Quantifizierung relevanter Meßgrößen des Felsenbeins im Computertomogramm vor Cochlear-Implant-Operation

Zusammenfassung

Die für die Cochlear-Implant-Operation relevanten anatomischen Strukturen des Felsenbeins wurden sowohl im CT als auch am anatomischen Präparat an einer Schädelbasis vermessen und deren Differenzen bestimmt. Die im CT ermittelten Werte sind im Durchschnitt um 5 % größer als im Präparat. Zurückzuführen ist dieser Vergrößerungseffekt auf den Partial-Volumen-Effekt, welcher besonders an Grenzflächen unterschiedlicher Medien des Felsenbeins diese Ungenauigkeit hervorruft. Es wurde der Einfluß des Partial-Volumen-Effektes auf CT's von Patienten untersucht, die ein Cochlear Implant erhielten. Quantitativ war der Vergrößerungseffekt von 5 % im Computertomogramm gering, so dass eine präoperative radiologische Beurteilung, der für Cochlear Implant relevanten Felsenbeinstrukturen uneingeschränkt möglich ist.

Summary

In this investigation the following anatomical measurements of the petrous bone preceding cochlear implant were evaluated using computed tomography (CT): the width of the basal coil of the cochlea, the thickness of the promontory, the distance between the sigmoid sinus and the posterior wall of the external auditory canal and the thickness of the squamous part of the temporal bone in the area of operation. Initially it was necessary to ascertain how accurately CT represents the anatomical structures of the petrous bone. The procedure of CT investigation in adult patients was simulated using the base of a skull. The CT plane in which the above mentioned measurements preceding cochlear implant can be made was represented and measurements were taken. subsequently the same plane in CT was represented macroscopically with a specially developed method. The results show that anatomical structures measured in CT are magnified by 5 % in contrast to the original. This magnification is presumably attributable to the computing of connective tissue which is adjacent to bone and the incapacity of CT to image structures of different density in the same voxel. In the second part of this investigation we evaluated 66 preoperative CT's of patients who were given a cochlear implant. The results must be adjusted by 5 % to allow for this error in magnification. In conclusion a preoperative radiologic evaluation of the anatomical structures relevant to cochlear implant is without doubt tenable. Also the negligible difference between CT and the anatomical original requires no operative consequences. Because cochleostomy is carried out with a diamond burr of 1 mm diameter, a tenth of a millimeter is negligible according to our experience.

Schlüsselwörter

Computertomographie - Cochlear Implant - Felsenbein - Partial-Volumen-Effekt

Key words

Computed tomography - Cochlear implant - Petrous bone - Partial volume effect