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We addressed the prevalence, consequences and indicators of difficult detection of the RWM in cochlear implant surgery.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This study retrospectively analysed the operative reports and preoperative high resolution axial-computed tomography (CT) scans of a consecutive cohort of patients who underwent a CI insertion. The main outcomes were surgical outcomes of the RW approach, and assessment of radiological \nmarkers.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The operative reports showed that RWM insertion was feasible in 151 out of 153 patients. In 18% of the patients the RWM was difficult to visualize. All these patients had at least one intraoperative event. The chorda tympani nerve (CTN) or posterior canal wall was affected in 8% of the 153 patients and the fallopian canal in 6%. These patients had a facial-chorda tympani nerve distance on the CT scan that was considerably smaller than normal patients (1.5\u00a0mm vs 2.3\u00a0mm). In addition, a prediction line towards the anterolateral side of the RWM was found to be more prevalent in these patients\u2019 CT scans (sensitivity 81%, specificity 63%).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The RW approach is feasible in almost all patients undergoing CI surgery. Difficult visualisation of the RWM seems to lead to at least one intraoperative event. Radiological measures showed that these patients had a smaller facial recess and a more anteriorly placed facial nerve, which can be used to better plan a safe insertion approach.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00405-021-06611-0","type":"journal-article","created":{"date-parts":[[2021,1,20]],"date-time":"2021-01-20T10:03:26Z","timestamp":1611137006000},"page":"67-74","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Radiological and surgical aspects of round window visibility during cochlear implantation: a retrospective analysis"],"prefix":"10.1007","volume":"279","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8027-0681","authenticated-orcid":false,"given":"Saad","family":"Jwair","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Job J. 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