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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleHead and Neck Imaging
Open Access

Vestibular Implant Imaging

A. Hedjoudje, D.P. Schoo, B.K. Ward, J.P. Carey, C.C. Della Santina and M. Pearl
American Journal of Neuroradiology December 2020, DOI: https://doi.org/10.3174/ajnr.A6991
A. Hedjoudje
aFrom the Department of Otolaryngology–Head and Neck Surgery (A.H., D.P.S., B.K.W., J.P.C., C.C.D.S.)
bDivision of Interventional Neuroradiology (A.H., M.P.)
dNeuroradiology Unit (A.H.), Service of diagnostic and interventional imaging, Sion Hospital, Sion, Valais, Switzerland
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  • ORCID record for A. Hedjoudje
D.P. Schoo
aFrom the Department of Otolaryngology–Head and Neck Surgery (A.H., D.P.S., B.K.W., J.P.C., C.C.D.S.)
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B.K. Ward
aFrom the Department of Otolaryngology–Head and Neck Surgery (A.H., D.P.S., B.K.W., J.P.C., C.C.D.S.)
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J.P. Carey
aFrom the Department of Otolaryngology–Head and Neck Surgery (A.H., D.P.S., B.K.W., J.P.C., C.C.D.S.)
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C.C. Della Santina
aFrom the Department of Otolaryngology–Head and Neck Surgery (A.H., D.P.S., B.K.W., J.P.C., C.C.D.S.)
cDepartment of Biomedical Engineering (C.C.D.S.), Johns Hopkins University School of Medicine, Baltimore, Maryland
eLabyrinth Devices (C.C.D.S.), Baltimore, Maryland
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M. Pearl
bDivision of Interventional Neuroradiology (A.H., M.P.)
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  • FIG 1.
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    FIG 1.

    A, The MVI stimulator comprises 3 fixation magnets, an inductive coil link, electrical current stimulator circuitry, a stimulation electrode array, a stimulation reference electrode, and a recording reference electrode. The electrode array includes a 3-electrode shank for the posterior canal (B, E3–E5), a forked subarray with 2 shanks for the horizontal (C, E6–E8) and anterior (C, E9–E11) canals, and a stimulation reference electrode (D). eCAP indicates electrically evoked compound action potential. Reprinted with permission from Labyrinth Devices, LLC, 2019.

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    FIG 2.

    Method for generating MSCT (A and B) and FPCT (C and D) MPR. Two planes are generated. The first plane is approximately tangential to the thin segments of the superior and horizontal SCCs at their junctions with their ampullae and includes the 6 electrode contacts of the forked array inserted into the superior and horizontal ampullae. The second plane is in the posterior plane of the SCC and includes the 3 electrode contacts of the linear array implanted in the posterior canal and the tip of braided platinum/iridium wire inserted into the common crus. Section thickness was set to 2 mm to include all electrode contacts on 1 image for both planes. Window width and contrast level were adjusted as needed to optimize the visibility of electrode contacts. A 3D representation of the vestibular lumen and vestibular nerve is added in transparency (E and F) to help visualize the anatomy.

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    FIG 3.

    Subject: Participant 7. Method for calculating the angle (θ) of the angular insertion depth of the common crus reference electrode. CC indicates common crus of the implanted labyrinth; PE, posterior electrode array; PSCC, posterior semicircular canal; SSCC, superior semicircular canal; RE, reference electrode; Sup, superior; Lat, lateral.

  • FIG 4.
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    FIG 4.

    MSCT (A–D) and FPCT (E–P) multiplanar reconstructions for all participants. A and B, Participant 1 MSCT. C and D, Participant 2 MSCT. E and F, Participant 3 FPCT. G and H, Participant 4 FPCT. I and J, Participant 5 FPCT. K and L, Participant 6 FPCT, M and N, Participant 7 FPCT. O and P, Participant 8 FPCT. In every panel, the top of the image is superior and the left edge of the image is anteromedial. Sep indicates September; Feb, February; Oct, October; Nov, November; Jan, January.

  • FIG 5.
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    FIG 5.

    A, Lateral scout view showing electrode arrays visible through the external auditory canals (yellow arrowhead) and cephalic edges of the infraorbital rims (yellow diamond). Those palpable landmarks define the Reid plane (yellow line) and the plane of horizontal canals (red line). The plane of the horizontal semicircular canals, the standard “axial” plane for temporal bone CT reconstructions, is at a ∼20° pitch from the Reid plane.17 By supporting the head on a firm wedge to pitch the head forward from supine (and flexing the neck until the Reid plane is pitched ∼20° nose toward chest from Earth vertical), one can minimize scatter artifacts from the stimulator cannister to the inner ear by keeping them on opposite sides of a separation plane perpendicular to the gantry rotation axis (B).

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    Table 1:

    Demographic information for participants with vestibular implants

    ParticipantsDate ImplantedDate ImagedAge (yr),a SexImaging ProtocolImplant SideReference Location
    112 Aug 2016Sep 201662, MMSCTLeftCC
    24 Nov 2016Nov 201657, MMSCTLeftCC
    33 Feb 2017Feb 201763, FFPCT, HR modeLeftCC
    415 Dec 2017Jan 201862, FFPCT, FF modeLeftCC
    524 Aug 2018Sep 201851, FFPCT, HR modeRightCC
    631 Aug 2018Sep 201866, FFPCT, FF modeRightCC
    714 Jan 2019Feb 201953, FFPCT, HR modeLeftCC
    813 Sep 2019Oct 201955, MFPCT, HR modeRightSP
    • Note:—CC indicates common crus of the implanted labyrinth; SP, in a subperiosteal pocket outside the temporal bone; Aug, August; Jan, January; Sep, September; Dec, December; Feb, February; Nov, November.

    • ↵a Age in years at time of implantation.

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    Table 2:

    Common crus reference electrode angular depth and insertion length calculations and locations

    Participant No.CC Insertion IntendedInsertion Depth AngleInsertion Length (mm)Anatomic Location of the Reference Electrode Tip
    1Yes–3°39Common crus
    2Yes+26°66Superior canal
    3Yes–30°42Posterior canal
    4Yes–57°21Posterior canal
    5Yes+21°46Common crus
    6Yes–2°41Posterior canal
    7Yes+4551Common crus
    8NoNANAOutside temporal bone
    • Note:—NA indicates not appliable.

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Cite this article
A. Hedjoudje, D.P. Schoo, B.K. Ward, J.P. Carey, C.C. Della Santina, M. Pearl
Vestibular Implant Imaging
American Journal of Neuroradiology Dec 2020, DOI: 10.3174/ajnr.A6991

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Vestibular Implant Imaging
A. Hedjoudje, D.P. Schoo, B.K. Ward, J.P. Carey, C.C. Della Santina, M. Pearl
American Journal of Neuroradiology Dec 2020, DOI: 10.3174/ajnr.A6991
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