{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T17:58:56Z","timestamp":1774893536973,"version":"3.50.1"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cochlear implant fixation in pediatric patients can be challenging due to the thin cranial bone. The dura matter can be exposed by drilling a bony recess leading to possible complications. A minimally invasive newer fixation method might avoid such risks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The study focus is to assess the feasibility of drilling a bony well adequate for cochlear implant receiver\/stimulator device embedment in pediatric patients of different age groups. We also aim report the occurred complications and device failure rates using different surgical techniques for cochlear approach and fixation of the implant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Computed tomography (CT) scans of 96 pediatric patients (192 ears) were acquired. An optimal location was found within a predetermined area of the temporal bone, using an in-house designed algorithm in Materialise Python API. The feasibility of drilling a bony well was assessed by digitally removing a ramped shaped bony well. Skull thickness descriptive data were calculated, before and after the removal of the bone. Clinical data of pediatric CI patients receiving their cochlear implant between 1996 and 2021 in our tertiary center, were retrospectively collected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 153 ears (79.7%) it was not feasible to create a bony well without exposing the dura mater. In young children aged 0-4 years, drilling a bony well was not feasible in almost all patients (n=69, 98.6%). Mean minimum bone thickness of the location determined by the algorithm, in different age groups, varied from 1.84 mm in the 0-4 years, to 3.31 mm in the 15-17 years age group. We included 344 cochlear implants in 230 patients with a mean age of 3 years. Most implants were placed using the mastoidectomy with posterior tympanotomy (MPTA) approach technique (n=256, 74.4%) and fixated with the bony well fixation technique with or without bony tie-down sutures (n=293, 85.1%). Major complications occurred in all surgical techniques groups. Device related complications occurred in both the bony well and the tight pocket groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Drilling a bony well for fixation of the cochlear implant without exposing the dura matter is not feaible in children. No difference in complication rates was reported regarding device failure between subgroups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2025.1665266","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:04:56Z","timestamp":1761894296000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Retrospective cohort study analyzing temporal bone cortical thickness and perioperative complication rate, in pediatric cochlear implantation"],"prefix":"10.3389","volume":"13","author":[{"given":"Laura M.","family":"Markodimitraki","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan W.","family":"Dankbaar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Inge","family":"Stegeman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans G. X. M.","family":"Thomeer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"S9","DOI":"10.3109\/14992027.2016.1157268","article-title":"Evidence-based guidelines for recommending cochlear implantation for young children: audiological criteria and optimizing age at implantation","volume":"55","author":"Leigh","year":"2016","journal-title":"Int J Audiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"233121652110317","DOI":"10.1177\/23312165211031751","article-title":"Cochlear implantation in infants: why and how","volume":"25","author":"Purcell","year":"2021","journal-title":"Trends Hear"},{"key":"B3","author":"van Eindhoven","year":""},{"key":"B4","article-title":"Richtlijn indicatie bilaterale cochleaire implantatie voor kinderen van 5 tot en met 18 jaar","author":"Brienesse","year":"2014","journal-title":"Cochleaire Implantatie Overleg Nederland"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1001\/jamaoto.2020.0030","article-title":"Evaluating reasons for revision surgery and device failure rates in patients who underwent cochlear implantation surgery","author":"Kim","year":"2020","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1097\/MAO.0000000000002940","article-title":"Failure and revision surgery after cochlear implantation in the adult population: a 10-year single-institution retrospective and systematic review of the literature","volume":"42","author":"Layfield","year":"2021","journal-title":"Otol Neurotol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2393","DOI":"10.1002\/lary.24649","article-title":"Rates of revision and device failure in cochlear implant surgery: a 30-year experience","volume":"124","author":"Wang","year":"2014","journal-title":"Laryngoscope"},{"key":"B8","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1097\/MAO.0000000000002152","article-title":"Assessment of cochlear implant revision surgeries in a cohort of 802 patients","volume":"40","author":"Karamert","year":"2019","journal-title":"Otol Neurotol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1080\/14670100.2018.1513386","article-title":"Occurrence of major complications after cochlear implant surgery in Ireland","volume":"19","author":"Petersen","year":"2018","journal-title":"Cochlear Implants Int"},{"key":"B10","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1097\/00129492-200409000-00015","article-title":"Surgical complications and their management in a series of 300 consecutive pediatric cochlear implantations","volume":"25","author":"Bhatia","year":"2004","journal-title":"Otol Neurotol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.amjoto.2015.09.002","article-title":"Analyzing complications of minimally invasive pediatric cochlear implantation: a review of 248 implantations","volume":"37","author":"Googe","year":"2016","journal-title":"Am J Otolaryngol Head Neck Med Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1097\/MAO.0000000000001302","article-title":"Analysis and management of complications in a cohort of 1,065 minimally invasive cochlear implantations","volume":"38","author":"Jiang","year":"2017","journal-title":"Otology and Neurotology"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.1001\/jamaoto.2015.2154","article-title":"Delayed complications after cochlear implantation","volume":"141","author":"Terry","year":"2015","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1111\/coa.12582","article-title":"Retrospective complication rate comparison between surgical techniques in paediatric cochlear implantation","volume":"41","author":"Bruijnzeel","year":"2016","journal-title":"Clin Otolaryngol"},{"key":"B15","year":""},{"key":"B16","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1002\/lio2.574","article-title":"Early pediatric cochlear implantation: an update","volume":"6","author":"Naik","year":"2021","journal-title":"Laryngoscope Investig Otolaryngol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/14670100.2022.2051242","article-title":"Variability in surgical techniques for cochlear implantation: an international survey study","author":"Kant","year":"2022","journal-title":"Cochlear Implants Int"},{"key":"B18","year":""},{"key":"B19","year":""},{"key":"B20","year":""},{"key":"B21","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1179\/146701010X486426","article-title":"Delayed retroauricular cerebrospinal fluid (CSF) collection in cochlear implantation","volume":"12","author":"Filipo","year":"2011","journal-title":"Cochlear Implants Int"},{"key":"B22","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1159\/000229299","article-title":"Technique of mobile bony island for cochlear implantation in children","volume":"71","author":"Jian-Jun","year":"2009","journal-title":"ORL"},{"key":"B23","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1007\/s00405-012-2007-6","article-title":"Cochlear implant fixation: are sutures really necessary?","volume":"270","author":"Gekeler","year":"2013","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1097\/mao.0b013e31802fba94","article-title":"Intracranial complications of cochlear implantation","volume":"28","author":"Dodson","year":"2007","journal-title":"Otol Neurotol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"980","DOI":"10.1258\/0022215042790646","article-title":"Subdural haematoma: a complication of cochlear implantation","volume":"118","author":"Sunkaraneni","year":"2004","journal-title":"J Laryngol Otol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1097\/00129492-200503000-00012","article-title":"Epidural hematoma after cochlear implantation in a 2.5-year-old boy","volume":"26","author":"Gosepath","year":"2005","journal-title":"Otol Neurotol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"2116","DOI":"10.1097\/01.mlg.0000149443.22393.ab","article-title":"Cochlear implant fixation using polypropylene mesh and titanium screws","volume":"114","author":"Davis","year":"2004","journal-title":"Laryngoscope"},{"key":"B28","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1097\/MAO.0b013e3181b4e904","article-title":"The temporalis pocket technique for cochlear implantation: an anatomic and clinical study","volume":"30","author":"Balkany","year":"2009","journal-title":"Otol Neurotol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1017\/S0022215117001165","article-title":"Delayed-onset haematoma formation after cochlear implantation","volume":"131","author":"Low","year":"2017","journal-title":"J Laryngol Otol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"540","DOI":"10.3109\/00016480903358261","article-title":"Unexpected findings and surgical complications in 505 consecutive cochlear implantations: a proposal for reporting consensus","volume":"130","author":"Hansen","year":"2010","journal-title":"Acta Otolaryngol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1002\/cii.7","article-title":"Cochlear implant soft failures consensus development conference statement","volume":"6","author":"Balkany","year":"2005","journal-title":"Cochlear Implants Int"},{"key":"B32","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1097\/mao.0000000000002919","article-title":"Assessment of temporal bone thickness for implantation of a new active bone-conduction transducer","volume":"42","author":"Rahne","year":"2020","journal-title":"OtolNeurotol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1366","DOI":"10.1097\/MAO.0000000000001172","article-title":"A review of temporal bone CT imaging with respect to pediatric bone-anchored hearing aid placement","volume":"37","author":"Baker","year":"2016","journal-title":"Otol Neurotol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1097\/MAO.0000000000000682","article-title":"Study of the feasible size of a bone conduction implant transducer in the temporal bone","volume":"36","author":"Reinfeldt","year":"2015","journal-title":"Otol Neurotol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1016\/j.wjorl.2017.12.001","article-title":"Cochlear implantation in infants below 12 months of age","volume":"3","author":"Miyamoto","year":"2017","journal-title":"World J Otorhinolaryngol Head Neck Surg"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1016\/j.ijporl.2014.07.002","article-title":"Surgical outcomes with subperiosteal pocket technique for cochlear implantation in very young children","volume":"78","author":"Reinfeldt","year":"2014","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1177\/0194599814567111","article-title":"228 Cases of cochlear implant receiver-stimulator placement in a tight subperiosteal pocket without fixation","volume":"152","author":"Sweeney","year":"2015","journal-title":"Otolaryngol Head Neck Surg"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1674","DOI":"10.1002\/lary.24426","article-title":"Cochlear implant fixation using a subperiosteal tight pocket without either suture or bone-recess technique","volume":"124","author":"Jethanamest","year":"2014","journal-title":"Laryngoscope"},{"key":"B39","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1097\/MAO.0000000000003108","article-title":"Cochlear implant fixation techniques: a systematic review of the literature","volume":"42","author":"Markodimitraki","year":"2021","journal-title":"Otol Neurotol"},{"key":"B40","author":"Markodimitraki","year":""},{"key":"B41","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1177\/01945998211067741","article-title":"Safety of cochlear implantation in children 12 months or younger: systematic review and meta-analysis","volume":"167","author":"Sbeih","year":"2022","journal-title":"Otolaryngol Head Neck Surg (United States)"},{"key":"B42","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/j.anorl.2013.05.005","article-title":"Cochlear implant complications in 403 patients: comparative study of adults and children and review of the literature","volume":"131","author":"Farinetti","year":"2014","journal-title":"Eur Ann Otorhinolaryngol Head Neck Dis"},{"key":"B43","doi-asserted-by":"publisher","first-page":"16","DOI":"10.5152\/tao.2020.5025","article-title":"Management of complications in 1452 pediatric and adult cochlear implantations","volume":"58","author":"Da\u011fk\u0131ran","year":"2020","journal-title":"Turk Arch Otorhinolaryngol"},{"key":"B44","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1016\/S0030-6665(20)31089-6","article-title":"Epidemiology of otitis media","volume":"24","author":"Daly","year":"1991","journal-title":"Otolaryngol Clin North Am"},{"key":"B45","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1159\/000358549","article-title":"Epidemiology and pathogenesis of otitis media: construction of a phenotype landscape","volume":"19","author":"Bhutta","year":"2014","journal-title":"Audiol Neurotol"},{"key":"B46","doi-asserted-by":"publisher","first-page":"830768","DOI":"10.3389\/fnins.2022.830768","article-title":"Cochlear implant awareness: development and validation of a patient reported outcome measure","volume":"16","author":"Markodimitraki","year":"2022","journal-title":"Front Neuroscience"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1665266\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:04:56Z","timestamp":1761894296000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1665266\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":46,"alternative-id":["10.3389\/fped.2025.1665266"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1665266","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,31]]},"article-number":"1665266"}}