[蜗轴缺损的形态学特征及人工耳蜗手术入路]

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014 Sep;28(17):1296-300.

OBJECTIVE

To review the classification of cochlear modiolus deficiency and decision on surgical approach for above case,in order to provide mastery for cochlear implant (CI) indication.

METHOD

Basing on temporal bone HRCT pre-operation, CI subjects with modiolus deficiency were defined as following groups: (1) deficiency caused by cochlear dysplasia (Mondini malformation); (2) deficiency caused by dysplasia of cochlear and vestibule (Common cavity malformation); (3) deficiency caused by absence of internal acoustic meatus fundus (IP-III malformation). Three types of surgical approach were utilized: type I, electrode array was introduced through facial recess, enlarged the round window, type II, opened the surface of chchlea, electrode array was introduced through facial recess, fenestration on posterior promontory and then inserted around lateral wall of inner-cochlear cavity. type III, electrode array was introduce through fenestration of lateral semicircular canal and then placed close to the bony wall of common cavity.

RESULT

One hundred and sixty-six cochlear modiolus deficiency cases were identified into 3 groups as following: 135 Mondini malformation cases into group a, 18 common cavity malformation cases into group b, and 13 IP-III malformation cases into group c. Surgical approach: type I were used in 136 cases (123 Mondini cases and 13 IP-III cases), while approach type II in 12 cases (12 Mondini cases), and approach type III in 18 cases (18 common cavity cases). Income post-operation of CI: For group a (Mondini malformation), post-activation mean hearing threshold in sound field was 65 dB, speech recognition score is 95% (single finals test) and 25% (signal initials test), while it was 80 dB, 60% and 0 for group b (Conmon cavity malformation), and it was 55 dB, 100% and 45% for group c (IP-III malformation).

CONCLUSION

The income of speech recognition score for cochlear modiolus deficiency was relatively poor, group b was worst and group c was best, while group a moderate.

目的

回顾耳蜗蜗轴缺损的分类及上述病例的手术方式选择，以掌握人工耳蜗植入（CI）适应证。

方法

根据术前颞骨高分辨率CT，将存在蜗轴缺损的CI受检者分为以下几组：（1）耳蜗发育异常（Mondini畸形）导致的缺损；（2）耳蜗和前庭发育异常（共同腔畸形）导致的缺损；（3）内耳道底缺失（IP-III畸形）导致的缺损。采用三种手术方式：I型，电极阵列经面神经隐窝插入，扩大圆窗；II型，打开耳蜗表面，电极阵列经面神经隐窝插入，在后岬开窗后插入至耳蜗内空腔侧壁周围；III型，电极阵列经外半规管开窗插入，然后置于共同腔骨壁附近。

结果

166例耳蜗蜗轴缺损病例分为以下3组：a组为135例Mondini畸形病例，b组为18例共同腔畸形病例，c组为13例IP-III畸形病例。手术方式：136例采用I型（123例Mondini病例和13例IP-III病例），12例采用II型（12例Mondini病例），18例采用III型（18例共同腔病例）。CI术后收益：a组（Mondini畸形），声场中激活后平均听阈为65dB，言语识别率在单次决赛测试中为95%，在信号起始测试中为25%；b组（共同腔畸形）分别为80dB、60%和0；c组（IP-III畸形）分别为55dB、100%和45%。