Radiologically assisted navigation in cochlear implantation for X-linked deafness malformation ANTJE ASCHENDORFF, WOLFGANG MAIER, KATRIN JAEKEL, THOMAS WESARG, SUSAN ARNDT, ROLAND LASZIG, Department of Otorhino- laryngology, University of Freiburg, Freiburg, Germany PIT VOSS, MARC METZGER, DIRK SCHULZE, Department of Maxillofacial Surgery, University of Freiburg, Freiburg, Germany ABSTRACT The X-linked deafness syndrome is characterised by a complex labyrinth malformation with a shortened cochlea with missing bony separation between the cochlea and internal auditory canal and a deviant route of the facial nerve. Cochlear implant surgery in this malformation may be complicated by an unintended electrode insertion into the internal auditory canal. The authors report a new surgical approach: intraopera- tive three dimensional-volume tomography (3D-VT)-based navigation and direct intra- operative control by 3D-VT. The navigation dataset was based on intraoperative 3D-VT after performing the mastoidectomy and posterior tympanotomy. The cochleostomy was then performed under navigation control. After insertion, the electrode position was directly visualised by 3D-VT. On the basis of the reconstruction results, the electrode position was corrected and an intracochlear insertion resulted. Cochlear implantation in X-linked deafness malformation can be facilitated using intraoperative 3D-VT-assisted navigation and intraoperative 3D-VT control of the electrode position. This approach enhances the precision of navigation and reduces the risk of improper electrode placement and additional surgery in complex malformations. Copyright © 2009 John Wiley & Sons, Ltd. Keywords: Cochlear implant; malformation; navigation; 3D-volume CT Introduction Cochlear implant surgery is an accepted method of auditory rehabilitation in con- genital and acquired deafness. The rate and complexity of malformations detected Cochlear Implants International Cochlear Implants Int. 10(S1), 14–18, 2009 Published online 13 January 2009 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/cii.379 14