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Pre-operative Screening and Manual Drilling Strategies to Reduce the Risk of Thermal Injury During Minimally Invasive Cochlear Implantation Surgery

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Abstract

This article presents the development and experimental validation of a methodology to reduce the risk of thermal injury to the facial nerve during minimally invasive cochlear implantation surgery. The first step in this methodology is a pre-operative screening process, in which medical imaging is used to identify those patients that present a significant risk of developing high temperatures at the facial nerve during the drilling phase of the procedure. Such a risk is calculated based on the density of the bone along the drilling path and the thermal conductance between the drilling path and the nerve, and provides a criterion to exclude high-risk patients from receiving the minimally invasive procedure. The second component of the methodology is a drilling strategy for manually-guided drilling near the facial nerve. The strategy utilizes interval drilling and mechanical constraints to enable better control over the procedure and the resulting generation of heat. The approach is tested in fresh cadaver temporal bones using a thermal camera to monitor temperature near the facial nerve. Results indicate that pre-operative screening may successfully exclude high-risk patients and that the proposed drilling strategy enables safe drilling for low-to-moderate risk patients.

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Acknowledgments

Funding was provided by Foundation for the National Institutes of Health (Grant Nos. NIDCD 1R01DC012593-01A1 and NIDCD 2R01DC008408-05A1).

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Authors and Affiliations

  1. Department of Mechanical Engineering, Vanderbilt University, 2301 Vanderbilt Place, PMB 401592, Nashville, TN, 37240-1592, USA

    Neal P. Dillon, Loris Fichera, Jason E. Mitchell & Robert J. Webster III

  2. Vanderbilt University School of Medicine, Nashville, TN, USA

    Kyle Kesler

  3. Department of Otolaryngology, Vanderbilt University Medical Center, 1215 21st Ave. South, MCE 10450, South Tower, Nashville, TN, USA

    M. Geraldine Zuniga, Robert J. Webster III & Robert F. Labadie

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  1. Neal P. Dillon
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  2. Loris Fichera
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Correspondence to Neal P. Dillon.

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Associate Editor Jane Grande-Allen oversaw the review of this article.

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Dillon, N.P., Fichera, L., Kesler, K. et al. Pre-operative Screening and Manual Drilling Strategies to Reduce the Risk of Thermal Injury During Minimally Invasive Cochlear Implantation Surgery. Ann Biomed Eng 45, 2184–2195 (2017). https://doi.org/10.1007/s10439-017-1854-0

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