Otology & neurotology open · 2024
Cochlear Apex Triangulation Utilizing Ct Measures And Middle Ear Landmarks.
СтатьяНазвание и аннотация: Перевод в очереди
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Cottrell Justin, Landsberger David, Breen Matt, Lebowitz Joseph, Hagiwara Mari, Moonis Gul, Shapiro William, Friedmann David R, Jethanamest Daniel, McMenomey Sean, Roland J Thomas
Аннотация
OBJECTIVE: To better characterize the cochlear apex in relation to surgically relevant landmarks to guide surgeons and improve procedural success of apical electrode placement.
STUDY DESIGN: Retrospective image analysis.
SETTING: Tertiary referral center.
PATIENTS: Cochlear implant recipients with available preoperative computed tomography (CT) imaging.
INTERVENTION: None.
MAIN OUTCOME MEASURE: Cochlear dimensions and cochlear apex distance measures to surgically relevant middle ear landmarks and critical structures.
RESULTS: Eighty-two temporal bone CT scans were analyzed utilizing multiplanar reformats. The average lateral width of promontory bone over the cochlear apex was 1.2 mm (standard deviation [SD], 0.3). The anteroposterior distance from the round window (avg, 4.2 mm; SD, 0.5), oval window (avg, 3.3 mm; SD, 0.3), cochleariform process (avg, 2.3; SD, 0.5), and superior-inferior distance from the cochleariform process (avg, -0.9; SD, 0.8) to the cochlear apex were measured. The relationship of the cochlear apex to critical structures was highly variable.A newly developed stapes vector was created and found to mark the posterior/superior boundary of the apex in 94% of patients. When a vector parallel to the stapes vector was drawn through the round window, it marked the anterior/inferior boundary of the cochlear apex in 89% of patients.
CONCLUSIONS: This study assists in characterizing cochlear apex anatomy and its relation to surrounding structures as a means of improving procedural accuracy and reducing trauma during apical cochleostomy. Understanding both distance relationships and expected boundaries of the apex could help to inform future surgical approaches.
STUDY DESIGN: Retrospective image analysis.
SETTING: Tertiary referral center.
PATIENTS: Cochlear implant recipients with available preoperative computed tomography (CT) imaging.
INTERVENTION: None.
MAIN OUTCOME MEASURE: Cochlear dimensions and cochlear apex distance measures to surgically relevant middle ear landmarks and critical structures.
RESULTS: Eighty-two temporal bone CT scans were analyzed utilizing multiplanar reformats. The average lateral width of promontory bone over the cochlear apex was 1.2 mm (standard deviation [SD], 0.3). The anteroposterior distance from the round window (avg, 4.2 mm; SD, 0.5), oval window (avg, 3.3 mm; SD, 0.3), cochleariform process (avg, 2.3; SD, 0.5), and superior-inferior distance from the cochleariform process (avg, -0.9; SD, 0.8) to the cochlear apex were measured. The relationship of the cochlear apex to critical structures was highly variable.A newly developed stapes vector was created and found to mark the posterior/superior boundary of the apex in 94% of patients. When a vector parallel to the stapes vector was drawn through the round window, it marked the anterior/inferior boundary of the cochlear apex in 89% of patients.
CONCLUSIONS: This study assists in characterizing cochlear apex anatomy and its relation to surrounding structures as a means of improving procedural accuracy and reducing trauma during apical cochleostomy. Understanding both distance relationships and expected boundaries of the apex could help to inform future surgical approaches.