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人工耳蜗植入术中内耳基础结构的保留

Preservation of basal inner ear structures in cochlear implantation.

作者信息

Adunka Oliver, Gstoettner Wolfgang, Hambek Markus, Unkelbach Marc H, Radeloff Andreas, Kiefer Jan

机构信息

ENT Department, J.W. Goethe University, Frankfurt am Main, Germany.

出版信息

ORL J Otorhinolaryngol Relat Spec. 2004;66(6):306-12. doi: 10.1159/000081887.

Abstract

The aim of this report was to examine basal trauma in implanted human temporal bones and discuss modified approaches to the basal cochlear turn to avoid destruction of basal cochlear structures. Thirty-three human temporal bones were implanted with four different cochlear implant electrode arrays manufactured by MED-EL using either a caudal approach cochleostomy or round window membrane insertions. All specimens were processed with a special histological technique that allows sectioning of undecalcified bone with the electrode in situ. All bones were evaluated histologically in terms of basal cochlear trauma. Two pathomechanisms of basal trauma could be distinguished and were evaluated separately, buckling of the basal end of the array and trauma by drilling. Using the caudal approach cochleostomy, the total percentage of destructive basal trauma was 48% compared to less than 15% when performing round window membrane insertions. Although it is still unclear whether basal cochlear trauma influences apical cochlear function or not, adapted surgical procedures and no forceful insertion maneuvers should be used when performing cochlear implantations with hearing preservation.

摘要

本报告的目的是研究植入的人类颞骨中的基底创伤,并讨论改良的基底蜗管转弯处理方法,以避免破坏基底蜗管结构。使用MED-EL生产的四种不同的人工耳蜗电极阵列,通过尾侧入路耳蜗造孔术或圆窗膜插入术,对33块人类颞骨进行植入。所有标本均采用一种特殊的组织学技术进行处理,该技术允许在电极原位的情况下对未脱钙的骨进行切片。所有颞骨均从组织学角度评估基底蜗管创伤情况。基底创伤的两种病理机制可被区分并分别进行评估,即阵列基底端的弯曲和钻孔造成的创伤。采用尾侧入路耳蜗造孔术时,基底破坏性创伤的总发生率为48%,而采用圆窗膜插入术时则低于15%。尽管目前尚不清楚基底蜗管创伤是否会影响蜗顶功能,但在进行保留听力的人工耳蜗植入时,应采用适当的手术方法,避免强力插入操作。

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