Intraoperative conebeam CT for assessment of intracochlear positioning of electrode arrays in adult recipients of cochlear implants

BACKGROUND AND PURPOSE: Intraoperative conebeam CT has been introduced into the operating room and provides quick radiologic feedback. This study aimed to investigate its utility in the assessment of the positioning of the electrode array after cochlear implantation. MATERIALS AND METHODS: This was a retrospective study of 51 patients (65 ears) with intraoperative imaging by conebeam CT (O-arm) after cochlear implantation between 2013 and 2017. Correct placement into the cochlea was immediately identified. Positioning assessments were later analyzed with OsiriX software. RESULTS: Intraoperative imaging was quickly performed in all cases. No misplacement into the vestibule or semicircular canals was found. Afoldover of the implanted array was identified in 1 patient. Secondary analysis by 2 raters showed excellent agreement on insertion depth angle (intraclass correlation = 0.96, P <.001) and length of insertion of the electrode array (intraclass correlation coefficient = 0.93, P =.04) measurements. The evaluation of the number of extracochlear electrodes was identical between the 2 raters in 78% of cases (Cohen κ = 0.55, P <.001). The scalar position was inconsistent between raters. When we compared O-arm and high-resolution CT images in 14 cases, the agreement was excellent for insertion depth angle (intraclass correlation coefficient = 0.97, P <.001) and insertion length (intraclass correlation coefficient = 0.98, P <.001), good for the number of extracochlear electrodes (Cohen K = 0.63, P =.01), but moderate for the scalar position (Cohen κ = 0.59, P =.02). CONCLUSIONS: Intraoperative conebeam CT using the O-arm is a safe, rapid, easy, and reliable procedure to immediately identify a misplacement or foldover of an electrode array. The insertion depth angle, insertion length, and number of electrodes inserted can be accurately assessed.