Xie Li-Hong, Tang Jie, Miao Wen-Jie, Tang Xiang-Long, Li Heng, Tang An-Zhou
Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Surg Radiol Anat. 2018 Jun;40(6):705-711. doi: 10.1007/s00276-018-1972-x. Epub 2018 Jan 16.
We evaluated the risk of cochlear implantation through the round window membrane in the facial recess through a preoperative analysis of the angle between the facial nerve-round window and the cranial midline using high-resolution temporal bone CT.
Temporal bone CT films of 176 patients with profound sensorineural hearing loss at our hospital from 2013 to 2015 were reviewed. The preoperative temporal bone CT scans of the patients were retrospectively analysed. The vertical distance (d value) from the leading edge of the facial nerve to the posterior wall of the external auditory canal and the angle (α value) between the line from the leading edge of the facial nerve to the midpoint of the round window membrane and the median sagittal line on the round window membrane plane were measured. Based on intraoperative observation, the round window membrane was divided into complete round window membrane exposure (group A), partial exposure (group B), and unexposed (group C) groups, and statistical analysis was performed.
The α value could be effectively measured for all 176 patients (62.60 ± 7.12), and the d value could be effectively measured for 95 cases (5.53 ± 1.00). An analysis of the correlation between the α and d values of these 95 cases found a negative correlation. Of the 176 cases, one-way analysis of variance (ANOVA) showed that the differences among the groups were significant [P = 0.000 (< 0.05)].
The angle (α value) between the line connecting the leading edge of the facial nerve to the midpoint of the round window and the median sagittal line measured in preoperative CT scans was associated with the difficulty of intraoperatively exposing the round window membrane. When the α value was larger than a certain degree, the difficulty of exposing the round window membrane was increased. In such cases, the surgeon should fully expose the round window membrane during surgery, which could result decrease the likelihood of complications.
通过使用高分辨率颞骨CT对术前面神经-圆窗与颅中线之间的角度进行分析，评估经面神经隐窝的圆窗膜进行人工耳蜗植入的风险。
回顾性分析我院2013年至2015年176例重度感音神经性听力损失患者的颞骨CT片。对患者术前的颞骨CT扫描进行回顾性分析。测量面神经前缘至外耳道后壁的垂直距离（d值）以及面神经前缘至圆窗膜中点的连线与圆窗膜平面上的正中矢状线之间的角度（α值）。根据术中观察，将圆窗膜分为完全暴露（A组）、部分暴露（B组）和未暴露（C组）三组，并进行统计学分析。
176例患者的α值均可有效测量（62.60±7.12），95例患者的d值可有效测量（5.53±1.00）。对这95例患者的α值和d值进行相关性分析发现呈负相关。176例患者的单因素方差分析显示组间差异有统计学意义[P = 0.000（<0.05）]。
术前CT扫描测量的面神经前缘至圆窗中点的连线与正中矢状线之间的角度（α值）与术中暴露圆窗膜的难度相关。当α值大于一定程度时，暴露圆窗膜的难度增加。在这种情况下，外科医生在手术中应充分暴露圆窗膜，这可能会降低并发症的发生率。
