Anatomical investigation of safety determining factors for keyhole drilling trajectories for robotic cochlear implant surgery.

IF 2.2 3区 医学 Q2 OTORHINOLARYNGOLOGY
Saliha Seda Adanır, Piraye Kervancıoğlu, İlhan Bahşi, Mohammad Al Saadi, Paul Van de Heyning, Vedat Topsakal
{"title":"Anatomical investigation of safety determining factors for keyhole drilling trajectories for robotic cochlear implant surgery.","authors":"Saliha Seda Adanır, Piraye Kervancıoğlu, İlhan Bahşi, Mohammad Al Saadi, Paul Van de Heyning, Vedat Topsakal","doi":"10.1007/s00405-024-09198-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Cochlear implants (CI) are the most successful bioprosthesis in medicine probably due to the tonotopic anatomy of the auditory pathway and of course the brain plasticity. Correct placement of the CI arrays, respecting the inner ear anatomy are therefore important. The ideal trajectory to insert a cochlear implant array is defined by an entrance through the round window membrane and continues as long as possible parallel to the basal turn of the cochlea. Image-guided surgery can directly drill with a robotic arm through the mastoid and execute an exact drilling of this precalculated most ideal trajectory. Here, we aim to identify critical anatomical structures determining the safest keyhole drilling trajectory by comparing easy and difficult CI surgeries performed with the HEARO Procedure: a robotic tool for image-guided surgery.</p><p><strong>Methods: </strong>Cone-beam computed tomography images of patients who underwent robot-assisted cochlear implantation surgery (RACIS) were included. Three of 25 cases had to be converted to conventional surgery because of the current safety mitigations based on anatomical distance. Radiological images in DICOM format were transferred to dedicated software (OTOPLAN® Cascination GMHB Bern Switzerland) for analyses. Surgical segmentation and previously planned trajectories were analyzed for these 25 cases by comparing cochlear sizes, facial recess sizes, round window sizes, and trajectory angles. In addition, facial recess angle, and cochlear orientation angles were measured with RadiAnt DICOM Viewer (Medixant, Pozan, Poland).</p><p><strong>Results: </strong>Facial recess size, facial recess angle, and distance between the facial nerve and safe trajectory were smaller in patient who converted from robotic surgery to conventional. A significant positive correlation existed between basal turn angle and in-plane angle (p = 0.001, r = 0.859). In addition, there was a significant negative correlation between the basal turn length and the last electrode insertion depth degree (p = 0.007, r = 0.545).</p><p><strong>Conclusion: </strong>In our robotic surgery cases, we demonstrate that the limiting factors of anatomical relationships are constituted by the dimensions of the facial recess and the cochlear orientation. The findings of this study are considered to be a reference for future studies in achieving collision-free trajectory planning in robotic-assisted cochlear implant surgery.</p>","PeriodicalId":11952,"journal":{"name":"European Archives of Oto-Rhino-Laryngology","volume":" ","pages":"3037-3050"},"PeriodicalIF":2.2000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122655/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Archives of Oto-Rhino-Laryngology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00405-024-09198-4","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/17 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Purpose: Cochlear implants (CI) are the most successful bioprosthesis in medicine probably due to the tonotopic anatomy of the auditory pathway and of course the brain plasticity. Correct placement of the CI arrays, respecting the inner ear anatomy are therefore important. The ideal trajectory to insert a cochlear implant array is defined by an entrance through the round window membrane and continues as long as possible parallel to the basal turn of the cochlea. Image-guided surgery can directly drill with a robotic arm through the mastoid and execute an exact drilling of this precalculated most ideal trajectory. Here, we aim to identify critical anatomical structures determining the safest keyhole drilling trajectory by comparing easy and difficult CI surgeries performed with the HEARO Procedure: a robotic tool for image-guided surgery.

Methods: Cone-beam computed tomography images of patients who underwent robot-assisted cochlear implantation surgery (RACIS) were included. Three of 25 cases had to be converted to conventional surgery because of the current safety mitigations based on anatomical distance. Radiological images in DICOM format were transferred to dedicated software (OTOPLAN® Cascination GMHB Bern Switzerland) for analyses. Surgical segmentation and previously planned trajectories were analyzed for these 25 cases by comparing cochlear sizes, facial recess sizes, round window sizes, and trajectory angles. In addition, facial recess angle, and cochlear orientation angles were measured with RadiAnt DICOM Viewer (Medixant, Pozan, Poland).

Results: Facial recess size, facial recess angle, and distance between the facial nerve and safe trajectory were smaller in patient who converted from robotic surgery to conventional. A significant positive correlation existed between basal turn angle and in-plane angle (p = 0.001, r = 0.859). In addition, there was a significant negative correlation between the basal turn length and the last electrode insertion depth degree (p = 0.007, r = 0.545).

Conclusion: In our robotic surgery cases, we demonstrate that the limiting factors of anatomical relationships are constituted by the dimensions of the facial recess and the cochlear orientation. The findings of this study are considered to be a reference for future studies in achieving collision-free trajectory planning in robotic-assisted cochlear implant surgery.

机器人人工耳蜗手术锁眼钻孔轨迹安全决定因素的解剖学研究。
目的:人工耳蜗是医学上最成功的生物假体,这可能是由于其听觉通路的张力异位解剖和大脑的可塑性。因此,尊重内耳解剖结构的CI阵列的正确放置是重要的。植入人工耳蜗阵列的理想轨迹是通过圆形窗口膜的入口来定义,并尽可能长时间地平行于耳蜗的基底转动。图像引导手术可以直接用机械臂钻穿乳突骨,并按照预先计算的最理想轨迹进行精确的钻穿。在这里,我们的目标是通过比较使用图像引导手术的机器人工具HEARO程序进行的简单和困难的CI手术来确定关键的解剖结构,从而确定最安全的锁孔钻孔轨迹。方法:对接受机器人辅助人工耳蜗植入术(RACIS)患者的锥形束计算机断层扫描图像进行分析。由于目前基于解剖距离的安全性降低,25例中有3例必须转为常规手术。DICOM格式的放射图像传输到专用软件(OTOPLAN®Cascination GMHB Bern Switzerland)进行分析。通过比较耳蜗大小、面隐窝大小、圆窗大小和轨迹角度,对25例患者的手术分割和先前计划的轨迹进行分析。此外,使用RadiAnt DICOM Viewer (Medixant, Pozan, Poland)测量面部隐窝角和耳蜗定向角。结果:由机器人手术转为常规手术的患者面部隐窝大小、面部隐窝角度、面神经与安全轨迹的距离更小。基底转角与面内角呈显著正相关(p = 0.001, r = 0.859)。基底匝长与最后电极插入深度呈显著负相关(p = 0.007, r = 0.545)。结论:在我们的机器人手术案例中,我们证明了解剖关系的限制因素是由面隐窝的尺寸和耳蜗的方向构成的。本研究结果可为未来机器人辅助人工耳蜗手术中实现无碰撞轨迹规划的研究提供参考。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
5.30
自引率
7.70%
发文量
537
审稿时长
2-4 weeks
期刊介绍: Official Journal of European Union of Medical Specialists – ORL Section and Board Official Journal of Confederation of European Oto-Rhino-Laryngology Head and Neck Surgery "European Archives of Oto-Rhino-Laryngology" publishes original clinical reports and clinically relevant experimental studies, as well as short communications presenting new results of special interest. With peer review by a respected international editorial board and prompt English-language publication, the journal provides rapid dissemination of information by authors from around the world. This particular feature makes it the journal of choice for readers who want to be informed about the continuing state of the art concerning basic sciences and the diagnosis and management of diseases of the head and neck on an international level. European Archives of Oto-Rhino-Laryngology was founded in 1864 as "Archiv für Ohrenheilkunde" by A. von Tröltsch, A. Politzer and H. Schwartze.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信