Alicandri-Ciufelli Matteo, Guarino Pierre, Fabbri Filippo, Cunsolo Elio Maria, Presutti Livio, Anschuetz Lukas
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy.
Department of Neurosurgery, New Civil Hospital Sant'Agostino-Estense, Baggiovara, Modena, MO, Italy.
Eur Arch Otorhinolaryngol. 2018 Apr;275(4):889-894. doi: 10.1007/s00405-018-4905-8. Epub 2018 Feb 10.
To describe the in vivo vascularization of middle ear by an endoscopic point of view, particularly focusing on the medial wall of tympanic cavity and incudostapedial region (ISR).
Case series with surgical videos review and anatomical description.
48 videos from exclusive endoscopic middle ear surgery performed at the University Hospital of Modena from November 2015 to July 2017 were reviewed. Data about anatomy of vessels, and blood flow direction (BFD) were collected in an appropriate database for further analyses.
48 cases were included in the present study. In 18/48 patients (37,5%), a clearly identifiable inferior tympanic artery (ITA) was present, running just anteriorly to the round window (RW), with a superior BFD (65% of cases) from the hypotympanic region toward the epitympanum. Some promontorial variants were described in 67% of cases and the most common finding was a mucosal vascular network with a multidirectional BFD. On the ISR, an incudostapedial artery (ISA) was detected in 65% of cases with BFD going from the long process of the incus (LPI) toward the pyramidal eminence in the majority of cases.
The vascular anatomy and BFD of the medial wall of the tympanic cavity can be easily studied in transcanal endoscopy. ITA (with a superior BFD in most cases) and ISA (with a main BFD from the incus to the stapes) are the most constant identifiable vessels.
以内窥镜视角描述中耳的体内血管形成情况，尤其关注鼓室的内侧壁和砧镫关节区域（ISR）。
带有手术视频回顾和解剖学描述的病例系列。
回顾了2015年11月至2017年7月在摩德纳大学医院进行的48例独家中耳内镜手术的视频。将有关血管解剖结构和血流方向（BFD）的数据收集到合适的数据库中以便进一步分析。
本研究纳入了48例病例。在18/48例患者（37.5%）中，存在一条清晰可辨的下鼓室动脉（ITA），恰好在圆窗（RW）前方走行，血流方向向上（65%的病例），从下鼓室区域流向鼓室上隐窝。67%的病例描述了一些鼓岬变异情况，最常见的发现是具有多方向血流方向的黏膜血管网络。在ISR上，65%的病例检测到砧镫动脉（ISA），大多数病例中血流方向是从砧骨长突（LPI）朝向锥隆起。
通过经耳道内窥镜可以轻松研究鼓室内侧壁的血管解剖结构和血流方向。ITA（大多数情况下血流方向向上）和ISA（主要血流方向从砧骨到镫骨）是最常能识别的血管。
