使用基于影像的患者特异性3D模型评估畸形耳蜗中手动和机器人辅助电极放置
Evaluation of manual and robot-assisted electrode placement in malformed cochleae using imaging-based patient specific 3D models.
文献信息
| PMID | 42760372 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Fiona Anna Molnár |
| 作者单位 | Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Szeged, Hungary. drmolnarfiona@gmail.com. |
| 期刊 | European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 先天性内耳畸形的人工耳蜗植入在技术上可能具有挑战性，因为非典型解剖结构可能限制电极选择、轨迹和插入深度。尽管高分辨率CT/MRI和规划工具（如OTOPLAN®）可支持术前评估，但严重畸形可能需要额外验证。我们使用患者特异性3D模型评估了机器人辅助插入是否能改善畸形耳蜗中的插入性能。
方法： 使用8名儿科候选者的高分辨率CT和/或MRI重建并3D打印了16个耳蜗（畸形耳蜗加上一个解剖学正常但第八神经发育不全的对照，如适用）。由一位专家外科医生（P1）、一位新手外科医生（P2）和一个机器人系统（RobOtol®，R1）插入四种电极阵列（MED-EL Medium、MED-EL Compressed、MED-EL Flex24和Cochlear Straight）。结局为插入完整性（完整/不完整）和难易度（容易/困难）。数据使用Firth惩罚逻辑回归和分类树分析进行分析。使用标准分类指标比较了仅由P1进行的术前预测与P1+OTOPLAN®的术前预测。
结果： 电极类型和耳蜗解剖结构是插入结局的主要决定因素。活动长度较短的电极阵列（MED-EL Compressed）在解剖受限的畸形耳蜗中表现出更高的插入完整性，而Flex24和Cochlear Straight在限制性发育不全耳蜗中显示出完整性降低。操作者身份，包括机器人辅助，影响极小；难易度总体较高。OTOPLAN®辅助规划改善了预测性能并减少了假阴性评估。
结论： 在畸形耳蜗中，在所评估的结局指标内，插入完整性主要受耳蜗形态和电极特征影响。患者特异性3D模型为电极-解剖兼容性评估和术前规划提供了有用的平台；然而，仍需纳入音调定位覆盖、听力学结局和客观机器人性能指标的临床验证。
英文摘要
PURPOSE: Cochlear implantation in congenital inner ear malformations can be technically challenging due to the atypical anatomy which can limit electrode selection, trajectory, and insertion depth. Although high-resolution CT/MRI and planning tools (e.g., OTOPLAN®) support preoperative assessment, severe malformations may require additional validation. We evaluated whether robot-assisted insertion improves insertion performance in malformed cochleae using patient-specific 3D models.
METHODS: High-resolution CT and/or MRI from 8 paediatric candidates were used to reconstruct and 3D print 16 cochleae (malformed cochleae plus one anatomically normal control with eighth nerve aplasia, as applicable). Four electrode arrays (MED-EL Medium, MED-EL Compressed, MED-EL Flex24, and Cochlear Straight) were inserted by an expert surgeon (P1), a novice surgeon (P2), and a robotic system (RobOtol®, R1). Outcomes were insertion completeness (complete/incomplete) and ease (easy/hard). Data were analysed using Firth's penalized logistic regression and classification tree analysis. Preoperative prediction by P1 alone versus P1 + OTOPLAN® was compared using standard classification metrics.
RESULTS: Electrode type and cochlear anatomy were the primary determinants of insertion outcomes. Electrode arrays with shorter active lengths (MED-EL Compressed) demonstrated higher insertion completeness in anatomically restricted malformed cochleae, whereas Flex24 and Cochlear Straight showed reduced completeness in restrictive hypoplastic cochleae. Operator identity, including robotic assistance, had minimal impact; ease was generally high. OTOPLAN® assisted planning improved prediction performance and reduced false-negative assessments.
CONCLUSION: In malformed cochleae, insertion completeness was influenced primarily by cochlear morphology and electrode characteristics within the outcome measures assessed. Patient-specific 3D models provide a useful platform for electrode-anatomy compatibility assessment and preoperative planning; however, clinical validation incorporating tonotopic coverage, audiological outcomes, and objective robotic performance metrics is warranted.