The middle fossa approach with self-drilling screws: a novel technique for BONEBRIDGE implantation

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Abstract

Background

Bone conduction implants can be used in the treatment of conductive or mixed hearing loss. The BONEBRIDGE bone conduction implant (BB-BCI) is an active, transcutaneous device. BB-BCI implantation can be performed through either the transmastoid or retrosigmoid approach with their respective limitations. Here, we present a third, novel approach for BB-BCI implantation.

Objective

Describe the detailed surgical technique of BB-BCI implantation through a middle fossa approach with self-drilling screws and present preliminary audiometric outcome data following this approach.

Methods

A single institution, retrospective chart review was completed for patients implanted with the BB-BCI via the middle fossa approach. Preoperative planning and modelling were performed using 3D Slicer. Audiological testing was performed pre- and post-operatively following standard audiometric techniques.

Results

Forty patients underwent BB-BCI implantation using the middle fossa approach. Modelling techniques allowed for implantation through the use of external landmarks, obviating the need for intraoperative image guidance. The surgical technique was refined over time through experience and adaptation. Mean follow-up was 29 months (range 3–71 months) with no surgical complications, favourable cosmesis, and expected audiometric outcomes. An average functional gain of 39.6 dB (± 14.7 SD) was found.

Conclusion

The middle fossa technique with self-drilling screws is a safe and effective option for BONEBRIDGE implantation. As a reference for other groups considering this approach, an annotated video has been included as a supplement to the study.

Electronic supplementary material

The online version of this article (10.1186/s40463-019-0354-7) contains supplementary material, which is available to authorized users.

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Most cited references 16

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3D Slicer: A Platform for Subject-Specific Image Analysis, Visualization, and Clinical Support

Ron Kikinis, Steve D. Pieper, Kirby G Vosburgh (2014)

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Surgery for vestibular schwannomas: a systematic review of complications by approach.

Colin Terry, Aaron A Cohen Gadol, F Ansari (2012)

Various studies report outcomes of vestibular schwannoma (VS) surgery, but few studies have compared outcomes across the various approaches. The authors conducted a systematic review of the available data on VS surgery, comparing the different approaches and their associated complications. MEDLINE searches were conducted to collect studies that reported information on patients undergoing VS surgery. The authors set inclusion criteria for such studies, including the availability of follow-up data for at least 3 months, inclusion of preoperative and postoperative audiometric data, intraoperative monitoring, and reporting of results using established and standardized metrics. Data were collected on hearing loss, facial nerve dysfunction, persistent postoperative headache, CSF leak, operative mortality, residual tumor, tumor recurrence, cranial nerve (CN) dysfunction involving nerves other than CN VII or VIII, and other neurological complications. The authors reviewed data from 35 studies pertaining to 5064 patients who had undergone VS surgery. The analyses for hearing loss and facial nerve dysfunction were stratified into the following tumor categories: intracanalicular (IC), size (extrameatal diameter) 3.0 cm. The middle cranial fossa approach was found to be superior to the retrosigmoid approach for hearing preservation in patients with tumors 3.0 cm (30.2% vs 42.5%, respectively, p < 0.001). Postoperative headache was significantly more likely after the retrosigmoid approach than after the translabyrinthine approach, but neither differed significantly from the middle cranial fossa approach (17.3%, 0%, and 8%, respectively; p < 0.001). The incidence of CSF leak was significantly greater after the retrosigmoid approach than after either the middle cranial fossa or translabyrinthine approaches (10.3%, 5.3%, 7.1%; p = 0.001). The incidences of residual tumor, mortality, major non-CN complications, residual tumor, tumor recurrence, and dysfunction of other cranial nerves were not significantly different across the approaches. The middle cranial fossa approach seems safest for hearing preservation in patients with smaller tumors. Based on the data, the retrosigmoid approach seems to be the most versatile corridor for facial nerve preservation for most tumor sizes, but it is associated with a higher risk of postoperative pain and CSF fistula. The translabyrinthine approach is associated with complete hearing loss but may be useful for patients with large tumors and poor preoperative hearing.

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Transcutaneous bone-conduction hearing device: audiological and surgical aspects in a first series of patients with mixed hearing loss.

Maurizio Barbara, Marco Perotti, Barbara Gioia … (2013)

The Bonebridge(®) (BB) transcutaneous bone conductive implant (BCI) may overcome some of the issues related to a percutaneous BCI, such as management of the external screw, delayed activation or possible skin complications. Moreover, it has been shown to enable a functional outcome similar to percutaneous BCI in both conductive and mixed types of hearing loss.

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Author and article information

Contributors

Peng You: Peng.you@lhsc.on.ca

Lauren H. Siegel: Lauren.Siegel@schulich.uwo.ca

Zahra Kassam: zahra.kassam@sjhc.london.on.ca

Matthew Hebb: matthew.hebb@lhsc.on.ca

Lorne Parnes: lorne.parnes@lhsc.on.ca

Hanif M. Ladak: hladak@uwo.ca

Sumit Kishore Agrawal:

ORCID: http://orcid.org/0000-0002-1309-3838

sumit.agrawal@lhsc.on.ca

Journal

Journal ID (nlm-ta): J Otolaryngol Head Neck Surg

Journal ID (iso-abbrev): J Otolaryngol Head Neck Surg

Title: Journal of Otolaryngology - Head & Neck Surgery

Publisher: BioMed Central (London )

ISSN (Print): 1916-0208

ISSN (Electronic): 1916-0216

Publication date (Electronic): 29 July 2019

Publication date PMC-release: 29 July 2019

Publication date Collection: 2019

Volume: 48

Electronic Location Identifier: 35

Affiliations

[1 ]ISNI 0000 0004 1936 8884, GRID grid.39381.30, Department of Otolaryngology-Head and Neck Surgery, , Schulich School of Medicine & Dentistry, Western University, ; London, Canada

[2 ]ISNI 0000 0004 1936 8884, GRID grid.39381.30, Department of Medical Imaging, , Schulich School of Medicine & Dentistry, Western University, ; London, Canada

[3 ]ISNI 0000 0004 1936 8884, GRID grid.39381.30, Department of Clinical Neurological Sciences, , Schulich School of Medicine & Dentistry, Western University, ; London, Canada

[4 ]ISNI 0000 0004 1936 8884, GRID grid.39381.30, Department of Medical Biophysics, , Schulich School of Medicine & Dentistry, Western University, ; London, Canada

[5 ]GRID grid.449710.f, University Hospital, Room B1-333, London Health Sciences Centre – University Hospital, ; 339 Windermere Road, London, Ontario N6A 5A5 Canada

[6 ]ISNI 0000 0004 1936 8884, GRID grid.39381.30, Department of Electrical & Computer Engineering, Faculty of Engineering, , Western University, ; London, Canada

Author information

Sumit Kishore Agrawal http://orcid.org/0000-0002-1309-3838

Article

Publisher ID: 354

DOI: 10.1186/s40463-019-0354-7

PMC ID: 6664741

PubMed ID: 31358057

SO-VID: 6396b74a-5a74-42a8-b266-772980806c77

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 16 April 2019

Date accepted : 25 June 2019

Custom metadata

Keywords: bone conduction implant,bonebridge,middle fossa approach,conductive hearing loss,surgical technique,implants

Data availability:

Keywords: bone conduction implant, bonebridge, middle fossa approach, conductive hearing loss, surgical technique, implants

The middle fossa approach with self-drilling screws: a novel technique for BONEBRIDGE implantation

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Conclusion

Electronic supplementary material

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Most cited references 16

3D Slicer: A Platform for Subject-Specific Image Analysis, Visualization, and Clinical Support

Surgery for vestibular schwannomas: a systematic review of complications by approach.

Transcutaneous bone-conduction hearing device: audiological and surgical aspects in a first series of patients with mixed hearing loss.

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