The sense of hearing is provided by receptors within the cochlear duct. A pair of perilymph-filled chambers is found on each side of the duct. The entire apparatus makes turns around a central bony hub, much like a snail shell. See the image below.

For more information the relevant anatomy, see Inner Ear Anatomy and Ear Anatomy.

Campisi P, Hayward L, Papsin B. Mitek QuickAnchor fixation of cochlear im using a minimal access technique. Int J Pediatr Otorhinolaryngol. 2005 Dec. 69(12):1655-8. [Medline].

Davis BM, Labadie RF, McMenomey SO, Haynes DS. Cochlear implant fixation using polypropylene mesh and titanium sews. Laryngoscope. 2004 Dec. 114(12):2116-8. [Medline].

Stratigoule ED, Perry BP, King SM, Syms CA 3rd. Complication rate of minimally invive cochlear implantation. Otolaryngol Head Neck Surg. 2006 Sep. 135(3):383-6. [Medline].

Mann WJ, Gosepath J. Technical Note: minimal access surgery for cochlear implantation with MED-EL devices. ORL J Otorhinolaryngol Relat Spec. 2006. 68(5):270-2. [Medline].

Mack KF, Heermann R, Issing PR, Lenarz T, Schwab B. Four years’ with the minimally invive surgical approach in cochlear implant surgery. Minim Invive Ther Allied Technol. 2006. 15(3):187-92. [Medline].

Davids T, Ramsden JD, Gorn KA, James AL, Papsin BC. Soft tissue complications after small incision pediatric cochlear implantation. Laryngoscope. 2009 May. 119(5):980-3. [Medline].

Labadie RF, Chodhury P, Cetinkaya E, Balachandran R, Haynes DS, Fenlon MR. Minimally invive, image-guided, facial-recess approach to the : demonstration of the concept of percutaneous cochlear access in vitro. Otol Neurotol. 2005 Jul. 26(4):557-62. [Medline].

Majdani O, Bartling SH, Leinung M, Stöver T, Lenarz M, Dullin C. A true minimally invive approach for cochlear implantation: high accuracy in anial be navigation through flat-panel-bed volume computed tomography. Otol Neurotol. 2008 Feb. 29(2):120-3. [Medline].

Majdani O, Rau TS, Baron S, Eilers H, Baier C, Heimann B. A robot-guided minimally invive approach for cochlear implant surgery: preliminary results of a temporal bone study. Int J Comput sist Radiol Surg. 2009 Sep. 4(5):475-86. [Medline].

Labadie RF, Balachandran R, Mitchell JE, Noble JH, Majdani O, Haynes DS. Clinical validation study of percutaneous cochlear access using patient-customized miostereotactic frames. Otol Neurotol. 2010 Jan. 31(1):94-9. [Medline].

Rodney C Diaz, MD, FACS Professor of Otology, Neurotology, and Skull Be Surgery, Residency Program Director, Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center

Rodney C Diaz, MD, FACS is a member of the following medical societies: Acoustical Society of America, American Academy of Otolaryngology-Head and Neck Surgery, American Association for the Advancement of Science, Association for Research in Otolaryngology, North American Skull Base Society, Politzer Society, The International Society for Otologic Surgery and Science

Disclosure: Nothing to disclose.

Brent J Wilkerson, MD Resident Physician, Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center

Disclosure: Nothing to disclose.

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colora School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;Cliexa;Preacute Population Health Management;The Physicians Edge
Received income in an amount equal to or greater than $250 from: The Physicians Edge, Cliexa
Received stock from RxRevu; Received ownership interest from Cerescan for consulting; for: Rxblockchain;Bridge Health.

Minimally Invive Cochlear Implant Surgery


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