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M&M: Unsupervised Mamba-based Mastoidectomy for Cochlear Implant Surgery with Noisy Data

Cochlear Implant (CI) procedures involve inserting an array of electrodes into the cochlea located inside the inner ear. Mastoidectomy is a surgical procedure that uses a high-speed drill to remove part of the mastoid region of the temporal bone, providing safe access to the cochlea through the middle and inner ear. We aim to develop an intraoperative navigation system that registers plans created using 3D preoperative Computerized Tomography (CT) volumes with the 2D surgical microscope view. Herein, we propose a method to synthesize the mastoidectomy volume using only the preoperative CT scan, where the mastoid is intact. We introduce an unsupervised learning framework designed to synthesize mastoidectomy. For model training purposes, this method uses postoperative CT scans to avoid manual data cleaning or labeling, even when the region removed during mastoidectomy is visible but affected by metal artifacts, low signal-to-noise ratio, or electrode wiring. Our approach estimates mastoidectomy regions with a mean dice score of 70.0%. This approach represents a major step forward for CI intraoperative navigation by predicting realistic mastoidectomy-removed regions in preoperative planning that can be used to register the pre-surgery plan to intraoperative microscopy.

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