• Thomas J Balkany, Matthew Whitley, Yisgav Shapira, Simon I Angeli, Kevin Brown, Elias Eter, Thomas Van De Water, Fred F Telischi, Adrien A Eshraghi, Adrien E Eshrahgi, and Claudiu Treaba.
• University of Miami Ear Institute Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA. tbalkany@miami.edu
• Otol. Neurotol. 2009 Oct 1; 30 (7): 903-7.

ObjectiveTo describe the surgical anatomy and clinical outcomes of a technique for securing cochlear implant receiver/stimulators (R/S). Receiver/stimulators are generally secured by drilling a custom-fit seat and suture-retaining holes in the skull. However, rare intracranial complications and R/S migration have been reported with this standard method. Newer R/S designs feature a low profile and larger, rigid flat bottoms in which drilling a seat may be less appropriate. We report a technique for securing the R/S without drilling bone.Study DesignAnatomic: Forty-eight half-heads were studied. Digital photography and morphometric analysis demonstrated anatomic boundaries of the subpericranial pocket (t-pocket). Clinical: Retrospective series of 227 consecutive Cochlear implant recipients implanted during a 2-year period using either the t-pocket or standard technique. The main outcome measures were rates of R/S migration and intracranial complications. Minimum follow-up was 12 months.ResultsThe t-pocket is limited anteriorly by dense condensations of pericranium anteriorly at the temporal-parietal suture, posteroinferiorly at the lamdoid suture, and anteroinferiorly by the bony ridge of the squamous suture. One hundred seventy-one subjects were implanted using the t-pocket technique and 56 using the standard technique, with a minimum follow-up of 12 months. There were no cases of migration or intracranial complications in either group.ConclusionThe t-pocket secures the R/S with anatomically consistent strong points of fixation while precluding dural complications. There were no cases of migration or intracranial complication noted. Further trials and device-specific training with this technique are necessary before it is widely adopted.

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