Anatomical Variations and Surgical Challenges in Pediatric Cochlear Implantation: A Single-Center Experience of 489 Cases
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Cochlear implantation (CI) is the gold standard for severe-to-profound sensorineural hearing loss in children.However, temporal bone anatomical variations and inner ear malformations can significantly increase surgical complexity.Objective: To evaluate the prevalence of anatomical variations in pediatric CI candidates, identify associated surgical challenges, and describe technical adaptations implemented to achieve safe and complete electrode array insertion.Methods: A retrospective single-center study was conducted between 2014 and 2025 at Ibn Rochd University Hospital, including 489 pediatric patients (<18 years) who underwent primary CI.Preoperative radiological evaluation included high-resolution temporal bone computed tomography (HRCT) and 3T magnetic resonance imaging (MRI).Results: The mean age was 59 months, with a male-to-female ratio of 51% to 49%.Significant anatomical variations/anomalies were identified in 18.6% of cases.Facial nerve anomalies included tympanic segment dehiscence (7.2%), bifid nerve (0.2%), and aberrant course (0.2%).Vascular variations were dominated by sigmoid sinus procidence (10.5%).Round window (RW) access required surgical modification (extended RW or cochleostomy) in 30% of patients.Surgical adaptations-such as diamond drill usage, bone dust/cartilage obliteration (1.2%), and scala vestibuli insertion in complete tympanic scala ossification (2 cases)enabled successful insertion across the cohort.Conclusions: Pediatric anatomical variability necessitates comprehensive preoperative radio-anatomical mapping.Systematic surgical adaptation strategies are crucial to optimize surgical outcomes and prevent major neurovascular complications.
Language: English
Subfield: Speech and Hearing
Field: Health Professions
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7214001087