Vandersteen Clair, Demarcy Thomas, Roger Coralie, Fontas Eric, Raffaelli Charles, Ayache Nicholas, Delingette Hervé, Guevara Nicolas
Department of Ear Nose Throat Surgery, Institut Universitaire de la Face et du Cou, Centre Hospitalo-Universitaire, 31 Avenue de Valombrose, 06100, Nice, France.
Asclepios Research Team, INRIA, 2004 Route des Lucioles, Valbonne, 06902, France.
Eur Arch Otorhinolaryngol. 2016 Sep;273(9):2355-61. doi: 10.1007/s00405-015-3792-5. Epub 2015 Oct 16.
The goal of this study was to evaluate, in the hands of an inexperienced surgeon, the cochleostomy location of an endaural approach (MINV) compared to the conventional posterior tympanotomy (MPT) approach. Since 2010, we use in the ENT department of Nice a new surgical endaural approach to perform cochlear implantation. In the hands of an inexperienced surgeon, the position of the cochleostomy has not yet been studied in detail for this technique. This is a prospective study of 24 human heads. Straight electrode arrays were implanted by an inexperienced surgeon: on one side using MPT and on the other side using MINV. The cochleostomies were all antero-inferior, but they were performed through an endaural approach with the MINV or a posterior tympanotomy approach with the MPT. The positioning of the cochleostomies into the scala tympani was evaluated by microdissection. Cochleostomies performed through the endaural approach were well placed into the scala tympani more frequently than those performed through the posterior tympanotomy approach (87.5 and 16.7 %, respectively, p ≤ 0.001). This study highlights the biggest challenge for an inexperienced surgeon to achieve a reliable cochleostomy through a posterior tympanotomy, which requires years of experience. In case of an uncomfortable view through a posterior tympanotomy, an inexperienced surgeon might be able to successfully perform a cochleostomy through an endaural (combined approach) or an extended round window approach in order to avoid opening the scala vestibuli.
本研究的目的是评估在经验不足的外科医生操作下，耳内入路（MINV）与传统后鼓室切开术（MPT）入路的蜗窗造口位置。自2010年以来，我们在尼斯耳鼻喉科使用一种新的耳内手术入路进行人工耳蜗植入。在经验不足的外科医生操作下，尚未对该技术的蜗窗造口位置进行详细研究。这是一项对24颗人类头颅的前瞻性研究。由一位经验不足的外科医生植入直电极阵列：一侧使用MPT，另一侧使用MINV。所有蜗窗造口均位于前下方，但分别通过MINV的耳内入路或MPT的后鼓室切开术入路进行。通过显微解剖评估蜗窗造口在鼓阶中的定位。通过耳内入路进行的蜗窗造口比通过后鼓室切开术入路进行的蜗窗造口更频繁地良好置入鼓阶（分别为87.5%和16.7%，p≤0.001）。本研究强调了经验不足的外科医生通过后鼓室切开术实现可靠蜗窗造口面临的最大挑战，这需要多年经验。在后鼓室切开术视野不佳的情况下，经验不足的外科医生或许能够通过耳内（联合入路）或扩大圆窗入路成功进行蜗窗造口，以避免打开前庭阶。
