TY - JOUR
T1 - Optimizing vestibular implant electrode positioning using fluoroscopy and intraoperative CT imaging
AU - Loos, Elke
AU - Stultiens, Joost J.A.
AU - Volpe, Benjamin
AU - Vermorken, Bernd L.
AU - Van Boxel, Stan C.J.
AU - Devocht, Elke M.J.
AU - van Hoof, Marc
AU - Postma, Alinda A.
AU - Guinand, Nils
AU - Pérez-Fornos, Angelica
AU - Van Rompaey, Vincent
AU - Denys, Sam
AU - Desloovere, Christian
AU - Verhaert, Nicolas
AU - van de Berg, Raymond
N1 - Funding Information:
EL is funded by the Klinische Onderzoeks- en OpleidingsRaad (KOOR) of the University Hospitals Leuven. NV received a senior clinical investigator fund 1804816N from the Flemish Research Foundation. VVR received a senior clinical investigator fund 18E2524N from the Flemish Research Foundation. B.L.V. and E.D. are supported through funding of MED-EL and ZonMw. B.V. and S.C.J.v.B. are supported through funding of MED-EL, Heinsius Houbolt fonds, and Stichting De Weijerhorst. The funders had no role in the study, data collection, data analysis, interpretation of data, decision to publish, or preparation of the manuscript. The authors declare they have no financial interests.
Publisher Copyright:
© 2024, The Author(s).
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Purpose: Vestibular implant electrode positioning close to the afferent nerve fibers is considered to be key for effective and selective electrical stimulation. However, accurate positioning of vestibular implant electrodes inside the semicircular canal ampullae is challenging due to the inability to visualize the target during the surgical procedure. This study investigates the accuracy of a new surgical protocol with real-time fluoroscopy and intraoperative CT imaging, which facilitates electrode positioning during vestibular implant surgery. Methods: Single-center case-controlled cohort study with a historic control group at a tertiary referral center. Patients were implanted with a vestibulocochlear implant, using a combination of intraoperative fluoroscopy and cone beam CT imaging. The control group consisted of five patients who were previously implanted with the former implant prototype, without the use of intraoperative imaging. Electrode positioning was analyzed postoperatively with a high-resolution CT scan using 3D slicer software. The result was defined as accurate if the electrode position was within 1.5 mm of the center of the ampulla. Results: With the new imaging protocol, all electrodes could be positioned within a 1.5 mm range of the center of the ampulla. The accuracy was significantly higher in the study group with intraoperative imaging (21/21 electrodes) compared to the control group without intraoperative imaging (10/15 electrodes), (p = 0.008). Conclusion: The combined use of intraoperative fluoroscopy and CT imaging during vestibular implantation can improve the accuracy of electrode positioning. This might lead to better vestibular implant performance.
AB - Purpose: Vestibular implant electrode positioning close to the afferent nerve fibers is considered to be key for effective and selective electrical stimulation. However, accurate positioning of vestibular implant electrodes inside the semicircular canal ampullae is challenging due to the inability to visualize the target during the surgical procedure. This study investigates the accuracy of a new surgical protocol with real-time fluoroscopy and intraoperative CT imaging, which facilitates electrode positioning during vestibular implant surgery. Methods: Single-center case-controlled cohort study with a historic control group at a tertiary referral center. Patients were implanted with a vestibulocochlear implant, using a combination of intraoperative fluoroscopy and cone beam CT imaging. The control group consisted of five patients who were previously implanted with the former implant prototype, without the use of intraoperative imaging. Electrode positioning was analyzed postoperatively with a high-resolution CT scan using 3D slicer software. The result was defined as accurate if the electrode position was within 1.5 mm of the center of the ampulla. Results: With the new imaging protocol, all electrodes could be positioned within a 1.5 mm range of the center of the ampulla. The accuracy was significantly higher in the study group with intraoperative imaging (21/21 electrodes) compared to the control group without intraoperative imaging (10/15 electrodes), (p = 0.008). Conclusion: The combined use of intraoperative fluoroscopy and CT imaging during vestibular implantation can improve the accuracy of electrode positioning. This might lead to better vestibular implant performance.
KW - Bilateral vestibulopathy
KW - Fluoroscopy
KW - Imaging
KW - Vestibular dysfunction
KW - Vestibular implant
U2 - 10.1007/s00405-023-08428-5
DO - 10.1007/s00405-023-08428-5
M3 - Article
SN - 0937-4477
JO - European Archives of Oto-Rhino-Laryngology
JF - European Archives of Oto-Rhino-Laryngology
ER -