Robotized Cochlear Implantation under Fluoroscopy: A Preliminary Series.

It is known that visual feedback by fluoroscopy can detect electrode array (EA) misrouting within the cochlea while robotized EA-insertion (rob-EAI) permits atraumatic cochlear implantation. We report here our unique experience of both fluoroscopy feedback and rob-EAI in cochlear implant surgery. We retrospectively analyzed a cohort of consecutive patients implanted from November 2021−October 2022 using rob-EAI, with the RobOtol®, to determine the quality of EA-insertion and the additional time required. Twenty-three patients (10 females, 61+/−19 yo) were tentatively implanted using robot assistance, with a rob-EAI speed < 1 mm/s. Only three cases required a successful revised insertion by hand. Under fluoroscopy (n = 11), it was possible to achieve a remote rob-EAI (n = 8), as the surgeon was outside the operative room, behind an anti-radiation screen. No scala translocation occurred. The additional operative time due to robot use was 18+/−7 min with about 4 min more for remote rob-EAI. Basal cochlear turn fibrosis precluded rob-EAI. In conclusion, Rob-EAI can be performed in almost all cases with a low risk of scala translocation, except in the case of partial cochlear obstruction such as fibrosis. Fluoroscopy also permits remote rob-EAI.

3D-Fast Gray Matter Acquisition with Phase Sensitive Inversion Recovery Magnetic Resonance Imaging at 3 Tesla: Application for detection of spinal cord lesions in patients with multiple sclerosis.

BACKGROUND AND PURPOSE: To compare 3D-Fast Gray Matter Acquisition with Phase Sensitive Inversion Recovery (3D-FGAPSIR) with conventional 3D-Short-Tau Inversion Recovery (3D-STIR) and sagittal T1-and T2-weighted MRI dataset at 3 Tesla when detecting MS spinal cord lesions. MATERIAL AND METHODS: This prospective single-center study was approved by an institutional review board and enrolled participants from December 2016 to August 2018. Two neuroradiologists blinded to all data, individually analyzed the 3D-FGAPSIR and the conventional datasets separately and in random order. Discrepancies were resolved by consensus by a third neuroradiologist. The primary judgment criterion was the number of MS spinal cord lesions. Secondary judgment criteria included lesion enhancement, lesion delineation, reader-reported confidence and lesion-to-cord-contrast-ratio. A Wilcoxon's test was used to compare the two datasets. RESULTS: 51 participants were included. 3D-FGAPSIR detected significantly more lesions than the conventional dataset (344 versus 171 respectively, p<0.001). Two participants had no detected lesion on the conventional dataset, whereas 3D-FGAPSIR detected at least one lesion. 3/51 participants had a single enhancing lesion detected by both datasets. Lesion delineation and reader-reported confidence were significantly higher with 3D-FGAPSIR: 4.5 (IQR 1) versus 2 (IQR 0.5), p<0.0001 and 4.5 (IQR 1) versus 2.5 (IQR 0.5), p<0.0001. Lesion-to-cord-contrast-ratio was significantly higher using 3D-FGAPSIR as opposed to 3D-STIR and T2: 1.4 (IQR 0,3) versus 0.4 (IQR 0,1) and 0.3 (IQR 0,1)(p = 0.04). Correlations with clinical data and inter- and intra-observer agreements were higher with 3D-FGAPSIR. CONCLUSION: 3D-FGAPSIR improved overall MS spinal cord lesion detection as compared to conventional set and detected all enhancing lesions.

Efficacy of pentoxifylline-tocopherol-clodronate in mandibular osteoradionecrosis.

OBJECTIVES/HYPOTHESIS: PENTOCLO treatment, associating pentoxifylline, tocopherol, and clodronate, resolves radiation-induced fibrosis. The main aim of the present study was to prospectively assess efficacy in mandibular osteoradionecrosis (ORN). STUDY DESIGN: Prospective cohort study. METHODS: Twenty-seven patients with mandibular ORN were included in the Pentoclauvergne Study between January 2014 and February 2016. After an initial 28-day phase of antibiotic, antifungal, and corticosteroid therapy, they received the PENTOCLO association daily until cure or a maximum of 24 months. The main assessment criterion was exposed bone area (EBA); secondary criteria comprised the Subjective, objective, management, and analytic (SOMA) score. RESULTS: Under PENTOCLO, EBA decreased by 28% at 2 months, 55% at 6 months, and 92% at 24 months; the SOMA score decreased by 23%, 38%, and 50%, respectively. A complete treatment course cured 76.5% of patients at a mean 9.6 months. CONCLUSIONS: PENTOCLO is a simple, well-tolerated, and effective treatment for mandibular ORN. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:E559-E566, 2020.