The temporalis pocket technique for cochlear implantation: An anatomic and clinical study

Thomas J. Balkany, Matthew Whitley, Yisgav Shapira, Simon I. Angeli, Kevin Brown, Elias Eter, Thomas Van De Water, Fred F. Telischi, Adrien E. Eshrahgi, Claudiu Treaba

Research output: Contribution to journalArticlepeer-review

58 Scopus citations


OBJECTIVE: To 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 DESIGN: Anatomic: 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. RESULTS: The 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. CONCLUSION: The 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.

Original languageEnglish (US)
Pages (from-to)903-907
Number of pages5
JournalOtology and Neurotology
Issue number7
StatePublished - Oct 1 2009


  • Cochlear implant surgery
  • Complications
  • Deafness
  • Hearing loss
  • Technique

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Clinical Neurology
  • Sensory Systems


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