Navigation as a quality management tool in cochlear implant surgery

TLDR

Computer‑assisted surgery is applicable to cochlear implantation and serves as a non‑invasive quality‑management tool. The study evaluated the value of navigation in cochlear implant surgery using a cadaver model. The authors simulated cochlear implantation on a cadaver with a Stryker‑Leibinger navigation system and a Nucleus 24 Contour implant, comparing a conventional mastoidectomy‑based approach to a navigated procedure assessed for accuracy, reliability, reproducibility, and practicability, and noting that sub‑millimeter precision may require additional referencing.

Abstract

This cadaver study assessed the value of navigation in cochlear implant surgery. Cochlear implantation was simulated on a cadaver using a Stryker-Leibinger navigation system and a Nucleus 24 Contour implant. A conventional surgical strategy consisting of mastoidectomy, posterior tympanotomy, and cochleostomy was performed. The navigated surgical procedure was evaluated for accuracy, reliability, reproducibility, and practicability. The technology of computer-assisted surgery is applicable in cochlear implantation and beneficial in as much as the navigation-controlled implantation constitutes a non-invasive instrument of quality management. Nevertheless, in order to keep the point accuracy below one millimeter, a referencing method using concealed bordering anatomical structures may be further needed to perform the cochleostomy reliably under the guidance of a navigation system. More reproducible reference systems are needed if navigated lateral skull base surgery is to be fully relied upon.