Hassan A M, Patel R, Redleaf M
College of Medicine,University of Illinois at Chicago,Illinois,USA.
York ENT Surgical Consultants,Hinsdale,Illinois,USA.
J Laryngol Otol. 2015 Sep;129(9):923-7. doi: 10.1017/S0022215115001966.
This paper reports five cases of aberrant cochlear implant electrode array insertion into the vestibular labyrinth. A review of the literature was conducted in order to clarify reasonable preventive and detection strategies and endorse the routine use of intra-operative plain skull X-ray.
The study entailed a clinical case series and literature review. The setting was a tertiary academic referral centre. The following data were evaluated: pre-operative temporal bone computed tomography, operative reports, intra-operative imaging, neural response telemetry/imaging and post-operative imaging.
There were no consistent pre-operative risk factors found on computed tomography scans and no reliable intra-operative signs of electrode array misdirection. All misdirections in our case series, and those in the literature, were easily detectable on intra-operative plain film X-ray.
These reported cases demonstrate implant misdirection without the surgeon's awareness. Aberrant insertion cannot be anticipated, and neural response telemetry/imaging is not a reliable indicator of misdirection. Routine intra-operative anteroposterior plain X-ray of the head is a reliable indicator of misdirection, and is fast and relatively inexpensive.
本文报告了5例人工耳蜗植入电极阵列误入前庭迷路的病例。进行文献回顾以阐明合理的预防和检测策略，并支持术中使用头颅平片X线检查的常规操作。
本研究包括临床病例系列和文献回顾。研究地点为三级学术转诊中心。评估了以下数据：术前颞骨计算机断层扫描、手术报告、术中成像、神经反应遥测/成像以及术后成像。
在计算机断层扫描上未发现一致的术前危险因素，且没有可靠的术中电极阵列误植入迹象。我们病例系列中的所有误植入情况以及文献中的误植入情况，在术中平片X线检查上均易于检测到。
这些报告的病例显示植入物在外科医生未察觉的情况下发生了误植入。无法预料到异常插入情况，且神经反应遥测/成像并非误植入的可靠指标。术中常规进行头颅前后位平片X线检查是误植入的可靠指标，且快速且相对便宜。
