Di Lella Filippo, Falcioni Maurizio, Piccinini Silvia, Iaccarino Ilaria, Bacciu Andrea, Pasanisi Enrico, Cerasti Davide, Vincenti Vincenzo
Otolaryngology and Otoneurosurgery Department, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126, Parma, Italy.
The Neuroradiology Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
Eur Arch Otorhinolaryngol. 2017 Nov;274(11):3883-3892. doi: 10.1007/s00405-017-4747-9. Epub 2017 Sep 20.
The objective of this study is to illustrate prevention strategies and management of vascular complications from the jugular bulb (JB) and internal carotid artery (ICA) during middle ear surgery or cochlear implantation. The study design is retrospective case series. The setting is tertiary referral university hospital. Patients were included if presented pre- or intraoperative evidence of high-risk anatomical anomalies of ICA or JB during middle ear or cochlear implant surgery, intraoperative vascular injury, or revision surgery after the previous iatrogenic vascular lesions. The main outcome measures are surgical outcomes and complications rate. Ten subjects were identified: three underwent cochlear implant surgery and seven underwent middle ear surgery. Among the cochlear implant patients, two presented with anomalies of the JB impeding access to the cochlear lumen and one underwent revision surgery for incorrect positioning of the array in the carotid canal. Subtotal petrosectomy was performed in all cases. Anomalies of the JB were preoperatively identified in two patients with attic and external auditory canal cholesteatoma, respectively. In a patient, a high and dehiscent JB was found during myringoplasty, while another underwent revision surgery after iatrogenic injury of the JB. A dehiscent ICA complicated middle ear effusion in one case, while in another case, a carotid aneurysm determined a cholesterol granuloma. Rupture of a pseudoaneurysm of the ICA occurred in a child during second-stage surgery and required permanent balloon occlusion without neurological complications. Knowledge of normal anatomy and its variants and preoperative imaging are the basis for prevention of vascular complications during middle ear or cochlear implant surgery.
本研究的目的是阐述中耳手术或人工耳蜗植入术中颈静脉球（JB）和颈内动脉（ICA）血管并发症的预防策略及处理方法。研究设计为回顾性病例系列研究。研究地点为三级转诊大学医院。纳入标准为在中耳手术或人工耳蜗植入术中出现ICA或JB高危解剖异常的术前或术中证据、术中血管损伤或既往医源性血管病变后的翻修手术患者。主要观察指标为手术结果和并发症发生率。共确定10例患者：3例行人工耳蜗植入手术，7例行中耳手术。在人工耳蜗植入患者中，2例出现JB异常妨碍进入耳蜗腔，1例因电极阵列在颈动脉管内位置不当而接受翻修手术。所有病例均行岩骨次全切除术。分别在2例上鼓室和外耳道胆脂瘤患者中术前发现JB异常。1例患者在鼓膜成形术中发现高位且裸露的JB，另1例在JB医源性损伤后接受翻修手术。1例ICA裸露并发中耳积液，另1例颈动脉动脉瘤导致胆固醇肉芽肿形成。1例儿童在二期手术中发生ICA假性动脉瘤破裂，需行永久性球囊闭塞术，未出现神经并发症。了解正常解剖结构及其变异情况以及术前影像学检查是预防中耳手术或人工耳蜗植入术中血管并发症的基础。
