Minimally invasive, image-guided, facial-recess approach to the middle ear: demonstration of the concept of percutaneous cochlear access in vitro.

Hypothesis: Image-guided surgery will permit accurate access to the middle ear via the facial recess using a single drill hole from the lateral aspect of the mastoid cortex.

Background: The widespread use of image-guided methods in otologic surgery has been limited by the need for a system that achieves the necessary level of accuracy with an easy-to-use, noninvasive fiducial marker system. We have developed and recently reported such a system (accuracy within the temporal bone = 0.