Department of Otorhinolaryngology, Hillel Yaffe Medical Center Affiliated to the Technion University Haifa, Hadera, Israel,
Gruppo Otologico, Quaternary Referral Center for Otology, Neurotology and Skull Base Surgery, Piacenza, Italy,
Audiol Neurootol. 2020;25(6):323-335. doi: 10.1159/000507419. Epub 2020 May 29.
To assess the validity of the subtotal petrosectomy (STP) technique in problematic cases of cochlear implant (CI) surgery, and review indications, outcomes, and related controversies.
This is a retrospective review of data from a private quaternary referral center of otology and skull base surgery.
A review of patients who underwent CI with STP (STP-CI) as the leading approach was performed. Demographics, indications, surgical details, and main outcomes were evaluated. The surgeries performed were usually single-stage procedures encompassing a comprehensive mastoidectomy, blind sac closure of the external auditory canal (EAC), and mastoid obliteration with autologous fat.
A total of 107 cases were included. Mean follow-up was 7.1 years (range 1-13 years). The most frequent indication for STP-CI was chronic otitis media with/without cholesteatoma (32.7%), followed by open mastoid cavity (26.1%), and cochlear ossification (17.7%). Other difficult conditions where STP facilitates successful implantation include inner-ear malformations, temporal-bone trauma, unfavorable anatomic conditions, and revision surgery. A planned staged procedure was performed in 3 cases. The rate of major complications was 5.6% (n = 6). Three patients developed postauricular wound dehiscence which eventually resulted in device extrusion. No cases of recurrent/entrapped cholesteatoma, EAC breakdown, or meningitis were encountered. This is the largest single-center series of STP-CI reported in the literature.
When CI is intended in technically challenging cases or associated with a high risk of complications, STP is effective and reliable. Safe implantation and excellent long-term outcomes can be achieved provided surgical steps are properly followed. Single-stage procedures can be performed in most cases, even when there is active middle-ear disease.
评估半规管次全切除（STP）技术在耳蜗植入（CI）手术中复杂病例中的有效性，并回顾其适应证、结果及相关争议。
这是对一家耳鼻喉科和颅底手术四级转诊中心数据的回顾性研究。
对行 CI 且以 STP 为主导术式的患者（STP-CI）进行了回顾。评估了患者的人口统计学资料、适应证、手术细节和主要结果。所进行的手术通常为单阶段手术，包括全面乳突切除术、外耳道盲袋封闭、自体脂肪乳突填塞。
共纳入 107 例患者。平均随访时间为 7.1 年（1-13 年）。STP-CI 最常见的适应证为慢性中耳炎伴/不伴胆脂瘤（32.7%），其次为开放性乳突腔（26.1%）和耳蜗骨化（17.7%）。STP 有助于成功植入的其他困难情况包括内耳畸形、颞骨外伤、解剖条件不佳和翻修手术。3 例患者行计划性分期手术。主要并发症发生率为 5.6%（n=6）。3 例患者出现耳后伤口裂开，最终导致装置脱出。未发生复发性/残留胆脂瘤、外耳道破裂或脑膜炎。这是文献中报道的最大的单中心 STP-CI 系列研究。
在技术挑战性大的病例或并发症风险高的情况下，行 CI 时，STP 是有效且可靠的。如果正确遵循手术步骤，可实现安全植入和良好的长期结果。大多数情况下可进行单阶段手术，即使中耳有活动性疾病也是如此。
