Introduction Cochlear implant (CI) surgery is a relatively established technique with little variance when performed in patients with normal anatomy. However, an increasing number of successful CI cases in children have encouraged both medical staff and patient's family to consider inserting CIs into cochleae with anomalies. Surgery in patients with cochlear anomalies is always challenging, and thus we believe that there is a wider set of pediatric patients than adults who would benefit from image-guided surgery (IGS). One of the important issues to be solved before employing IGS to children would be to reduce the burden of the patients without compromising the accuracy of the IGS. Preoperative marking on the skull using titanium screws is one of the most accurate methods for registration. However, neither preoperative invasive screwing process nor additional CT scanning would be readily accepted in most cases, especially in children. The registration of the patient and surgical tools consume additional surgical time, sometimes up to 30 min. This also makes it difficult to employ conventional IGS to short surgery such as CI insertion. We recently developed the "STAMP method" for quick and accurate registration without requiring preoperative fiducial marking and additional CT. Releasing patients from additional burden for IGS immediately widened the indication of this safety equipment. Here we introduce our workflow to employ IGS to pediatric CI candidates.
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