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摘要: 目的:探讨共同腔畸形患者人工耳蜗植入手术进路的选择。目的:对17例耳蜗前庭外半规管共同腔畸形患者进行术前影像学及听力学评估,选择常规面隐窝进路或经乳突侧外半规管进路2种手术方法行人工耳蜗植入。结果:17例耳蜗前庭外半规管共同腔畸形患者全部顺利开放共同腔并植入电极,其中3例经常规面隐窝入路,14例经乳突侧外半规管入路。全部患者成功植入电极,4例术中出现"井喷",无面瘫、脑脊液漏及脑膜炎等并发症发生。术后随访,全部患者建立主观听觉,EABR检出非典型Ⅴ波,平均声场听阈为65 dB HL,汉语单元音言语识别率平均为75%,单辅音半开放式测试识别水平＜10%。结论:①共同腔畸形患者人工耳蜗植入手术进路的选择:如果术前影像学检查在共同腔畸形的中后鼓室部可见耳蜗底转或大部分底转结构,按常规面隐窝进路植入电极;如前庭、外半规管、耳蜗完全融合呈近球形,经乳突侧外半规管进路植入电极。②共同腔畸形患者人工耳蜗植入进路的选择会影响电极植入位置的准确性和术后疗效。③共同腔畸形患者人工耳蜗植入术后效果较差,达不到社会语言交流水平。Abstract: Objective: To discuss the surgical approach of cochlear implantation in patients with common cavity.Method: Seventeen patients with common cavity underwent cochlear implantations through facial recess approach or transmatoid lateral semicircular canal approach,according to the preoperative imaging and audiological evaluation.Result: Common cavity was opened and electrodes were inserted smoothly in all cases. Facial recess approach was used in 3 patients, while transmatoid lateral semicircular canal approach was used in the others. Intraoperative "gush" occurred in 4 cases. None of the cases developed intraoperative or postoperative complications, such as facial paralysis, meningitis and cerebrospinal fluid leakage. All cases had improvements in hearing. Atypical postoperative EABR responses were detected, the average free filed hearing threshold was 65 dB HL, the average speech recognition score of Chinese vowels was 75%,and the average speech recognition score of Chinese consonant was less than 10%. Conclusion: ①Selection of surgical approach for patients with common cavity:if the basal turn of cochlear could be distinguished at the posterior tympanum side of common cavity, the facial recess approach was used;if the cohlear,vestibule and the lateral semicircular canal merged to be a spherical cavity, the transmatoid lateral semicircular canal approach was used. ②Surgical approach of cochlear implantation affected the postoperative outcomes. ③Outcomes of cochlear implatation in common cavity patients were much poorer than normal cochlear cases.
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Key words:
- common cavity /
- cochlear implantation /
- surgical approach
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