The Insertion Results of a Mid-scala Electrode Assessed by MRI and CBCT Image Fusion

Abstract

OBJECTIVES: To investigate the results of clinical surgical insertions with a Mid-scala array (HIFocus Mid-Scala Electrode, HFms). STUDY DESIGN: Consecutive retrospective case study. SETTINGS: Tertiary referral center. PATIENTS: Analyses of imaging data of 26 consecutive patients (31 insertions) implanted with the HFms. INTERVENTION (S): The evaluation of insertion trauma evoked by a previously validated image fusion technique. Electrode reconstructions from postoperative cone-beam computed tomography (CBCT) were overlaid onto preoperative magnetic resonance imaging (MRI) scans to create artifact-free images. MAIN OUTCOME MEASURES: The electrode position was quantified in relation to the basilar membrane. Trauma scaling adopted from Eshraghi was used for evaluating insertion trauma. The results of the visual assessment of the postoperative CBCT were compared to those obtained with the fusion technique. RESULTS: Three insertions had to be excluded due to incompatibility of the imaging data with the fusion software. We found consistent peri- to mid-modiolar placement of the HFms with a mean insertion depth angle of 376°. According to the medical records, a visual examination of the postoperative CBCT indicated that there had been no scala dislocations but when assessed by the image fusion technique, five scala dislocations (17.8%) were found. Additionally, one tip fold-over was detected in the postoperative CBCT even though this was not evident in any intraoperative measurements. CONCLUSION: HFms showed atraumatic surgical insertion results with consistent mid-modiolar placement. Image fusion enhances the accuracy of the insertion trauma assessment. Routine postoperative imaging is recommended for identifying tip fold-over as well as for quality control and documentation.