*Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; †Department of Otolaryngology, Hospital San Juan de Dios, Universidad de Chile, Santiago, Chile; and ‡Division of Otology und Neurotology, Department of Otolaryngology, University of Heidelberg, Heidelberg, Germany.
Otol Neurotol. 2015 Apr;36(4):610-7. doi: 10.1097/MAO.0000000000000719.
Based on a three-dimensional analysis, the orientation of the basal turn of the cochlea, the disposition of the basilar membrane, and the characteristics of the hook region--all of which determine the ideal electrode insertion vector during cochlear implantation--might vary among individuals to a greater degree than previously considered. The aim of this study is to assess the variability of an ideal insertion vector among a sample of surgical candidates from a purely anatomical perspective as well as from a more intraoperative-surgical perspective.
During cochlear implantation through a cochleostomy or round window approach, the angle or vector of insertion after the first entry point seems to be related to intracochlear damage, which might correlate with anatomical and functional features.
Three-dimensional reconstructions of the temporal bones of 50 cochlear implant candidates (a total of 100 ears) were assessed. The spatial orientation of an ideal insertion vector for a cochleostomy and a round window approach were estimated.
A difference as great as 60 degrees was observed for an ideal insertion vector among the subjects. From an intraoperative perspective, this variability involves pushing the electrodes "as near to the buttress" or "as near to the emergence of the corda tympani" as possible, depending on the case.
The orientation of the basal turn and the corresponding ideal electrode insertion vector vary widely among subjects. A proper preoperative estimation on a case-to-case scenario for this feature might lead to technique adaptation during insertion, possibly contributing to minimizing electrode insertion trauma and thus optimizing the anatomical and functional results.
基于三维分析，耳蜗底回的方位、基底膜的排列以及钩状区域的特征——所有这些都决定了耳蜗植入过程中理想的电极插入向量——在个体之间的差异可能比以前认为的要大。本研究旨在从纯粹的解剖学角度以及更具术中手术角度评估手术候选者样本中理想插入向量的可变性。
通过耳蜗造口术或圆窗入路进行耳蜗植入时，第一次进入点后的插入角度或向量似乎与耳蜗内损伤有关，这可能与解剖和功能特征相关。
评估了 50 名耳蜗植入候选者（共 100 只耳朵）的颞骨三维重建。估计了耳蜗造口术和圆窗入路的理想插入向量的空间方向。
在研究对象中，观察到理想插入向量之间存在高达 60 度的差异。从术中角度来看，这种可变性涉及尽可能地将电极“推向支柱”或“推向鼓索的出现”，具体取决于病例。
基底回的方位和相应的理想电极插入向量在个体之间差异很大。在病例到病例的基础上对该特征进行适当的术前估计可能会导致插入过程中的技术适应，从而有助于最大程度地减少电极插入创伤，并优化解剖和功能结果。
