内耳畸形CT分类在人工耳蜗植入手术中的应用  

Application of CT Classification of Inner Ear Malformation in Cochlear Implantation

作　　者：黄宏明[1] 周正根[2] 葛润梅 王晓茜[1] 吴佩娜[1] HUANG Hongming;ZHOU Zhenggen;GE Runmei;WANG Xiaoqian;WU Peina(Department of Otorhinolaryngology,Guangdong General Hospital,Guangdong Academy of Medical Sciences(Guangzhou 510080);Department of Radiology,Guangdong General Hospital,Guangdong Academy of Medical Sciences(Guangzhou 510080))

机构地区：[1]广东省人民医院(广东省医学科学院)耳鼻咽喉科,广州510080 [2]广东省人民医院(广东省医学科学院)放射科,广州510080

出　　处：《中华耳科学杂志》2018年第5期629-633,共5页Chinese Journal of Otology

基　　金：广东省医学科学技术研究基金(A2014038);广州市科技计划项目(201607010392)~~

摘　　要：目的探讨内耳畸形CT分类在人工耳蜗植入手术中的临床应用价值。方法对人工耳蜗植入患者的高分辨率颞骨CT结果进行评估,筛选出内耳畸形的病例,根据Sennaroglu的分类方法(2010年),对内耳畸形患者进行分类,依次为:米歇尔畸形、耳蜗未发育、共同腔畸形、耳蜗发育不良I型、耳蜗发育不良II型、耳蜗发育不良III型、不完全分隔I型(incomplete partition type I,IP-I)、不完全分隔II型(incomplete partition type II,IP-II)、不完全分隔III型(incomplete partition type III,IP-III)、前庭及半规管畸形、大前庭导水管综合征及内听道狭窄等,并记录和分析人工耳蜗植入患者的内耳畸形类型、手术入路、电极类型和手术效果。结果 2011年4月至2016年9月,共有76例(150耳)内耳畸形患者,71例为双侧对称的内耳畸形,5例为双侧不对称的内耳畸形。共76例(80耳)内耳畸形患者实施人工耳蜗植入手术,双侧植入4例,左侧植入12例,右侧植入60例。无耳蜗结构的畸形4耳(耳蜗未发育1耳、共同腔畸形3耳)经乳突迷路开窗植入电极,有耳蜗结构的畸形76耳经鼓阶开窗或圆窗植入电极。耳蜗未发育和共同腔畸形选择直电极,耳蜗发育不良(I型、II型、III型)、IP-I和IP-III畸形选择短的直电极,IP-II畸形和耳蜗结构正常者选择标准电极。所有患者的工作电极均完全植入,术后的神经反应遥测除1例IP-I患者无反应外其余患者均可引出。1例IP-I患者术后出现脑脊液耳漏。所有患者无面瘫、皮瓣坏死及感染等其他并发症。结论内耳畸形的CT分类对内耳畸形患者的人工耳蜗植入手术具有指导价值,可根据内耳畸形的程度和类型选择合适的手术入路及电极类型。Objective To report clinical application of CT classification of inner ear malformation in cochlear implantation.Methods High-resolution temporal bone CT scans in Cochlear implant patients were screened for cases of inner ear malformation,which were classified according to the methods proposed by Sennaroglu in 2010,including michel deformity,cochlear aplasia,common cavity,cochlear hypoplasia type I-III,incomplete partition type I-III(IP-I,IP-II,IP-III),vestibular and semicircular canal malformations,large vestibular aqueduct syndrome and narrow internal auditory canal.The types of inner ear malformations,surgical approaches,electrode types and cochlear implant outcomes were recorded and analyzed.Results A total of 76 cases(150 ears)of inner ear malformation were diagnosed between April 2011 and September 2016,including 71 cases with bilateral symmetrical inner ear malformation and 5 cases with bilateral asymmetric inner ear malformation.All cases(80 ears)underwent cochlear implantation,bilateral in 4 cases,on the left in 12 cases,and on the right in 60 cases.Electrodes were implanted through a transmastoid labyrinthotomy approach in 4 ears with no cochlear structures(cochlear aplasia in 1 and common cavity in 3 ears)and through a cochleotomy or round window in 76 ears with cochlear structures.Straight electrodes were implanted in patients with cochlear aplasia or common cavity.Short straight electrodes were implanted in patients with cochlear hypoplasia type I-III and IP-I or IP-III.Standard electrodes were implanted in patients with IP-II or normal cochlear structures.The working electrodes were all successfully implanted,and postoperative neural telemetry responses were elicited in all but one patient with IP-I.One patients with IP-I developed postoperative cerebrospinal fluid leakage,but there were no other complications such as facial paralysis,flap necrosis or infection.Conclusion CT classification of inner ear malformation has guiding values for cochlear implantation.Appropriate surgical approaches and elec

关 键 词：内耳畸形 分类 人工耳蜗植入 

分 类 号：R764[医药卫生—耳鼻咽喉科]