Ex Vivo Evaluation of a Minimally Invasive Approach for Cochlear Implant Surgery.

OBJECTIVES: Drilling a minimally invasive access to the inner ear is a demanding task in which a computer-assisted surgical system can support the surgeon. Herein, we describe the design of a new micro-stereotactic targeting system dedicated to cochlear implant (CI) surgery and its experimental evaluation in an ex vivo study. METHODS: The proposed system consists of a reusable, bone-anchored reference frame, and a patient-specific drilling jig on top of it. Individualization of the jig is simplified to a single counterbored hole drilled out of a blank. For accurate counterboring, the setup includes a manufacturing device for individual positioning of the blank. The system was tested in a preclinical setting using twelve human cadaver donors. Cone beam computed tomograph (CBCT) scans were obtained and a drilling trajectory was planned pointing towards the basal part of the cochlea. The surgical drill was moved forward manually and slowly while the jig constrained the drill along the predetermined path. RESULTS: Drilling could be performed with preservation of facial nerve in all specimens. The mean error caused by the system at the target point in front of the cochlea was 0.30 mm ± 0.11 mm including an inaccuracy of 0.09 mm ± 0.03 mm for counterboring the guiding aperture into the jig. CONCLUSION: Feasibility of the proposed system to perform a minimally invasive posterior tympanotomy approach was shown successfully in all specimens. SIGNIFICANCE: First evaluation of the new system in a comprehensive ex vivo study demonstrating sufficient accuracy and the feasibility of the whole concept.

Minimally Invasive Cochlear Implantation: First-in-Man of Patient-Specific Positioning Jigs.

A minimally-invasive surgical (MIS) approach to cochlear implantation, if safe, practical, simple in surgical handling, and also affordable has the potential to replace the conventional surgical approaches. Our MIS approach uses patient-specific drilling templates (positioning jigs). While the most popular MIS approaches use robots, the robotic aspect is literally put aside, because our high-precision parallel kinematics is only used to individualize a positioning jig. This jig can then be mounted onto a bone-anchored mini-stereotactic frame at the patient's skull and used to create a drill-hole through the temporal bone to the patient's cochlea. We present the first clinical experience where we use sham drill bits of different diameters instead of drilling into the bone in order to demonstrate the feasibility and accuracy.

Laser-Facilitated Additive Manufacturing Enables Fabrication of Biocompatible Neural Devices.

Current personalized treatment of neurological diseases is limited by availability of appropriate manufacturing methods suitable for long term sensors for neural electrical activities in the brain. An additive manufacturing process for polymer-based biocompatible neural sensors for chronic application towards individualized implants is here presented. To process thermal crosslinking polymers, the developed extrusion process enables, in combination with an infrared (IR)-Laser, accelerated curing directly after passing the outlet of the nozzle. As a result, no additional curing steps are necessary during the build-up. Furthermore, the minimal structure size can be achieved using the laser and, in combination with the extrusion parameters, provide structural resolutions desired. Active implant components fabricated using biocompatible materials for both conductive pathways and insulating cladding keep their biocompatible properties even after the additive manufacturing process. In addition, first characterization of the electric properties in terms of impedance towards application in neural tissues are shown. The printing toolkit developed enables processing of low-viscous, flexible polymeric thermal curing materials for fabrication of individualized neural implants.

Toward 3D Printing of Medical Implants: Reduced Lateral Droplet Spreading of Silicone Rubber under Intense IR Curing.

The direct fabrication of silicone-rubber-based individually shaped active neural implants requires high-speed-curing systems in order to prevent extensive spreading of the viscous silicone rubber materials during vulcanization. Therefore, an infrared-laser-based test setup was developed to cure the silicone rubber materials rapidly and to evaluate the resulting spreading in relation to its initial viscosity, the absorbed infrared radiation, and the surface tensions of the fabrication bed's material. Different low-adhesion materials (polyimide, Parylene-C, polytetrafluoroethylene, and fluorinated ethylenepropylene) were used as bed materials to reduce the spreading of the silicone rubber materials by means of their well-known weak surface tensions. Further, O2-plasma treatment was performed on the bed materials to reduce the surface tensions. To calculate the absorbed radiation, the emittance of the laser was measured, and the absorptances of the materials were investigated with Fourier transform infrared spectroscopy in attenuated total reflection mode. A minimum silicone rubber spreading of 3.24% was achieved after 2 s curing time, indicating the potential usability of the presented high-speed-curing process for the direct fabrication of thermal-curing silicone rubbers.

3D silicone rubber interfaces for individually tailored implants.

For the fabrication of customized silicone rubber based implants, e.g. cochlear implants or electrocortical grid arrays, it is required to develop high speed curing systems, which vulcanize the silicone rubber before it runs due to a heating related viscosity drop. Therefore, we present an infrared radiation based cross-linking approach for the 3D-printing of silicone rubber bulk and carbon nanotube based silicone rubber electrode materials. Composite materials were cured in less than 120 s and material interfaces were evaluated with scanning electron microscopy. Furthermore, curing related changes in the mechanical and cell-biological behaviour were investigated with tensile and WST-1 cell biocompatibility tests. The infrared absorption properties of the silicone rubber materials were analysed with fourier transform infrared spectroscopy in transmission and attenuated total reflection mode. The heat flux was calculated by using the FTIR data, emissivity data from the infrared source manufacturer and the geometrical view factor of the system.