Image-Based Planning of Minimally Traumatic Inner Ear Access for Robotic Cochlear Implantation.

Mueller, Fabian; Hermann, Jan; Weber, Stefan; O'Toole Bom Braga, Gabriela; Topsakal, Vedat (2021). Image-Based Planning of Minimally Traumatic Inner Ear Access for Robotic Cochlear Implantation. Frontiers in Surgery, 8, p. 761217. Frontiers 10.3389/fsurg.2021.761217

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Objective: During robotic cochlear implantation, an image-guided robotic system provides keyhole access to the scala tympani of the cochlea to allow insertion of the cochlear implant array. To standardize minimally traumatic robotic access to the cochlea, additional hard and soft constraints for inner ear access were proposed during trajectory planning. This extension of the planning strategy aims to provide a trajectory that preserves the anatomical and functional integrity of critical intra-cochlear structures during robotic execution and allows implantation with minimal insertion angles and risk of scala deviation. Methods: The OpenEar dataset consists of a library with eight three-dimensional models of the human temporal bone based on computed tomography and micro-slicing. Soft constraints for inner ear access planning were introduced that aim to minimize the angle of cochlear approach, minimize the risk of scala deviation and maximize the distance to critical intra-cochlear structures such as the osseous spiral lamina. For all cases, a solution space of Pareto-optimal trajectories to the round window was generated. The trajectories satisfy the hard constraints, specifically the anatomical safety margins, and optimize the aforementioned soft constraints. With user-defined priorities, a trajectory was parameterized and analyzed in a virtual surgical procedure. Results: In seven out of eight cases, a solution space was found with the trajectories safely passing through the facial recess. The solution space was Pareto-optimal with respect to the soft constraints of the inner ear access. In one case, the facial recess was too narrow to plan a trajectory that would pass the nerves at a sufficient distance with the intended drill diameter. With the soft constraints introduced, the optimal target region was determined to be in the antero-inferior region of the round window membrane. Conclusion: A trend could be identified that a position between the antero-inferior border and the center of the round window membrane appears to be a favorable target position for cochlear tunnel-based access through the facial recess. The planning concept presented and the results obtained therewith have implications for planning strategies for robotic surgical procedures to the inner ear that aim for minimally traumatic cochlear access and electrode array implantation.

Item Type:

Journal Article (Original Article)

Division/Institute:

10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research > ARTORG Center - Image Guided Therapy

Graduate School:

Graduate School for Cellular and Biomedical Sciences (GCB)

UniBE Contributor:

Müller, Fabian Matthias; Hermann, Jan; Weber, Stefan and O'Toole Bom Braga, Gabriela

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2296-875X

Publisher:

Frontiers

Language:

English

Submitter:

Fabian Matthias Müller

Date Deposited:

10 Feb 2022 12:27

Last Modified:

13 Feb 2022 01:48

Publisher DOI:

10.3389/fsurg.2021.761217

PubMed ID:

34901143

Uncontrolled Keywords:

cochlear implantation computer-assisted surgery image-guided surgery patient-specific planning sensorineural hearing loss task-autonomous robotics

BORIS DOI:

10.48350/164353

URI:

https://boris.unibe.ch/id/eprint/164353

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