@article{HerrmannMuellerGraffKaulitzetal.2022,
  author    = {Herrmann, David P. and M{\"u}ller-Graff, Franz-Tassilo and Kaulitz, Stefan and Cebulla, Mario and Kurz, Anja and Hagen, Rudolf and Neun, Tilmann and Rak, Kristen},
  title     = {Application of intentional facial nerve stimulation during cochlear implantation as an electrophysiological tool to estimate the intracochlear electrode position},
  series = {Scientific Reports},
  volume    = {12},
  journal   = {Scientific Reports},
  number    = {1},
  doi       = {10.1038/s41598-022-17732-9},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-300197},
  year      = {2022},
  abstract  = {This proof of concept describes the use of evoked electromyographic (EMG) activation of the facial nerve for intraoperative monitoring of the electrode insertion during cochlear implantation (CI). Intraoperative EMG measurements from the facial nerve were conducted in nine patients undergoing CI implantation. Electric current pulses were emitted from contacts on the CI array during and immediately after electrode insertion. For control, the results of EMG measurements were compared to postoperative flat panel volume computed tomography scans with secondary reconstruction (fpVCT\(_{SECO}\)). During insertion, the EMG response evoked by the electrical stimulation from the CI was growing with the stimulating contact approaching the facial nerve and declined with increasing distance. After full insertion, contacts on the apical half of the CI array stimulated higher EMG responses compared with those on the basal half. Comparison with postoperative imaging demonstrated that electrode contacts stimulating high EMG responses had the shortest distances to the facial nerve. It could be demonstrated that electrically evoked EMG activation of the facial nerve can be used to monitor the progress during CI electrode insertion and to control the intracochlear electrode position after full insertion.},
  language  = {en}
}
@article{NoyaletIlgenBuerkleinetal.2022,
  author    = {Noyalet, Laurent and Ilgen, Lukas and B{\"u}rklein, Miriam and Shehata-Dieler, Wafaa and Taeger, Johannes and Hagen, Rudolf and Neun, Tilmann and Zabler, Simon and Althoff, Daniel and Rak, Kristen},
  title     = {Vestibular aqueduct morphology and Meniere's disease - development of the vestibular aqueduct score by 3D analysis},
  series = {Frontiers in Surgery},
  volume    = {9},
  journal   = {Frontiers in Surgery},
  issn      = {2296-875X},
  doi       = {10.3389/fsurg.2022.747517},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-312893},
  year      = {2022},
  abstract  = {Improved radiological examinations with newly developed 3D models may increase understanding of Meniere's disease (MD). The morphology and course of the vestibular aqueduct (VA) in the temporal bone might be related to the severity of MD. The presented study explored, if the VA of MD and non-MD patients can be grouped relative to its angle to the semicircular canals (SCC) and length using a 3D model. Scans of temporal bone specimens (TBS) were performed using micro-CT and micro flat panel volume computed tomography (mfpVCT). Furthermore, scans were carried out in patients and TBS by computed tomography (CT). The angle between the VA and the three SCC, as well as the length of the VA were measured. From these data, a 3D model was constructed to develop the vestibular aqueduct score (VAS). Using different imaging modalities it was demonstrated that angle measurements of the VA are reliable and can be effectively used for detailed diagnostic investigation. To test the clinical relevance, the VAS was applied on MD and on non-MD patients. Length and angle values from MD patients differed from non-MD patients. In MD patients, significantly higher numbers of VAs could be assigned to a distinct group of the VAS. In addition, it was tested, whether the outcome of a treatment option for MD can be correlated to the VAS.},
  language  = {en}
}
@article{MuellerGraffIlgenSchendzielorzetal.2022,
  author    = {M{\"u}ller-Graff, Franz-Tassilo and Ilgen, Lukas and Schendzielorz, Philipp and Voelker, Johannes and Taeger, Johannes and Kurz, Anja and Hagen, Rudolf and Neun, Tilmann and Rak, Kristen},
  title     = {Implementation of secondary reconstructions of flat-panel volume computed tomography (fpVCT) and otological planning software for anatomically based cochlear implantation},
  series = {European Archives of Oto-Rhino-Laryngology},
  volume    = {279},
  journal   = {European Archives of Oto-Rhino-Laryngology},
  number    = {5},
  issn      = {1434-4726},
  doi       = {10.1007/s00405-021-06924-0},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-266798},
  pages     = {2309-2319},
  year      = {2022},
  abstract  = {Purpose For further improvements in cochlear implantation, the measurement of the cochlear duct length (CDL) and the determination of the electrode contact position (ECP) are increasingly in the focus of clinical research. Usually, these items were investigated by multislice computed tomography (MSCT). The determination of ECP was only possible by research programs so far. Flat-panel volume computed tomography (fpVCT) and its secondary reconstructions (fpVCT\(_{SECO}\)) allow for high spatial resolution for the visualization of the temporal bone structures. Using a newly developed surgical planning software that enables the evaluation of CDL and the determination of postoperative ECP, this study aimed to investigate the combination of fpVCT and otological planning software to improve the implementation of an anatomically based cochlear implantation. Methods Cochlear measurements were performed utilizing surgical planning software in imaging data (MSCT, fpVCT and fpVCT\(_{SECO}\)) of patients with and without implanted electrodes. Results Measurement of the CDL by the use of an otological planning software was highly reliable using fpVCT\(_{SECO}\) with a lower variance between the respective measurements compared to MSCT. The determination of the inter-electrode-distance (IED) between the ECP was improved in fpVCT\(_{SECO}\) compared to MSCT. Conclusion The combination of fpVCT\(_{SECO}\) and otological planning software permits a simplified and more reliable analysis of the cochlea in the pre- and postoperative setting. The combination of both systems will enable further progress in the development of an anatomically based cochlear implantation.},
  language  = {en}
}
@article{TaegerMuellerGraffNeunetal.2021,
  author    = {Taeger, Johannes and M{\"u}ller-Graff, Franz-Tassilo and Neun, Tilmann and K{\"o}ping, Maria and Schendzielorz, Philipp and Hagen, Rudolf and Rak, Kristen},
  title     = {Highly precise navigation at the lateral skull base by the combination of flat-panel volume CT and electromagnetic navigation},
  series = {Science Progress},
  volume    = {104},
  journal   = {Science Progress},
  number    = {3},
  issn      = {2047-7163},
  doi       = {10.1177/00368504211032090},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-250268},
  year      = {2021},
  abstract  = {This study aimed to evaluate the feasibility and accuracy of electromagnetic navigation at the lateral skull base in combination with flat panel volume computed tomography (fpVCT) datasets. A mastoidectomy and a posterior tympanotomy were performed on 10 samples of fresh frozen temporal bones. For registration, four self-drilling titanium screws were applied as fiducial markers. Multi-slice computed tomography (MSCT; 600 µm), conventional flat panel volume computed tomography (fpVCT; 466 µm), micro-fpVCT (197 µm) and secondary reconstructed fpVCT (100 µM) scans were performed and data were loaded into the navigation system. The resulting fiducial registration error (FRE) was analysed, and control of the navigation accuracy was performed. The registration process was very quick and reliable with the screws as fiducials. Compared to using the MSCT data, the micro-fpVCT data led to significantly lower FRE values, whereas conventional fpVCT and secondary reconstructed fpVCT data had no advantage in terms of accuracy. For all imaging modalities, there was no relevant visual deviation when targeting defined anatomical points with a navigation probe. fpVCT data are very well suited for electromagnetic navigation at the lateral skull base. The use of titanium screws as fiducial markers turned out to be ideal for comparing different imaging methods. A further evaluation of this approach by a clinical trial is required.},
  language  = {en}
}
@article{HackenbergMeyerHaefneretal.2022,
  author    = {Hackenberg, Stephan and Meyer, Till Jasper and H{\"a}fner, Johannes and Scheich, Matthias and St{\"o}th, Manuel and Al-Tinawi, Fadi and Neun, Tilmann and Mlynski, Robert and Hagen, Rudolf and Scherzad, Agmal},
  title     = {Surgical management of tympanojugular paragangliomas using the flexible CO\(_2\) laser},
  series = {European Archives of Oto-Rhino-Laryngology},
  volume    = {279},
  journal   = {European Archives of Oto-Rhino-Laryngology},
  number    = {12},
  doi       = {10.1007/s00405-022-07416-5},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-324164},
  pages     = {5623-5630},
  year      = {2022},
  abstract  = {Purpose Surgery is a standard therapy for tympanojugular paragangliomas (TJP). Maintaining the quality of life (QoL) requires functional preservation. The flexible CO\(_2\) laser allows contact-free tumor removal. This retrospective study compares the postoperative functional outcomes of TJP surgery with and without the flexible CO\(_2\) laser. Methods Between 2005 and 2019, 51 patients with TJP were surgically treated at a tertiary hospital. Until 2012, 17 patients received conventional surgery. Thereafter, the flexible laser was used in 34 patients. Tumor extend, pre- and postoperative cranial nerve function, and complications were compared between the groups. Results The cohort consisted of 33 class A and B tumors and 18 class C and D tumors. Preoperative embolization was performed in 17 cases. Class C/D TJP were usually removed via an infratemporal fossa type A approach. Gross total tumor removal was achieved in 14/18 class C/D tumors. 3/51 patients suffered from long-term partial or complete facial palsy. No differences in post-therapeutic cranial nerve function or complications were noted between the conventional and laser group. One recurrence was observed after complete tumor resection. Conclusion The flexible CO\(_2\) laser was shown to be a safe and effective alternative to conventional bipolar cauterization, which is appreciated by the surgeon in these highly vascularized tumors. Both techniques allowed a high tumor control rate and good long-term results also from a functional point of view.},
  language  = {en}
}