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Current Directions in Biomedical Engineering

Joint Journal of the German Society for Biomedical Engineering in VDE and the Austrian and Swiss Societies for Biomedical Engineering

Editor-in-Chief: Dössel, Olaf

Editorial Board: Augat, Peter / Buzug, Thorsten M. / Haueisen, Jens / Jockenhoevel, Stefan / Knaup-Gregori, Petra / Kraft, Marc / Lenarz, Thomas / Leonhardt, Steffen / Malberg, Hagen / Penzel, Thomas / Plank, Gernot / Radermacher, Klaus M. / Schkommodau, Erik / Stieglitz, Thomas / Urban, Gerald A.


CiteScore 2018: 0.47

Source Normalized Impact per Paper (SNIP) 2018: 0.377

Open Access
Online
ISSN
2364-5504
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Minimally invasive mastoidectomy approach using a mouldable surgical targeting system

Thomas S. Rau / Sina Witte
  • Department of Otolaryngology and Cluster of Excellence EXC 1077/1 “Hearing4all”, Hannover Medical School, Hannover, Germany
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/ Lea Uhlenbusch
  • Department of Otolaryngology and Cluster of Excellence EXC 1077/1 “Hearing4all”, Hannover Medical School, Hannover, Germany
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/ Jakob Lexow
  • Department of Otolaryngology and Cluster of Excellence EXC 1077/1 “Hearing4all”, Hannover Medical School, Hannover, Germany
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/ Silke Hügl
  • Department of Otolaryngology and Cluster of Excellence EXC 1077/1 “Hearing4all”, Hannover Medical School, Hannover, Germany
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/ Omid Majdani
  • Department of Otolaryngology and Cluster of Excellence EXC 1077/1 “Hearing4all”, Hannover Medical School, Hannover, Germany
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/ Thomas Lenarz
  • Department of Otolaryngology and Cluster of Excellence EXC 1077/1 “Hearing4all”, Hannover Medical School, Hannover, Germany
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Published Online: 2018-09-22 | DOI: https://doi.org/10.1515/cdbme-2018-0096

Abstract

Hearing restoration using a cochlear implant requires a surgical access to the inner ear. In order to enhance patient safety, reduce trauma, and shorten the patient’s time under anaesthesia current research focusses on minimally invasive cochlear implantation surgery by drilling only a single bore hole. This demands a highly accurate surgical assistance device to guide the drill along a predetermined trajectory planned in patient’s image data. In this study a recently developed surgical targeting system was evaluated for the first time in a human cadaver trial. After screwing a reference frame on a temporal bone specimen and imaging of both, a trajectory through the facial recess was planned in order to reach the middle ear. Based on this plan a patient specific surgical template including a linear guide for the surgical drill was composed utilizing bone cement. After the hardening of the bone cement the surgical template was mounted on top of the reference frame. The drilling could be performed as previously planned without harming facial nerve and chorda tympani. The deviation of the actual drill hole to the planned trajectory was 0.17 mm at the level of the facial recess. The minimal distance of the drill hole to the facial nerve was 0.59 mm. This proof-of-concept study demonstrates the feasibility of performing the access to the middle ear in a minimally invasive manner using the mouldable surgical targeting system. The presented process allows the patient specific individualization of a drill guide under sterile conditions. This might facilitate its integration into clinical routine.

Keywords: cochlear implant; micro-stereotactic frame; drill guide; temporal bone; drilling accuracy; image-guided surgery; direct cochlear access

About the article

Published Online: 2018-09-22

Published in Print: 2018-09-01


Citation Information: Current Directions in Biomedical Engineering, Volume 4, Issue 1, Pages 403–406, ISSN (Online) 2364-5504, DOI: https://doi.org/10.1515/cdbme-2018-0096.

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