Cochlear Implants (CI) are a widely successful neural-prosthetic device for improving quality of life for individuals experiencing severe to profound hearing loss. A minimally invasive technique for inserting the CI electrode, percutaneous cochlear access, typically involves a surgical trajectory through the facial recess. Image-based surgical planning techniques are heavily reliant on accurate segmentation of the chorda tympani since it is one of the delineating structures of the facial recess. Furthermore, damage to this structure can lead to loss of taste for the patient. However, the chorda’s thin nature and the surrounding appearance of pneumatized bone pose difficulties when segmenting this structure in conventional CT. Our previous automatic method still leads to unacceptable inaccuracies in difficult images. In this work, we propose the use of a conditional generative adversarial network for automatic segmentation of this structure. We use a weakly supervised approach, leveraging a dataset of sixteen hand-labelled images and 130 weakly-labelled images acquired through automatic atlas-based techniques. Our resulting network displays a 49% increase in segmentation performance over our previous automatic method with a mean localization error of 0.49mm. Even in the worst case, our method still provides sub-millimeter localization errors of 0.82mm. These results are encouraging for potential use in clinical settings as safe trajectory planning typically involves 1 mm error margins to sensitive structures.
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