摘要
目的 报告面神经垂直段遮窗患者人工耳蜗植入(cochlear implantation, CI)方法。方法 回顾性分析2015年1月至2021年1月收治的5例面神经垂直段遮窗的重度或极重度聋患者的临床资料,包括病史、听力资料、影像学资料、手术方法等。结果 5例面神经垂直段遮窗患者中,4例为面神经垂直段完全遮挡圆窗,调整患者体位及显微镜角度仍无法窥及圆窗,选择面后入路行人工耳蜗电极植入;1例为面神经垂直段部分遮挡圆窗,调整患者体位及显微镜角度可见部分圆窗,选择将骨性外耳道后壁磨低,低于鼓乳裂水平,直至充分暴露圆窗后行人工耳蜗电极植入。5例患者均顺利植入电极,术中神经反应遥测均引出,术后未见面神经麻痹、外耳道后壁塌陷、平衡障碍等并发症发生。结论 重度或极重度聋患者人工耳蜗植入术中发现面神经垂直段遮挡圆窗时可根据遮窗程度选择不同的手术方式,面神经垂直段完全遮窗可选择面后入路,部分遮窗可选择磨低骨性外耳道后壁完成人工耳蜗电极植入。
Objective To report the method of cochlear implantation in patients with severe or profound deafness with vertical segment of facial nerve covered round window. Methods The clinical data of 5 patients with severe or profound deafness with vertical segment of facial nerve covering round window admitted to Beijing Friendship Hospital of Capital Medical University from January 2015 to January 2021 were retrospectively analyzed, including medical history, audiological data, imaging data, and surgical methods. Results Of the 5 patients, 4 cases had the vertical segment of facial nerve completely covering round window, and round window could not be seen by adjusting the patient’s body position and microscope angle. The cochlear implant electrode was implanted through the retrofacial approach. One case had vertical section of facial nerve partially corering round window, round window was visible ofter adjusting the patient’s position and angle of microscope. The posterior wall of the bony external auditory canal was ground to the level below the tympanomastoid fissure until round window was fully exposed and electrode was inserted. Electrodes were successfully implanted in all patients, intraoperative neural response telemetry(NRT) was all elicited. No postoperative complications were observed, such as facial nerve palsy, collapse of posterior wall of external auditory canal and balance disorder. Conclusion For patients with severe or profound deafness, different surgical methods can be selected according to the coverage degree of round window during cochlear implantation. For patients with complete coverage, retrofacial approach can be used. For patients with partially coverage, the electrode implantation can be completed by grinding the posterior wall of the external auditory canal to lower level.
作者
张斯
王林娥
刘攀
王琪妹
韩曙光
朱桢
郑文蕊
王伟
Zhang Si;Wang Line;Liu Pan;Wang Qimei;Han Shuguang;Zhu Zhen;Zheng Wenrui;Wang Wei(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing,100050,China)
出处
《听力学及言语疾病杂志》
CAS
CSCD
北大核心
2023年第2期134-137,共4页
Journal of Audiology and Speech Pathology
关键词
人工耳蜗植入
面神经遮窗
面后入路
外耳道后壁
Cochlear implant
Facial nerve cover round window
Retrofacial approach
The posterior wall of the external auditory canal
