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The temporal bone is a part of the lateral skull surface that contains organs responsible for hearing and balance. Mastering surgery of the temporal bone is challenging because of this complex and microscopic three-dimensional anatomy. Segmentation of intra-temporal anatomy based on computed tomography (CT) images is necessary for applications such as surgical training and rehearsal, amongst others. However, temporal bone segmentation is challenging due to the similar intensities and complicated anatomical relationships among critical structures, undetectable small structures on standard clinical CT, and the amount of time required for manual segmentation. This paper describes a single multi-class deep learning-based pipeline as the first fully automated algorithm for segmenting multiple temporal bone structures from CT volumes, including the sigmoid sinus, facial nerve, inner ear, malleus, incus, stapes, internal carotid artery and internal auditory canal. The proposed fully convolutional network, PWD-3DNet, is a patch-wise densely connected (PWD) three-dimensional (3D) network. The accuracy and speed of the proposed algorithm was shown to surpass current manual and semi-automated segmentation techniques. The experimental results yielded significantly high Dice similarity scores and low Hausdorff distances for all temporal bone structures with an average of 86% and 0.755 millimeter (mm), respectively. We illustrated that overlapping in the inference sub-volumes improves the segmentation performance. Moreover, we proposed augmentation layers by using samples with various transformations and image artefacts to increase the robustness of PWD-3DNet against image acquisition protocols, such as smoothing caused by soft tissue scanner settings and larger voxel sizes used for radiation reduction. The proposed algorithm was tested on low-resolution CTs acquired by another center with different scanner parameters than the ones used to create the algorithm and shows potential for application beyond the particular training data used in the study.

Background: The BONEBRIDGE (MED-EL, Innsbruck, Austria) is a bone-conduction implant used in the treatment of conductive and mixed hearing loss. The BONEBRIDGE consists of an external audio processor and a bone-conduction floating mass transducer that is surgically implanted into the skull in either the transmastoid, retrosigmoid or middle fossa regions. The manufacturer includes self-tapping screws to secure the transducer; however, self-drilling screws have also been used with success. In cases where the skull is not thick enough to house the transducer, lifts are available in a variety of sizes to elevate the transducer away from the skull. The objective of the present study was to investigate the effects of screw type, lift thickness, and implant location on the sound transmission of the BONEBRIDGE., Method: Six cadaveric temporal bones were embalmed and dried for use in this study. In each sample, a hole was drilled in each of the three implant locations to house the implant transducer. At the middle fossa, six pairs of screw holes were pre-drilled; four pairs to be used with self-tapping screws and lifts (1, 2, 3, and 4 mm thick lifts, respectively), one pair with self-tapping screws and no lifts, and one pair with self-drilling screws and no lifts. At the transmastoid and retrosigmoid locations, one pair of screw holes were pre-drilled in each for the use of the self-tapping screws. The vibration of transmitted sound to the cochlea was measured using a laser Doppler vibrometry technique. The measurements were performed on the cochlear promontory at eight discrete frequencies (0.5, 0.75, 1, 1.5, 2, 3, 4 and 6 kHz). Vibration velocity of the cochlear wall was measured in all samples. Measurements were analyzed using a single-factor ANOVA to investigate the effect of each modification., Results: No significant differences were found related to either screw type, lift thickness, or implant location., Conclusions: This is the first known study to evaluate the effect of screw type, lift thickness, and implant location on the sound transmission produced by the BONEBRIDGE bone-conduction implant. Further studies may benefit from analysis using fresh cadaveric samples or in-vivo measurements.

Background: Trainees in Otolaryngology-Head and Neck Surgery must gain proficiency in a variety of challenging temporal bone surgical techniques. Traditional teaching has relied on the use of cadavers; however, this method is resource-intensive and does not allow for repeated practice. Virtual reality surgical training is a growing field that is increasingly being adopted in Otolaryngology. CardinalSim is a virtual reality temporal bone surgical simulator that offers a high-quality, inexpensive adjunct to traditional teaching methods. The objective of this study was to establish the face and content validity of CardinalSim through a national study., Methods: Otolaryngologists and resident trainees from across Canada were recruited to evaluate CardinalSim. Ethics approval and informed consent was obtained. A face and content validity questionnaire with questions categorized into 13 domains was distributed to participants following simulator use. Descriptive statistics were used to describe questionnaire results, and either Chi-square or Fishers exact tests were used to compare responses between junior residents, senior residents, and practising surgeons., Results: Sixty-two participants from thirteen different Otolaryngology-Head and Neck Surgery programs were included in the study (32 practicing surgeons; 30 resident trainees). Face validity was achieved for 5 out of 7 domains, while content validity was achieved for 5 out of 6 domains. Significant differences between groups (p-value of < 0.05) were found for one face validity domain (realistic ergonomics, p = 0.002) and two content validity domains (teaching drilling technique, p = 0.011 and overall teaching utility, p = 0.006). The assessment scores, global rating scores, and overall attitudes towards CardinalSim, were universally positive. Open-ended questions identified limitations of the simulator., Conclusion: CardinalSim met acceptable criteria for face and content validity. This temporal bone virtual reality surgical simulation platform may enhance surgical training and be suitable for patient-specific surgical rehearsal for practicing Otolaryngologists.

Purpose: To create a novel, multi-atlas-based segmentation algorithm of the facial nerve (FN) requiring minimal user intervention that could be easily deployed into an existing open-source toolkit. Specifically, the mastoid, tympanic and labyrinthine segments of the FN would be segmented., Methods: High-resolution micro-computed tomography (micro-CT) scans were pre-segmented and used as atlases of the FN. The algorithm requires the user to place four fiducials to orient the target, low-resolution clinical CT scan, and generate a centerline along the nerve. Based on this data, the appropriate atlas is chosen by the algorithm and then rigidly and non-rigidly registered to provide an automated segmentation of the FN., Results: The algorithm was successfully developed and implemented into an existing open-source software framework. Validation was performed on 28 temporal bones, where the automated segmentation was compared against gold-standard manual segmentation by an expert. The algorithm achieved an average Dice metric of 0.76 and an average Hausdorff distance of 0.17 mm for the tympanic and mastoid portions of the FN when segmenting healthy facial nerves, which are similar to previously published algorithms., Conclusion: A successful FN segmentation algorithm was developed using a high-resolution micro-CT multi-atlas approach. The algorithm was unique in its ability to segment the entire intratemporal FN, with the exception of the meatal segment, which was not included in the segmentation as it was not discernible from the vestibulocochlear nerve within the internal auditory canal. It will be published as an open-source extension to allow use in virtual reality simulators for automatic segmentation, greatly reducing the time for expert segmentation and verification.

A thorough knowledge of the gross and micro-anatomy of the human internal acoustic canal (IAC) is essential in vestibular schwannoma removal, cochlear implantation (CI) surgery, vestibular nerve section, and decompression procedures. Here, we analyzed the acoustic-facial cistern of the human IAC, including nerves and anastomoses using synchrotron phase contrast imaging (SR-PCI). A total of 26 fresh human temporal bones underwent SR-PCI. Data were processed using volume-rendering software to create three-dimensional (3D) reconstructions allowing soft tissue analyses, orthogonal sectioning, and cropping. A scalar opacity mapping tool was used to enhance tissue surface borders, and anatomical structures were color-labeled for improved 3D comprehension of the soft tissues. SR-PCI reproduced, for the first time, the variable 3D anatomy of the human IAC, including cranial nerve complexes, anastomoses, and arachnoid membrane invagination (acoustic-facial cistern; an extension of the cerebellopontine cistern) in unprocessed, un-decalcified specimens. An unrecognized system of arachnoid pillars and trabeculae was found to extend between the arachnoid and cranial nerves. We confirmed earlier findings that intra-meatal vestibular schwannoma may grow unseparated from adjacent nerves without duplication of the arachnoid layers. The arachnoid pillars may support and stabilize cranial nerves in the IAC and could also play a role in local fluid hydrodynamics., (© 2018 The Authors. Journal of Anatomy published by John Wiley & Sons Ltd on behalf of Anatomical Society.)

Objectives: To demonstrate that synchrotron radiation phase-contrast imaging (SR-PCI) can be used to visualize the intrascalar structures in implanted human cochleae and to find the optimal combination of the parameters object-to-detector distance (ODD) and beam energy (E) for visualization., Materials and Methods: Three cadaveric implanted human temporal bones underwent SR-PCI with varying combinations of parameters ODD (3, 2 and 1 m) and E (47, 60 and 72 keV). All images were then reconstructed to a three-dimensional (3D) stack of slices. The acquired 3D images were compared using contrast-to-noise ratios (CNRs) of the basilar membrane ( CNR BM ) and the electrode array (CNR E ) and the standard deviation of the beam streaks ( σ S ). Postprocessing calculations were performed using Matlab (Version 2017b, MathWorks Inc., Natick, MA, U.S.A.) with a standard significance level p < 0.05 to determine the most optimal combination of parameters., Results: SR-PCI with computed tomography reconstruction provided good visualization of the anatomical features of the implanted cochleae, specifically the exact location of the electrode with respect to the BM. A single-factor ANOVA revealed a significant difference of variance for both CNR E and CNR BM , but failed to show significance for σ S . A two-sample t-test failed to show any significant difference between CNR E columns of (3 m, 72 keV) and (2 m, 60 keV). The CNR BM was significantly different only at two pairs of columns, when (1 m, 72 keV) was compared against (2 m, 72 keV) and (3 m, 72 keV)., Conclusions: The results of this study show that SR-PCI is a viable method to visualize implanted human cochleae. SR-PCI is less invasive, less labour intensive and is associated with a much lower acquisition time compared to other methods for postimplantation imaging in humans, such as histological sectioning. We found that the optimal combination of E and ODD parameters was 72 keV and 2 m, respectively. These parameters resulted in high-contrast images of the electrode as well as all internal structures of the cochleae., Lay Description: Cochlear implants (CI) are currently the preferred method of treatment for hearing loss. Cochlear implantation surgery involves placement of a metallic, wire-shaped electrode inside the cochlea, the main organ of the human hearing system. Knowledge of the exact location of the electrode after implantation is beneficial in improving the extent of restored hearing. Common clinical imaging modalities such as computed-tomography (CT) are not ideal for providing such information, due to lack of resolution and streaking caused by the metallic electrode. Recent studies have developed algorithms to extract the electrode location from clinical computed-tomography images and have been validated using histology or micro computed-tomography (micro-CT). Synchrotron radiation phase contrast imaging (SR-PCI) is a high-resolution imaging technique used to visualize small structures in three dimensions. Recently, SR-PCI has been shown to be an alternative to histology or micro-CT for imaging the human cochlea. However, it has not been optimized for imaging implanted human cochleae. The main objective of the present work was to find the optimal organization of imaging parameters (i.e., object-to-detector distance and beam energy) for using SR-PCI to image implanted human cochleae. Three cadaveric human cochleae were imaged using five different combinations of imaging parameters at the Canadian Light Source Inc., Saskatoon, SK, Canada. The resulting images were compared both quantitatively and qualitatively. An optimal combination of parameters was found to produce high-contrast images of the both the CI electrode and all internal structures of the cochlea with minimal streaking. SR-PCI is therefore a viable alternative to histological or micro-CT studies for post-surgical imaging of implanted human cochleae., (© 2018 The Authors Journal of Microscopy © 2018 Royal Microscopical Society.)

Background: The Uppsala collection of human temporal bones and molds is a unique resource for education and international research collaboration. Micro-computerized tomography (micro-CT) and synchrotron imaging are used to investigate the complex anatomy of the inner ear. Impaired microcirculation is etiologically linked to various inner ear disorders, and recent developments in inner ear surgery promote examination of the vascular system. Here, for the first time, we present three-dimensional (3D) data from investigations of the major vascular pathways and corresponding bone channels., Methods: We used the archival Uppsala collection of temporal bones and molds consisting of 324 inner ear casts and 113 macerated temporal bones. Micro-CT was used to investigate vascular bone channels, and 26 fresh human temporal bones underwent synchrotron radiation phase contrast imaging (SR-PCI). Data were processed by volume-rendering software to create 3D reconstructions allowing orthogonal sectioning, cropping, and soft tissue analyses., Results: Micro-CT with 3D rendering was superior in reproducing the anatomy of the vascular bone channels, while SR-PCI replicated soft tissues. Arterial bone channels were traced from scala vestibuli (SV) arterioles to the fundus, cochlea, and vestibular apparatus. Drainage routes along the aqueducts were examined., Conclusion: Human inner ear vessels are difficult to study due to the adjoining hard bone. Micro-CT and SR-PCI with 3D reconstructions revealed large portions of the micro-vascular system in un-decalcified specimens. The results increase our understanding of the organization of the vascular system in humans and how altered microcirculation may relate to inner ear disorders. The findings may also have surgical implications.

High resolution images are used as a basis for finite-element modeling of the middle-ear structures to study their biomechanical function. Commonly used imaging techniques such as micro-computed tomography (CT) and optical microscopy require extensive sample preparation, processing or staining using contrast agents to achieve sufficient soft-tissue contrast. We compare imaging of middle-ear structures in unstained, non-decalcified human temporal bones using conventional absorption-contrast micro-CT and using synchrotron radiation phase-contrast imaging (SR-PCI). Four cadaveric temporal bones were imaged using SR-PCI and conventional micro-CT. Images were qualitatively compared in terms of visualization of structural details and soft-tissue contrast using intensity profiles and histograms. In order to quantitatively compare SR-PCI to micro-CT, three-dimensional (3D) models of the ossicles were constructed from both modalities using a semi-automatic segmentation method as these structures are clearly visible in both types of images. Volumes of the segmented ossicles were computed and compared between the two imaging modalities and to estimates from the literature. SR-PCI images provided superior visualization of soft-tissue microstructures over conventional micro-CT images. Intensity profiles emphasized the improved contrast and detectability of soft-tissue in SR-PCI in comparison to absorption-contrast micro-CT. In addition, the semi-automatic segmentations of SR-PCI images yielded accurate 3D reconstructions of the ossicles with mean volumes in accord with volume estimates from micro-CT images and literature. Sample segmentations of the ossicles and soft tissue structures were provided on an online data repository for benefit of the research community. The improved visualization, modeling accuracy and simple sample preparation make SR-PCI a promising tool for generating reliable FE models of the middle-ear structures, including both soft tissues and bone., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Traditional approaches to the human cochlear nerve have been impeded by its bony encasement deep inside the skull base. We present an innovative, minimally invasive, therapeutic pathway for direct access to the nerve to deliver novel regenerative therapies. Neuroanatomical studies on 10 cadaveric human temporal bones were undertaken to identify a potentially safe therapeutic pathway to the cochlear nerve. Simulations based on three-dimensional delineation of anatomical structures obtained from synchrotron phase-contrast imaging were analyzed. This enabled the identification of an approach to the nerve in the fundus of the internal auditory meatus by trephining the medial modiolar wall of the cochlea via the round window for a median depth of 1.48 mm (range 1.21–1.91 mm). The anatomical access was validated on 9 additional human temporal bones using radio-opaque markers and contrast injection with micro-computed tomography surveillance. We thus created an effective conduit for the delivery of therapeutic agents to the cochlear nerve. [ABSTRACT FROM AUTHOR]

The human inner ear contains minute three-dimensional neurosensory structures that are deeply embedded within the skull base, rendering them relatively inaccessible to regenerative therapies for hearing loss. Here we provide a detailed characterisation of the functional architecture of the space that hosts the cell bodies of the auditory nerve to make them safely accessible for the first time for therapeutic intervention. We used synchrotron phase-contrast imaging which offers the required microscopic soft-tissue contrast definition while simultaneously displaying precise bony anatomic detail. Using volume-rendering software we constructed highly accurate 3-dimensional representations of the inner ear. The cell bodies are arranged in a bony helical canal that spirals from the base of the cochlea to its apex; the canal volume is 1.6 μL but with a diffusion potential of 15 μL. Modelling data from 10 temporal bones enabled definition of a safe trajectory for therapeutic access while preserving the cochlea's internal architecture. We validated the approach through surgical simulation, anatomical dissection and micro-radiographic analysis. These findings will facilitate future clinical trials of novel therapeutic interventions to restore hearing. [ABSTRACT FROM AUTHOR]

The ossicular chain is a middle ear structure consisting of the small incus, malleus and stapes bones, which transmit tympanic membrane vibrations caused by sound to the inner ear. Despite being shown to be highly variable in shape, there are very few morphological studies of the ossicles. The objective of this study was to use a large sample of cadaveric ossicles to create a set of three‐dimensional models and study their statistical variance. Thirty‐three cadaveric temporal bone samples were scanned using micro‐computed tomography (μCT) and segmented. Statistical shape models (SSMs) were then made for each ossicle to demonstrate the divergence of morphological features. Results revealed that ossicles were most likely to vary in overall size, but that more specific feature variability was found at the manubrium of the malleus, the long process and lenticular process of the incus, and the crura and footplate of the stapes. By analyzing samples as whole ossicular chains, it was revealed that when fixed at the malleus, changes along the chain resulted in a wide variety of final stapes positions. This is the first known study to create high‐quality, three‐dimensional SSMs of the human ossicles. This information can be used to guide otological surgical training and planning, inform ossicular prosthesis development, and assist with other ossicular studies and applications by improving automated segmentation algorithms. All models have been made publicly available. [ABSTRACT FROM AUTHOR]

Background: Reports vary on the incidence of vestibular dysfunction and dizziness in patients following cochlear implantation (CI). Disequilibrium may be caused by surgery at the cochlear base, leading to functional disturbances of the vestibular receptors and endolymphatic duct system (EDS) which are located nearby. Here, we analyzed the three-dimensional (3D) anatomy of this region, aiming to optimize surgical approaches to limit damage to the vestibular organ. Material and Methods: A total of 22 fresh-frozen human temporal bones underwent synchrotron radiation phase-contrast imaging (SR-PCI). One temporal bone underwent micro-computed tomography (micro-CT) after fixation and staining with Lugol's iodine solution (I2KI) to increase tissue contrast. We used volume-rendering software to create 3D reconstructions and tissue segmentation that allowed precise assessment of anatomical relationships and topography. Macerated human ears belonging to the Uppsala collection were also used. Drilling and insertion of CI electrodes was performed with metric analyses of different trajectories. Results and Conclusions: SR-PCI and micro-CT imaging demonstrated the complex 3D anatomy of the basal region of the human cochlea, vestibular apparatus, and EDS. Drilling of a cochleostomy may disturb vestibular organ function by injuring the endolymphatic space and disrupting fluid barriers. The saccule is at particular risk due to its proximity to the surgical area and may explain immediate and long-term post-operative vertigo. Round window insertion may be less traumatic to the inner ear, however it may affect the vestibular receptors. [ABSTRACT FROM AUTHOR]

A thorough knowledge of the gross and micro‐anatomy of the human internal acoustic canal (IAC) is essential in vestibular schwannoma removal, cochlear implantation (CI) surgery, vestibular nerve section, and decompression procedures. Here, we analyzed the acoustic‐facial cistern of the human IAC, including nerves and anastomoses using synchrotron phase contrast imaging (SR‐PCI). A total of 26 fresh human temporal bones underwent SR‐PCI. Data were processed using volume‐rendering software to create three‐dimensional (3D) reconstructions allowing soft tissue analyses, orthogonal sectioning, and cropping. A scalar opacity mapping tool was used to enhance tissue surface borders, and anatomical structures were color‐labeled for improved 3D comprehension of the soft tissues. SR‐PCI reproduced, for the first time, the variable 3D anatomy of the human IAC, including cranial nerve complexes, anastomoses, and arachnoid membrane invagination (acoustic‐facial cistern; an extension of the cerebellopontine cistern) in unprocessed, un‐decalcified specimens. An unrecognized system of arachnoid pillars and trabeculae was found to extend between the arachnoid and cranial nerves. We confirmed earlier findings that intra‐meatal vestibular schwannoma may grow unseparated from adjacent nerves without duplication of the arachnoid layers. The arachnoid pillars may support and stabilize cranial nerves in the IAC and could also play a role in local fluid hydrodynamics. [ABSTRACT FROM AUTHOR]

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