Rask-Andersen Helge, Erixon Elsa, Kinnefors Anders, Löwenheim Hubert, Schrott-Fischer Anneliese, Liu Wei
Department of Surgical Sciences and Otolaryngology, Section of Otosurgery, Uppsala University Hospital, Uppsala, Sweden.
Cochlear Implants Int. 2011 May;12 Suppl 1:S8-13. doi: 10.1179/146701011X13001035752174.
Since the classical description by Retzius in 1884, many extensive studies of the micro-anatomy of the human cochlea have been presented. The human cochlea is one of the most difficult tissues to study due to the bony capsule and its delicate contents. Most preparations suffer from post-mortem changes caused by the delay between demise and fixation. For over a decade, we have analyzed human inner-ear tissue obtained at surgery using transmission electron microscopy, scanning electron microscopy, in vitro culture, and immunohistochemistry. These studies show the value of these techniques for fine structural and molecular analyses. Modern cochlear implant surgery requires that ear surgeons are familiar with the intricate anatomy of the human cochlea and its variations. The classical technique to insert electrode arrays through a drilled cochleostomy has been abandoned by some surgeons today. Instead a round-window approach can be used as originally implemented by William House for short electrodes. This so-called 'hook' region of the cochlea presents extensive anatomical variations that can be difficult to foresee on pre-operative computed tomography. CI depends on the functional status of remaining spiral ganglion neurons. These cells are more or less preserved in CI patients but how the conservation influences the outcome of CI is debatable. Notwithstanding their preservation is crucial and more information should be attained about their deterioration and how it can be prevented. Better understanding of structure, function, and regenerative capability is needed to comprehend the nature of electrical stimulation of the peripheral and central nervous system to improve the design of future implant systems.
自1884年雷丘斯（Retzius）进行经典描述以来，已经出现了许多关于人类耳蜗微观解剖学的广泛研究。由于骨囊及其精细的内部结构，人类耳蜗是最难研究的组织之一。大多数标本都存在死后变化，这是由死亡与固定之间的延迟所导致的。十多年来，我们使用透射电子显微镜、扫描电子显微镜、体外培养和免疫组织化学方法，对手术中获取的人类内耳组织进行了分析。这些研究显示了这些技术在精细结构和分子分析方面的价值。现代人工耳蜗手术要求耳科医生熟悉人类耳蜗复杂的解剖结构及其变异情况。如今，一些外科医生已经摒弃了通过钻开的耳蜗造口术插入电极阵列的经典技术。取而代之的是，可以采用威廉·豪斯（William House）最初为短电极实施的圆窗方法。耳蜗的这个所谓“钩”区域存在广泛的解剖变异，在术前计算机断层扫描中很难预见。人工耳蜗植入取决于剩余螺旋神经节神经元的功能状态。这些细胞在人工耳蜗植入患者中或多或少得以保留，但这种保留如何影响人工耳蜗植入的效果仍存在争议。尽管如此，它们的保留至关重要，应该获取更多关于它们退化以及如何预防退化的信息。需要更好地理解结构、功能和再生能力，以了解对周围和中枢神经系统进行电刺激的本质，从而改进未来植入系统的设计。
