Determination of the curling behavior of a preformed cochlear implant electrode array

PurposeAccurate insertion of a cochlear implant electrode array into the cochlea’s helical shape is a crucial step for residual hearing preservation. In image-guided surgery, especially using an automated insertion tool, the overall accuracy of the operative procedure can be improved by adapting the electrode array’s intracochlear movement to the individual cochlear shape.MethodsThe curling characteristic of a commercially available state-of-the-art preformed electrode array (Cochlear Ltd. Contour AdvanceTM Electrode Array) was determined using an image-processing algorithm to detect its shape in series of images. An automatic image-processing procedure was developed using Matlab and the Image Processing Toolbox (MathWorks, Natick, Massachusetts, USA) to determine the complete curvature of the electrode array by identifying the 22 platinum contacts of the electrode. A logarithmic spiral was used for a comprehensive mathematical description of the shape of the electrode array. A fitting algorithm for nonlinear least-squares problems was used to provide a complete mathematical description of the electrode array. The system was tested for curling behavior as a function of stylet extraction using nine Contour Advance Research Electrodes (RE) and additionally for nine Contour Advance Practice Electrodes (PE).ResultsAll arrays show a typical pattern of curling with adequate predictability after the first 2 or 3 millimeters of stylet extraction. Although non-negligible variations in the overall curling behavior were detected, the electrode arrays show a characteristic movement due to the stylet extraction and only vary minimally after this initial phase.ConclusionThese results indicate that the risk of intracochlear trauma can be reduced if the specific curling behavior of the electrode carrier is incorporated into the insertion algorithm. Furthermore, the determination of the curling behavior is an essential step in computer-aided cochlear implant electrode development. Experimental data are required for accurate evaluation of the simulation model.

[1]  C von Ilberg,et al.  Electric-acoustic stimulation of the auditory system. New technology for severe hearing loss. , 1999, ORL; journal for oto-rhino-laryngology and its related specialties.

[2]  A Aschendorff,et al.  [Navigation-controlled cochleostomy. Is an improvement in the quality of results for cochlear implant surgery possible?]. , 2004, HNO.

[3]  Omid Majdani,et al.  Force measurement of insertion of cochlear implant electrode arrays in vitro: comparison of surgeon to automated insertion tool , 2010, Acta oto-laryngologica.

[4]  Craig R. Friedrich,et al.  A Fluid Actuator for Thin-Film Electrodes , 2007 .

[5]  P.N. Brett,et al.  A surgical robot for cochleostomy , 2007, 2007 29th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[6]  A Aschendorff,et al.  [Current developments in cochlear implantation]. , 2004, HNO.

[7]  Bodo Heimann,et al.  An automated insertion tool for cochlear implants: another step towards atraumatic cochlear implant surgery , 2010, International Journal of Computer Assisted Radiology and Surgery.

[8]  G M Clark,et al.  3D finite element analyses of insertion of the Nucleus standard straight and the Contour electrode arrays into the human cochlea. , 2007, Journal of biomechanics.

[9]  D. Friedland,et al.  Soft Cochlear Implantation: Rationale for the Surgical Approach , 2009, Trends in amplification.

[10]  T. Lenarz,et al.  Impact of Low-Frequency Hearing , 2009, Audiology and Neurotology.

[11]  R. Balachandran,et al.  Minimally Invasive, Image-Guided, Facial-Recess Approach to the Middle Ear: Demonstration of the Concept of Percutaneous Cochlear Access In Vitro , 2005, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[12]  Fazel Naghdy,et al.  Force Application During Cochlear Implant Insertion: An Analysis for Improvement of Surgeon Technique , 2007, IEEE Transactions on Biomedical Engineering.

[13]  R. P. Taylor,et al.  An Autonomous Surgical Robot Applied in Practice , 2008 .

[14]  M. Merzenich,et al.  Strategies to improve electrode positioning and safety in cochlear implants , 1999, IEEE Transactions on Biomedical Engineering.

[15]  T. Ortmaier,et al.  Navigated, robot assisted drilling of a minimally invasive cochlear access , 2009, 2009 IEEE International Conference on Mechatronics.

[16]  Jian Zhang,et al.  Path Planning and Workspace Determination for Robot-Assisted Insertion of Steerable Electrode Arrays for Cochlear Implant Surgery , 2008, MICCAI.

[17]  A. Aschendorff,et al.  Aktuelle Entwicklung zum Cochlearimplantat , 2004, HNO.

[18]  O Majdani,et al.  [New developments in navigation technology]. , 2006, HNO.

[19]  J. Thomas Roland,et al.  Cochlear implant electrode insertion , 2005 .

[20]  Jian Zhang,et al.  Optimal Path Planning for Robotic Insertion of Steerable Electrode Arrays in Cochlear Implant Surgery , 2009 .

[21]  Omid Majdani,et al.  Clinical Validation of Percutaneous Cochlear Implant Surgery: Initial Report , 2008, The Laryngoscope.

[22]  Rohan J. Shah,et al.  In vitro assessment of image-guided otologic surgery: Submillimeter accuracy within the region of the temporal bone , 2005, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[23]  P. Brett,et al.  An autonomous surgical robot for drilling a cochleostomy: preliminary porcine trial , 2008, Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery.

[24]  P. K. Plinkert,et al.  Chirurgische Technik der Kochleaimplantation , 2009, HNO.

[25]  Bodo Heimann,et al.  Robotic-guided minimally-invasive cochleostomy : first results , 2007 .

[26]  Omid Majdani,et al.  Automated insertion of preformed cochlear implant electrodes: evaluation of curling behaviour and insertion forces on an artificial cochlear model , 2010, International Journal of Computer Assisted Radiology and Surgery.

[27]  H. Eilers,et al.  Computed Tomography for navigated procedures at the lateral skull base – proof of feasibility on phantom and human temporal bone specimens , 2007 .

[28]  J. Michael Fitzpatrick,et al.  Customized, rapid-production microstereotactic table for surgical targeting: description of concept and in vitro validation , 2009, International Journal of Computer Assisted Radiology and Surgery.

[29]  Bodo Heimann,et al.  Conception and design of an automated insertion tool for cochlear implants , 2008, 2008 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[30]  Rhys Jones,et al.  Finite element modeling of final placement and insertion depth of new cochlear implant electrode array embedded with nitinol shape memory alloy actuators , 2006, MSV.

[31]  R. Balachandran,et al.  Percutaneous Cochlear Access Using Bone-Mounted, Customized Drill Guides: Demonstration of Concept In Vitro , 2007, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[32]  J Thomas Roland,et al.  Surgical technique for the Nucleus Contour cochlear implant. , 2002, Ear and hearing.

[33]  H. Wörn,et al.  New strategies for high precision surgery of the temporal bone using a robotic approach for cochlear implantation , 2009, European Archives of Oto-Rhino-Laryngology.

[34]  Thomas Lenarz,et al.  Temporal Bone Results and Hearing Preservation with a New Straight Electrode , 2006, Audiology and Neurotology.

[35]  Bodo Heimann,et al.  A robot-guided minimally invasive approach for cochlear implant surgery: preliminary results of a temporal bone study , 2009, International Journal of Computer Assisted Radiology and Surgery.

[36]  P K Plinkert,et al.  [Surgical technique in cochlear implantation]. , 2009, HNO.

[37]  Thomas Lenarz,et al.  Hearing Conservation Surgery Using the Hybrid-L Electrode , 2009, Audiology and Neurotology.

[38]  Peter Kazanzides,et al.  An integrated system for planning, navigation and robotic assistance for skull base surgery , 2008, The international journal of medical robotics + computer assisted surgery : MRCAS.

[39]  A. Aschendorff,et al.  Navigiert-kontrollierte Kochleostomie , 2004, HNO.

[40]  Omid Majdani,et al.  Percutaneous access to the petrous apex in vitro using customized micro-stereotactic frames based on image-guided surgical technology , 2009, Acta oto-laryngologica.

[41]  Jan Kiefer,et al.  Impact of electrode insertion depth on intracochlear trauma , 2006, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[42]  R. Heermann,et al.  Neue Entwicklungen der Navigationstechnologie , 2006, HNO.

[43]  Omid Majdani,et al.  Clinical Validation Study of Percutaneous Cochlear Access Using Patient-Customized Microstereotactic Frames , 2010, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[44]  Kensall D. Wise,et al.  A flexible micromachined electrode array for a cochlear prosthesis , 1997, International Conference on Solid-State Sensors, Actuators and Microsystems.

[45]  P N Brett,et al.  ENT challenges at the small scale , 2007, The international journal of medical robotics + computer assisted surgery : MRCAS.

[46]  Thomas Klenzner,et al.  Navigation as a quality management tool in cochlear implant surgery , 2004, The Journal of Laryngology & Otology.

[47]  J Raczkowsky,et al.  [Update on computer- and mechatronic-assisted head and neck surgery in Germany]. , 2008, HNO.

[48]  O Majdani,et al.  [Image-guided minimal-invasive cochlear implantation--experiments on cadavers]. , 2008, Laryngo- rhino- otologie.

[49]  Jian Zhang,et al.  A Pilot Study of Robot-Assisted Cochlear Implant Surgery Using Steerable Electrode Arrays , 2006, MICCAI.

[50]  C. Coulson,et al.  A cochlear implantation robot in surgical practice , 2008, 2008 15th International Conference on Mechatronics and Machine Vision in Practice.

[51]  J. Raczkowsky,et al.  Update in der navigiert kontrollierten und mechatronisch assistierten Kopf-Hals-Chirurgie in Deutschland , 2008, HNO.

[52]  Kensall D. Wise,et al.  Active positioning device for a perimodiolar cochlear electrode array , 2004 .

[53]  Ge Wang,et al.  Three-dimensional geometric modeling of the cochlea using helico-spiral approximation , 2000, IEEE Trans. Biomed. Eng..

[54]  Jan Kiefer,et al.  Development and Evaluation of an Improved Cochlear Implant Electrode Design for Electric Acoustic Stimulation , 2004, The Laryngoscope.

[55]  T. Lenarz,et al.  A True Minimally Invasive Approach for Cochlear Implantation: High Accuracy in Cranial Base Navigation Through Flat-Panel-Based Volume Computed Tomography , 2008, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[56]  G M Clark,et al.  Evaluation of trajectories and contact pressures for the straight nucleus cochlear implant electrode array - a two-dimensional application of finite element analysis. , 2003, Medical engineering & physics.

[57]  K.D. Wise,et al.  A 32-Site 4-Channel High-Density Electrode Array for a Cochlear Prosthesis , 2006, IEEE Journal of Solid-State Circuits.