Abstract
PurposeAn auditory brainstem implant (ABI) represents an alternative for patients with profound hearing loss who are constrained from receiving a cochlear implant. The positioning of the ABI electrode influences the patient’s auditory capacity and, therefore, quality of life and is challenging even with available intraoperative electrophysiological monitoring. This work aims to provide and assess the feasibility of visual-spatial assistance for ABI positioning.MethodsThe pose of the forceps instrument that grasps the electrode was electromagnetically navigated and interactively projected in the eyepieces of a surgical microscope with respect to a target point. Intraoperative navigation was established with an experimental technique for automated nasopharyngeal patient registration. Two ABI procedures were completed in a human specimen head.ResultsAn intraoperative usability study demonstrated lower localization error when using the proposed visual display versus standard cross-sectional views. The postoperative evaluations of the preclinical study showed that the center of the electrode was misplaced to the planned position by 1.58 mm and 3.16 mm for the left and the right ear procedure, respectively.ConclusionThe results indicate the potential to enhance intraoperative feedback during ABI positioning with the presented system. Further improvements consider estimating the pose of the electrode itself to allow for better orientation during placement.
Highlights
Restoring speech understanding in deaf patients by stimulating the auditory nerve through a cochlear implant (CI) is a routine procedure [1]; inner ear anomalies such as bilateral damage of the auditory nerve may constraint receiving a CI
The auditory brainstem implant electrode pad bypasses the cochlea and the hearing nerve to directly stimulate the auditory network on the cochlear nucleus (CN) in the brainstem. This surgery was indicated for adult patients diagnosed with a neurofibromatosis type 2 (NF2) [3], but nowadays, ABI is considered for patients with other cochlear malformations as small or absent cochleae at pediatric patients [4]
Anatomical landmarks in proximity to the target structure serve for identification of the CN surface that is not fully visible during surgery; orientation may be altered due to previous surgeries around the cerbello-pontine angle (CPA)
Summary
Restoring speech understanding in deaf patients by stimulating the auditory nerve through a cochlear implant (CI) is a routine procedure [1]; inner ear anomalies such as bilateral damage of the auditory nerve may constraint receiving a CI. These patients can benefit from an auditory brainstem implant (ABI) [2]. The auditory brainstem implant electrode pad (electrode array) bypasses the cochlea and the hearing nerve to directly stimulate the auditory network on the cochlear nucleus (CN) in the brainstem This surgery was indicated for adult patients diagnosed with a neurofibromatosis type 2 (NF2) [3], but nowadays, ABI is considered for patients with other cochlear malformations as small or absent cochleae at pediatric patients [4]. Once detected, the optimal position is memorized by the surgeon and sometimes marked in situ and targeted with the ABI [8]
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