Application of intraoperative CT-assisted positioning in difficult cases of cochlear implantation
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摘要: 目的 总结严重内耳畸形和解剖异常等疑难病例中应用CT引导人工耳蜗植入的手术经验，探讨术中CT辅助定位在疑难病例人工耳蜗植入术中的应用价值。方法 回顾性分析2015年1月—2022年1月在郑州大学第一附属医院耳科应用术中CT辅助完成的23例疑难人工耳蜗植入术病例的临床资料。术中CT辅助定位，获取电极位置的信息并及时反馈，且允许修改以确保电极位置精准植入。结果 23例(27耳)中双侧植入4例，不完全分割Ⅰ型(IP-Ⅰ)6例、不完全分割Ⅱ型(IP-Ⅱ)1例、不完全分隔Ⅲ型(IP-Ⅲ)10例、共同腔畸形3例和脑膜炎后耳蜗骨化3例。术中发现面神经解剖异常9例，脑脊液严重“井喷”14例，电极位置异常需术中调整电极位置3例，解剖困难需术中CT辅助寻找解剖标志2例，电极不完全植入3例。结论 面对具有挑战性复杂颞骨解剖结构的疑难病例时，术中CT可以精确评估电极位置并提供术中解剖细节，必要时允许对电极位置立即进行调整，为疑难病例的人工耳蜗植入术提供安全保障，确保电极精准植入。Abstract: Objective To report the experience of using CT-guided cochlear implant surgery in difficult cases such as severe inner ear deformities and anatomical abnormalities, and to discuss the application value of intraoperative CT-assisted localization in difficult cases of cochlear implant surgery.Methods Retrospectively analyzed the clinical data of 23 cases of difficult cochlear implant surgery cases completed by our team with the assistance of intraoperative CT, and collected their medical data, including preoperative imaging manifestations, surgical conditions, and intraoperative imaging images for evaluation.Results During the study period, 23 difficult cases(27 ears) underwent cochlear implantation under the guidance of intraoperative CT, and 4 cases were bilaterally implanted. Including 6 cases of incomplete segmentation type Ⅰ(IP-Ⅰ), 1 case of incomplete segmentation type Ⅱ(IP-Ⅱ), 10 cases of incomplete segmentation type Ⅲ(IP-Ⅲ), 3 cases of common cavity deformity(CC) and 3 cases of cochlear ossification after meningitis. Facial nerve anatomy was abnormal in 9 cases, cerebrospinal fluid "blowout" was serious in 14 cases, electrode position was abnormal in 3 cases requiring intraoperative adjustment of electrode position, anatomical difficulties required intraoperative CT to assist in finding anatomical landmarks in 2 cases, and electrodes were not fully implanted in 3 cases.Conclusion When faced with difficult cases with challenging and complex temporal bone anatomy, intraoperative CT can accurately evaluate the electrode position and provide intraoperative anatomical details, allowing immediate adjustment of the electrode position if necessary, providing safety guarantee for difficult cases of cochlear implant surgery and ensure accurate implantation of electrodes.
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表 1 CT引导下疑难病例人工耳蜗植入术术中发现
例数 面神经异常 脑脊液严重“井喷” 术中调整电极位置 术中定位寻找解剖标志 电极不完全植入 IP-Ⅰ 6 3 3 0 0 1 IP-Ⅱ 1 0 0 0 0 0 IP-Ⅲ 10 5 10 2 0 1 共同腔畸形 3 1 1 1 1 0 耳蜗骨化 3 0 0 0 1 1 合计 23 9 14 3 2 3 
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