Gupta Anjali, Samdani Sunil, Sharma Shivam, Grover Mohnish, Soni Samanvaya, Hada Mahendra Singh, Kumar Amit
Department of Otorhinolaryngology and Head and Neck Surgery, S.M.S. Medical College and Attached Hospitals, A-1, New Heera Bagh Flats, Jaipur, Rajasthan 302004 India.
Indian J Otolaryngol Head Neck Surg. 2024 Feb;76(1):781-787. doi: 10.1007/s12070-023-04280-5. Epub 2023 Oct 21.
The round window approach has become the most preferred route for electrode insertion in cochlear implant surgery; however, it is not possible at times due to difficult round window membrane (RWM) visibility. Our study aims to investigate the relationship between preoperative radiological parameters and the surgical visibility of the RWM in Cochlear implant patients.
A prospective cross-sectional study of 31 patients, age < 6 years, with bilateral severe to profound sensorineural hearing loss was conducted at a tertiary care hospital. The preoperative HRCT temporal bone scan was studied, and the parameters evaluated were facial nerve location, facial recess width, and RWM visibility prediction. All patients were operated on via the posterior tympanotomy. The surgical RWM visibility was done after optimal drilling of the posterior tympanotomy recess. The relationship between the radiological parameters and surgical visibility of RWM was evaluated.
The difference in the facial nerve location as per the type of RWM was found to be significant (p value < 0.05). However, the facial recess width was not significantly associated with RWM visibility. The radiological prediction of RWM visibility by tracing the prediction line over RWM was significantly associated with intraoperative RWM visibility.
The goal to look for preoperative scans is to predict the ease or difficulty of RWM visibility during surgery. The difficult visualization of the RWM, can result in dire intraoperative consequences. A comprehensive understanding of preoperative radiological parameters, coupled with meticulous surgical planning, is crucial to address these challenges effectively by focusing on enhancing RWM visualization.
圆窗入路已成为人工耳蜗植入手术中最常用的电极插入途径；然而，由于圆窗膜（RWM）可视性差，有时无法采用该入路。我们的研究旨在探讨人工耳蜗植入患者术前影像学参数与RWM手术可视性之间的关系。
在一家三级医院对31例年龄小于6岁、双侧重度至极重度感音神经性听力损失的患者进行了一项前瞻性横断面研究。对术前颞骨高分辨率CT扫描进行研究，评估的参数包括面神经位置、面神经隐窝宽度和RWM可视性预测。所有患者均通过后鼓室切开术进行手术。在对后鼓室切开术隐窝进行最佳钻孔后评估手术中RWM的可视性。评估影像学参数与RWM手术可视性之间的关系。
发现根据RWM类型划分的面神经位置差异具有统计学意义（p值<0.05）。然而，面神经隐窝宽度与RWM可视性无显著相关性。通过在RWM上绘制预测线对RWM可视性进行的影像学预测与术中RWM可视性显著相关。
术前扫描的目的是预测手术中RWM可视性的难易程度。RWM难以可视化可能导致严重的术中后果。全面了解术前影像学参数，再加上精心的手术规划，对于通过专注于增强RWM可视化来有效应对这些挑战至关重要。
