A New Application of CBCT Image Fusion in Temporal Bone Studies

Objectives Temporal bone (TB) studies are essential during the development of new arrays. Postoperative cochlear histology is still regarded as golden standard for the assessment of electrode localization and trauma though it is time consuming, expensive and technically very demanding. The aim of this study is to investigate whether pre-operative evacuation of perilymph improve the assessment of electrode localization and insertion trauma in TBs applying fusion imaging. The results were compared to a prior validated image fusion technique based on the quantification of the electrode placement. Materials and methods 12 prototype electrodes were implanted in fresh frozen TBs. The perilymph was evacuated from the scale prior to pre-operative cone-beam computer tomography (CBCT). The TB were then immersed in Ringer solution to rehydrated both scalae. After electrode insertion post-operative CBCT were obtained. 3D fusions of the pre- and postoperative registration were reconstructed. The electrode localization with respect to the basilar membrane was visually assessed. Results The visualization of the BM on the pre-operative scans was achieved beyond the second turn in all TBs. The visual assessment was found to be as accurate as the previously validated fusion technique. There was no statistically significant difference between the methods (p=0.564). The image reconstructions and evaluations, however, were faster to perform and the insertion results are immediately available. Conclusion CBCT in combination with pre- and postoperative image fusion is an accurate method for the post-operative assessment of insertion trauma in TBs. This new application facilitates the identification of the BM and allows for a visual assessment of insertion trauma.