Morelli Luca, Damam Sachin K, Yilala M Hailu, Fancello G, Ferraro M, Caruso A, Sanna M
Department of Neurotology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy.
Audiology Unit, Department of Clinical Sciences and Community Health, Department of Specialistic Surgical Sciences, State University of Milano, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy.
Eur Arch Otorhinolaryngol. 2025 May 15. doi: 10.1007/s00405-025-09431-8.
To discuss indications (unfavorable conditions), surgical steps, complications, and follow-up of subtotal petrosectomy (STP) in cochlear implantation based on our experience of 348 cases. Anatomical variations associated with or without cochlear malformations and differences between electrode insertions were included in our analysis.
A retrospective case study was done in Gruppo Otologico (Piacenza, Italy), a quaternary referral center. Among 1002 cases that underwent subtotal petrosectomy, 348 were selected for cochlear implantation in the same setting. The study period was from 2004 to 2019. These patients' clinical and radiological follow-up ranged from 2 months to 180 months. Data were inspected, cleaned, and analyzed by SPSS software.
The selected group's mean age was 57.236 years, including 178 male and 170 female patients. The follow-up period lasted up to 108.65 months. Out of 348 cases, 8 were children (under the age of 18 years old). Inclusion criteria to be eligible for cochlear implantation in the same setting of subtotal petrosectomy was a preoperative pure tone average (PTA) of more than 90 decibels associated with low speech discrimination ranging from 0% in most cases up to 50% in the minority. 329 patients had a complete electrode insertion intra-operatively. Minor complications were observed in 6 cases. These include one case of implant extrusion due to a middle ear infection leading to labyrinthitis, three cases of post-auricular fistula causing one device failure, one subcutaneous CSF collection, and one subcutaneous seroma collection.
Although in most cases, standardized trans mastoid facial recess technique for cochlear implantation is ideal as the surgical risks are minimal, in complicated cases such as concomitant chronic otitis media, prior canal wall-down cases, radical cavities, or inner ear abnormalities with high risk of cerebrospinal fluid leak subtotal petrosectomy should be the first choice of management with complete disease clearance. Close clinical and radiological follow-up is therefore mandatory. Single-stage implantation is preferred to staging the procedure unless one is unsure of disease clearance.
基于我们348例的经验，探讨岩骨次全切除术（STP）在人工耳蜗植入中的适应证（不利情况）、手术步骤、并发症及随访情况。分析与有无耳蜗畸形相关的解剖变异以及电极插入情况的差异。
在意大利皮亚琴察的Gruppo Otologico（一家四级转诊中心）进行了一项回顾性病例研究。在1002例行岩骨次全切除术的病例中，选取348例在同一环境下进行人工耳蜗植入。研究时间段为2004年至2019年。这些患者的临床和影像学随访时间为2个月至180个月。数据由SPSS软件进行检查、清理和分析。
所选组的平均年龄为57.236岁，包括178例男性和170例女性患者。随访期长达108.65个月。在348例病例中，8例为儿童（18岁以下）。在岩骨次全切除术同一环境下符合人工耳蜗植入的纳入标准是术前纯音平均听阈（PTA）超过90分贝，言语辨别率低，大多数病例为0%，少数病例高达50%。329例患者术中电极完全插入。观察到6例轻微并发症。其中包括1例因中耳感染导致迷路炎的植入物外露，3例耳后瘘导致1例设备故障，1例皮下脑脊液积聚，1例皮下血清肿积聚。
尽管在大多数情况下标准化的经乳突面神经隐窝技术用于人工耳蜗植入是理想的，因为手术风险最小，但在复杂病例中，如合并慢性中耳炎、既往开放式乳突手术病例、根治性鼓室、或有高脑脊液漏风险的内耳异常，岩骨次全切除术应作为彻底清除疾病的首选治疗方法。因此密切的临床和影像学随访是必不可少的。除非不确定疾病是否清除，否则首选一期植入而非分期手术。
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