面神经隐窝进路骨性通路解剖及人工耳蜗植入术鼓阶开窗法  

Three-Dimensional Anatomy of Bony Entrance through Facial Recess Approach and of Cochleostomy in Cochlear Implantation

作　　者：王辉兵[1] 张峰[1] 孟昭进[1] 孙悍军[1] 赵龙珠[1] 单希征[1] 

机构地区：[1]武警总医院耳鼻咽喉头颈外科,北京100039

出　　处：《中华耳科学杂志》2013年第2期220-223,共4页Chinese Journal of Otology

基　　金：武警总医院科研课题基金(WZ2007031)

摘　　要：目的探讨面神经隐窝进路人工耳蜗植入术骨性通路的显微解剖和鼓阶开窗的立体定位方法,该手术进路骨性通路大小对人工耳蜗植入术的影响。方法对6例成人尸头12侧颞骨行颞骨高分辨率CT扫描,在手术显微镜下模拟经面神经隐窝进路行人工耳蜗植入术,观察和测量面神经隐窝进路骨性通路和鼓阶开窗口的大小以及鼓阶开窗处与面神经、镫骨头、锥隆起、圆窗、匙突等解剖结构的距离,数据进行统计学处理。结果 12侧颞骨标本中,颞骨CT观察到面神经隐窝气房11侧(91.7%),1侧无明显气房。面神经隐窝进路骨性通路内外宽度为(2.94±0.28)mm,上下高度为(8.79±0.88)mm,深度为(3.54±0.17)mm,面积为(20.32±3.19)mm2;鼓阶开窗口直径为(1.27±0.21)mm,植入鼓阶内电极长度为(26.2±1.82)mm,鼓阶开窗点与面神经水平段、面神经乳突段、锥隆起、镫骨头、匙突的距离分别为(4.22±0.39)mm、(7.25±0.26)mm、(3.40±0.44)mm、(3.82±0.46)mm和(5.10±0.60)mm。结论颞骨CT可了解面神经隐窝气房情况,面神经隐窝进路骨性通路的大小影响人工耳蜗植入术电极插入,圆窗龛、圆窗、镫骨头、锥隆起、匙突等解剖结构可作为鼓阶开窗的参考标志。Objective To study micro-anatomy of the bony entrance relevant to cochlear implantation through the facial recess approach and three dimensional positioning of coehleostomy, and to analyze the influence of bony entrance sizes on the operation. Methods Twelve human temporal bones from six adult cadaveric heads underwent high-resolution CT scans and were dissected under surgical microscope to simulate cochlear implantation through facial recess approach. Relevant anatomic structures were examined and measured, including the sizes of the bony entrance via facial recess approach and of the cochleos- tomy, and the distances from the eoehleostomy to the facial nerve, stapes, round window, pyramidal eminence, cochleariform process, etc. Results Air cells around the facial recess were found on temporal bone CT scans in 11 of the 12 temporal bones （91.7%）. The width, height and depth of the bony entrance via facial recess approach were 2.94±0.28 mm, 8.79±0.88 mm and 3.54±0.17 ram, respectively, and the area was 20.32±3.19 ram2. The diameter of cochleostomy was 1.27±0.21 ram, and the length of the cochlear electrode array insertion into the scala tympani was 26.2± 1.82 ram. The distances from the cochleostomy to the tympanic,and mastoid segments of the facial nerve, the pyramidal eminence, stapes, eochlearifoml process and the center of round window were 4.22±0.39 ram, 7.25±0.26 ram, 3.40±0.44 mm, 3.82±0.46 ram, 5.10±0.60 mm and 2.13±0.15 mm, re- spectively. Conclusion Air cells near the facial recess can be visualized by high-resolution CT scans of the temporal bone. The implantation of electrode can be affected by the size of the bony entrance in facial recess approach. Some structures, in- cluding the round window niche, round window, stapes, pyramidal eminence and eochleariform process, can be used as refer- ence landmarks for eochleostomy.

关 键 词：面神经隐窝进路 颞骨 解剖学 计算机断层摄影术 人工耳蜗植入术 

分 类 号：R318.18[医药卫生—生物医学工程]