Round Window Accessibility Prediction in Cochlear Implant Surgery.

Salah-Eddine Youbi, Omar Oulghoul, Youssef Lakhdar, Atmane Zaroual, Mohamed Chehbouni, Othmane Benhoummad, Youssef Rochdi, Abdelaziz Raji
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Abstract

Background: Clear identification of the round window (RW) through the facial recess is a key surgical step for successful cochlear implantation (CI) surgery, which may be very challenging in some cases. Objective is to predict round window (RW) accessibility during CI surgery using high-resolution computed tomography (HRCT).

Methods: We retrospectively reviewed preoperative HRCT scans of 142 patients who underwent CI surgery via the standard posterior tympanotomy approach at our ENT Head and Neck Surgery department. Surgical accessibility of the RW was assessed according to 2 methods, similar to the ones introduced by Mandour et al and Elzayat et al. Pre-operative imaging findings were then compared to the actual surgical accessibility of the RW by reviewing surgical notes and video recordings.

Results: Difficult surgical access to the RW was correctly predicted in our series by Mandour's method in 81.8% of the cases, with a sensitivity and specificity of 56.3% and 96.4%, respectively, and by Elzayat's method in 72.2% of the cases, with a sensitivity and specificity of 50% and 94.5%, respectively. Combining both methods showed an increase in sensitivity levels (Se=71.9%). When the 2 methods both predicted difficult RW access, there was a strong probability that drilling a cochleostomy would be necessary for safe electrode insertion along the scala tympani of the basal turn of the cochlea (P < .001).

Conclusion: These 2 methods are both simple and reliable tools that can help the surgeon anticipate difficult surgical access and prepare for the potential use of alternative techniques.

人工耳蜗手术的圆窗可及性预测。
背景:通过面隐窝清晰识别耳蜗圆窗(RW)是人工耳蜗植入(CI)手术成功的关键步骤,在某些情况下,这可能是非常具有挑战性的。目的是利用高分辨率计算机断层扫描(HRCT)预测CI手术中圆窗(RW)的可达性。方法:我们回顾性分析了我院耳鼻喉头颈外科142例经标准后鼓室切开术行CI手术的患者的术前HRCT扫描。RW的手术可及性根据2种方法进行评估,类似于Mandour等和Elzayat等引入的方法。然后通过回顾手术记录和视频记录,将术前影像学结果与RW的实际手术可及性进行比较。结果:在我们的研究中,Mandour的方法正确预测RW手术通道困难的病例占81.8%,敏感性和特异性分别为56.3%和96.4%;Elzayat的方法正确预测RW手术通道困难的病例占72.2%,敏感性和特异性分别为50%和94.5%。两种方法联合使用均可提高灵敏度(Se=71.9%)。当两种方法都预测难以进入RW时,为了沿耳蜗基底转的鼓膜安全插入电极,钻孔耳蜗造口是很有可能的(P < 0.001)。结论:这两种方法都是简单可靠的工具,可以帮助外科医生预测手术通道的困难,并为可能使用的替代技术做好准备。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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