Abstract
The bone-anchored port (BAP) is an investigational implant, which is intended to be fixed on the temporal bone and provide vascular access. There are a number of implants taking advantage of the stability and available room in the temporal bone. These devices range from implantable hearing aids to percutaneous ports. During temporal bone surgery, injuring critical anatomical structures must be avoided. Several methods for computer-assisted temporal bone surgery are reported, which typically add an additional procedure for the patient. We propose a surgical guide in the form of a bone-thickness map displaying anatomical landmarks that can be used for planning of the surgery, and for the intra-operative decision of the implant’s location. The retro-auricular region of the temporal and parietal bone was marked on cone-beam computed tomography scans and tridimensional surfaces displaying the bone thickness were created from this space. We compared this method using a thickness map (n = 10) with conventional surgery without assistance (n = 5) in isolated human anatomical whole head specimens. The use of the thickness map reduced the rate of Dura Mater exposition from 100% to 20% and suppressed sigmoid sinus exposures. The study shows that a bone-thickness map can be used as a low-complexity method to improve patient’s safety during BAP surgery in the temporal bone.
Highlights
There are several biomedical implants that use the temporal and parietal bones as implantation sites.The most common are implantable hearing aids
The state of the art approach for Cochlear implants (CI) implantation is to expose the round window in order to insert the electrode; (2) Middle ear implants usually consist of a mechanical actuator implanted in a cavity burred in the mastoid or directly in the middle ear cavity
These implants are either a percutaneous abutment implanted in the retro-aural region to which the actuator can be attached, such as for the bone-anchored hearing aid (Baha®), an active actuator implanted in the mastoid process with transcutaneous signal delivery, as for the Bonebridge® [4], or a passive transcutaneous device, such as the Sophono Alpha1 [5]
Summary
There are several biomedical implants that use the temporal and parietal bones as implantation sites.The most common are implantable hearing aids. The state of the art approach for CI implantation is to expose the round window in order to insert the electrode (facial recess approach); (2) Middle ear implants usually consist of a mechanical actuator implanted in a cavity burred in the mastoid or directly in the middle ear cavity Such implants stimulate the cochlear fluid either by coupling with the ossicular chain, or directly at the round window (RW) [2,3]. Such devices necessitate a bedding to host a transcutaneous induction antenna, similar to CI implantation; (3) Bone conduction implants generate a vibration of the skull, which is transmitted to the inner ear through a phenomenon called bone conduction. These implants are either a percutaneous abutment implanted in the retro-aural region to which the actuator can be attached, such as for the bone-anchored hearing aid (Baha®), an active actuator implanted in the mastoid process with transcutaneous signal delivery, as for the Bonebridge® [4], or a passive transcutaneous device, such as the Sophono Alpha1 [5]
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