Neuromonitoring During Robotic Cochlear Implantation: Initial Clinical Experience

Anso, Juan; Scheidegger, Olivier; Wimmer, Wilhelm; Gavaghan, Kate; Gerber, Nicolas; Schneider, Daniel; Hermann, Jan; Rathgeb, Christoph; Dür, Cilgia; Rösler, Kai Michael; Mantokoudis, Georgios; Caversaccio, Marco; Weber, Stefan (2018). Neuromonitoring During Robotic Cochlear Implantation: Initial Clinical Experience. Annals of biomedical engineering, 46(10), pp. 1568-1581. Springer 10.1007/s10439-018-2094-7

[img] Text
Ans-_et_al-2018-Annals_of_Biomedical_Engineering-2.pdf - Published Version
Restricted to registered users only until 27 July 2022.
Available under License Publisher holds Copyright.

Download (2MB) | Request a copy

During robotic cochlear implantation a drill trajectory often passes at submillimeter distances from the facial nerve due to close lying critical anatomy of the temporal bone. Additional intraoperative safety mechanisms are thus required to ensure preservation of this vital structure in case of unexpected navigation system error. Electromyography based nerve monitoring is widely used to aid surgeons in localizing vital nerve structures at risk of injury during surgery. However, state of the art neuromonitoring systems, are unable to discriminate facial nerve proximity within submillimeter ranges. Previous work demonstrated the feasibility of utilizing combinations of monopolar and bipolar stimulation threshold measurements to discretize facial nerve proximity with greater sensitivity and specificity, enabling discrimination between safe (>0.4 mm) and unsafe (<0.1 mm) trajectories during robotic cochlear implantation (in vivo animal model). Herein, initial clinical validation of the determined stimulation protocol and nerve proximity analysis integrated into an image guided system for safety measurement is presented. Stimulation thresholds and corresponding nerve proximity values previously determined from an animal model have been validated in a first-in-man clinical trial of robotic cochlear implantation. Measurements performed automatically at preoperatively defined distances from the facial nerve were used to determine safety of the drill trajectory intraoperatively. The presented system and automated analysis correctly determined sufficient safety distance margins (>0.4 mm) to the facial nerve in all cases.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Ear, Nose and Throat Disorders (ENT)
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DCR Unit Sahli Building > Forschungsgruppe Neurologie
10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research
10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research > ARTORG Center - Image Guided Therapy > ARTORG Center - Artificial Hearing Research
10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research > ARTORG Center - Image Guided Therapy

UniBE Contributor:

Anso, Juan; Scheidegger, Olivier; Wimmer, Wilhelm; Gerber, Kate; Gerber, Nicolas; Schneider, Daniel; Hermann, Jan; Rathgeb, Christoph Martin; Dür, Cilgia; Rösler, Kai Michael; Mantokoudis, Georgios; Caversaccio, Marco and Weber, Stefan

Subjects:

600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology
600 Technology > 620 Engineering

ISSN:

0090-6964

Publisher:

Springer

Funders:

[UNSPECIFIED] Swiss commission for technology and innovation (CTI) (Project MIRACI: 17618.1)
[UNSPECIFIED] Swiss National Science Foundation (Project: 205321_176007)

Projects:

[UNSPECIFIED] Ethics Committee of the Canton of Bern, Switzerland, KEK-BE 156/13
[UNSPECIFIED] Swissmedic 2013-MD-0042, EUDAMED CIV-13-12-011779

Language:

English

Submitter:

Juan Anso

Date Deposited:

26 Jul 2018 10:21

Last Modified:

13 Jan 2019 19:23

Publisher DOI:

10.1007/s10439-018-2094-7

PubMed ID:

30051248

Additional Information:

Special issue: Medical Robotics

BORIS DOI:

10.7892/boris.118938

URI:

https://boris.unibe.ch/id/eprint/118938

Actions (login required)

Edit item Edit item
Provide Feedback