In my institute (KAUH, KSU, RIYADH, KSA), during the work with my colleagues, CI surgeons (Prof. Al-Muhaimeed & Prof. Attallah, of the oldest & the best CI surgeons in KSA), we faced difficult cochleostomy despite a normal patent cochlea as confirmed by preoperative CT-Temporal.
2009, Of my knowledge, the above mentioned colleagues et al are the first worldwide who mentioned the explanation of this dilemma, mentioning a tilted (rotated cochlea) in their published article:
"Al-Muhaimeed HS, Al-Anazy F, Attallah MS, Hamed O. Coclear mplantation at King Abdulaziz University Hospital, Riyadh, Saudi Arabia: a 12-year experience. J Laryngol Otol 2009; 123:e20."
2010, Lloyd et al suggested a predictive tool which could diagnose a rotated cochlea by the preoperative CT-Scan, axial temporal bone, measuring the cochlear basal turn angle (BTA) in their published article:
"Lloyd SK, Kasbekar AV, Kenway B, Prevost T, Hockman M, Beale T,
Graham J Developmental changes in cochlear orientation – implications
for cochlear implantation. Otol Neurotol 2010; 31:902–907."
2015, of my knowledge, My colleague (Prof. Al-Muhaimeed HS) & I (Abdelwahed HY) were the first worldwide who investigated retro-prospectively the above mentioned predictive tool of Lloyd et al (BTA) & found that it was indicator & we suggested the solution to make cochleostomy more easy in such encountered difficult cases as mentioned in our published article:
"Al-Muhaimeed H S & Abdelwahed H Y. Difficult cochleostomy in the normal cochlea, Egypt J Otolaryngol, 2015 Jul, 31(3): 149-155. DOI: 10.4103/10125574.159791. Source: http://www.ejo.eg.net/preprintarticle.asp?id=159791. 1012-5574 © 2015 The Egyptian Oto - Rhino - Laryngological Society.'
I hope that all worldwide CI surgeons share my topic with their valuable comment & experiences regarding this important topic.
Hello,
it is very important step in a cochlear implant surgery. Sometimes it is difficult to see all structures on middle ear and of cochlea, like the round window. However will always can and need to see some important anatomicals marks that can help and guide your cochleostomy.
And there is more.. cochlea could have some inflammations inside that makes no so easy the electrode insertion. In this cases it is common the pre operative imagens be normal. That is why cochlear implants are not so easy as it looks like.
Hope this could help you!
Best regards
Dear colleague, thank you for sharing my topic which concentrates on difficult cochleostomy in an apparent normal patent cochlea (normal preoperative CT-temporal). Did you face this type of difficulty. You would add your experience.
Dear colleagues,
a few years ago I faced exactly the same problem in one implantation after more than 18 years of experience.
After drilling longer than expected, in the usual position and angle for the cochleostomy some bleeding appeared and I had to end surgery without implanting. The cochlea was patent in the preop CT. After a postop CT, we realized that the cochlea was slightly rotated, the direction of drilling was inappropriately tangential and it reached the carotid. One week later in a new a surgery, I thinned the promontory, I exposed the stria line and proceed to implant easily.
Fortunately (for the attendants) it was during our temporal dissection and otosurgery and now I offer my experience for if it is useful to any colleague.
Prof.Dr Rafael Urquiza MD PhD
University of Malaga. Spain
Dear Prof. Rafael,
Thanks so much for adding your experience which exactly related to my topic. If you still keep the CT- Temporal of your case. We can gather as a possible case of rotated cochlea & we add it to the worldwide other documented cases. Just you would send to me (E-mail) the axial view at the level of the basal turn of cochlea & I will measure BTA to confirm the diagnosis of a rotated cochlea. Also, you would support me with gender & age of pt & also preop diagnosis. I hope that other worldwide CI surgeons provide me with documented similar cases so as to reach a good number of such cases & we share all together a valuable CI multi-center international research. Now, we have 5 cases: 1 case of me & my colleague Prof. Almuhaimeed, Lloyd et al 's 3 cases & your case (1). At least 10 cases is required to run this valuable research.
Best regards
Hazem.
Thank you prof. Badr for your valuable comment particularly your saying "However in some cases the round window is totally hidden and the basal turn unreachable." because what you said, it is related to my topic. If you desire, you would send to me the operative findings of your cases in which the RW was totally hidden with unreachable basal turn & the preoperative CT-temporal bone axial view of cochlear basal turn. Also, you would provide me by the gender & age of pt at time of CI. I will measure by self the basal turn angle to know if it was a really rotated cochlea to be added to my case & other worldwide cases to do a multi-center international research including you and other colleagues having the same after their agreement.
Kind regards.
Hazem.
Dear Prof. Badr, Prof. Rafael & colleagues,
I hope you would reply on my suggestion of conducting a research all together after gathering our cases of rotated cochlea in one group comparing with another of non-rotated cochlea. Do you agree or disagree?
Best regards,
Hazem.
Dear colleagues
I think that the idea of professor Abdul wahid is a wonderful one.I believe that we should formulate a working plan and start it.
Thanks so much Prof. Badr for your intention & desire to share me my new article about rotated cochlea.
Dear colleagues
My plan is to share all together this multi-center international research. You would send to my inbox your e-mail to exchange how to start as near as possible this great project. You would provide me with detailed data about your cases of rotated cochlea (gender, age at time of CI & intra-operative findings, CT-temporal, axial view at level (multible cuts) of basal turn of cochlea, postop transorbital X-ray). I add your cases to my case & cases of others so as to build a group of rotated cochlea of good sample size to conduct the research.
Best regards,
Dr. Hazem ABDELWAHED.