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Imaging Criteria to Predict Surgical Difficulties During Stapes Surgery

Parra, Claire*; Trunet, Stéphanie; Granger, Benjamin; Nguyen, Yann§,||,¶; Lamas, Georges§,||; Bernardeschi, Daniele§,||,¶; Hervochon, Rémi§,#; Tankere, Frédéric§,#

doi: 10.1097/MAO.0000000000001417

Background and Purpose: Stapes surgery for otosclerosis can be challenging if access to the oval window niche is restricted. The aim of this study was to determine the accuracy of the computed tomographic (CT) scan in the evaluation of anatomical distances, and to analyze its reliability in predicting surgical technical difficulties.

Material and Methods: A total of 96 patients (101 ears) were enrolled in a prospective study between 2012 and May 2015. During surgery, we evaluated the distance D1 between the stapes and the facial nerve, distance D2 between the promontory and the facial nerve after ablation of the superstructure, and the intraoperative discomfort of the surgeon. On preoperative CT scans, we measured the width and depth of the oval window niche, and the angle formed by two axes starting from the center-point of the footplate, the first tangential to the superior wall of the promontory, and the second tangential to the inferior wall of the fallopian canal.

Results: Intraoperative distances D1 and D2 were correlated with the width of the oval window and with the facial-promontory angle measured on imaging. CT scan measurements of the facial-promontory angle and width of the oval window were associated with the degree of discomfort of the surgeon. The cut-off threshold for intraoperative subjective discomfort was computed as 1.1 mm for the width of the oval window niche, with a sensibility of 71% and a specificity of 84%.

Conclusion: Preoperative imaging analysis of the oval window width and the facialpromontory angle can predict operative difficulty in otosclerosis surgery.

*Otorhinolaryngology, Creteil Hospital, Creteil

Radiology Department

Biostatistic, Public Health and Medical Information Department

§Otorhinolaryngology Assistance Publique des Hôpitaux de Paris (APHP), Pitié Salpêtrière University Hospital

||Sorbonne University, UPMC univ Paris 6

National Institute of Health and Medical Research Pierre and Marie Curie University (UPMC INSERM), UMR S-1159, Minimally Invasive Robot-based Hearing Rehabilitation

#Brain and Spine Institute, Magnetoencephalography-Electroencephalography Center (MEG-EEG Center) (UMR 7225/U1127), Pierre and Marie Curie University (UPMC)/National Center of Scientific Research (CNRS)/National Institute of Health and Medical Research (INSERM), Paris, France

Address correspondence and reprint requests to Claire Parra, M.D., Service d’ORL et Chirurgie cervico-faciale, Centre Hospitalier Intercommunal de Créteil, 40 av de Verdun, 94100 Creteil, France; E-mail:

S.T. and B.G. work at Pitie Salpetriere Hospital, APHP, Paris.

The authors disclose no conflicts of interest.

Copyright © 2017 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company