ARRS 2022 Abstracts

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E1370. Cochlear Implantation: Surgical Approach and Surgeon’s Perspective of the Pre-Operative CT
Authors
  1. Sahithi Sharma; Mayo Clinic
  2. Veena Gautam; Synergy Radiology Associates
Background
Preoperative CT of the temporal bone is an integral part of surgical planning prior to cochlear implantation. In addition to ruling out the pathologies, an important role of pre-operative study is to evaluate the anatomy of the temporal bone and assess for any variants along the surgical path. These variants may influence the level of the difficulty of accessing the round window or even necessitate an alternate approach to gain adequate exposure to it. A clear understanding of the surgical approach and the various challenges surgeons face during the surgery will enable us to provide an adequate interpretation for these studies.

Educational Goals / Teaching Points
The key surgical steps for cochlear implantation include cortical mastoidectomy, posterior tympanotomy, round window identification, and cochleostomy. This approach may be influenced by anatomical variants that make it easy or difficult to access the round window/cochlea. Based on the variant anatomy, the surgical approach may be modified, if necessary, to gain adequate surgical exposure to the round window. The goal of this poster is to explain the basic steps of cochlear implantation and explain the various anatomical variants that may pose challenges to our surgical colleagues.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will 1) explain the steps of cochlear implantation with attention to the surgical approach to the round window/cochlea (cortical mastoidectomy, posterior tympanotomy, round window identification and cochleostomy); 2) describe the pertinent anatomy of T-bone with respect to the surgical approach to the round window/cochlea including degree of mastoid pneumatization, position of the mastoid tegmen/temporal dura, sigmoid sinus position, high riding jugular bulb or dehiscence, and facial nerve course; and 3( provide an easy pictorial description of variants and why we need to evaluate and report them.

Conclusion
Cochlear implants are used to treat sensorineural hearing loss, and preoperative T-bone imaging is an integral part of surgical planning. Aided with a good understanding of the procedure and relevant anatomy as well potential situations that preclude surgery or require modifying standard surgical approaches, we can provide adequate information to our surgical colleagues and improve patient care in general.