On the Anatomy of the 'Hook' Region of the Human Cochlea and How It Relates to Cochlear Implantation
On the Anatomy of the 'Hook' Region of the Human Cochlea and How It Relates to Cochlear Implantation
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DOI：
10.1159/000365585
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发表时间：
2014-01-01
影响因子：
1.6
通讯作者：
Rask-Andersen, Helge
中科院分区：
文献类型：
--
作者：
Atturo, Francesca;Barbara, Maurizio;Rask-Andersen, Helge
背景：在听力保留人工耳蜗植入手术中，电极阵列的最佳插入路径仍然是试验性的。耳蜗造口术（CO）和圆窗（RW）技术今天都在使用。在本研究中，我们分析了人类耳蜗“钩”区的尺寸变化和地形解剖，以更好地理解各种电阵列插入模式的Testo效应。材料和方法：在23人，microdisserted颞骨通过测量椭圆形和圆形窗口之间的距离，还概述了螺旋韧带/螺旋板的耳蜗“钩”区域的大小变化进行了评估。螺旋韧带的位置和不同的手术方法的基础上的大小变化的影响进行了评估，在一个子集的“小”和“大”耳蜗执行不同类型的CO。此外，微解剖的副管外壳耳蜗下静脉和RW之间的关系进行了分析。结果如下：前庭外侧壁和耳蜗“钩”显示出较大的解剖变异，这极大地影响了潜在手术区域的大小。结果表明，CO仅在非常靠后的位置进入鼓阶，而不会对螺旋韧带和螺旋板造成损伤。下入路可能会挑战耳蜗下静脉。结论：术前评估圆窗与卵圆窗之间的距离可指导手术者进行CI保听手术。CO技术，特别是在“小”耳朵中，可能会导致内耳结构的频繁损伤。在那些有大量残余听力的病例中，通过RW入路可能更好地进行CI手术。(C)2014 S. Karger AG，巴塞尔
Background: The optimal insertion route for an electrode array in hearing preservation cochlear implantation (CI) surgery is still tentative. Both cochleostomy (CO) and round window (RW) techniques are used today. In the present study we analyzed size variations and topographic anatomy of the 'hook' region of the human cochlea to better comprehend the Testo effects of various electric array insertion modes. Material and Methods: Size variations of the cochlear 'hook' region were assessed in 23 human, microdissected temporal bones by measuring the distances between the oval and round windows, also outlining the spiral ligament/spiral lamina. Influence of size variations on spiral ligament position and fundamentals for different surgical approaches were evaluated in a subset of 'small' and 'large' cochleae performing different types of CO. In addition, the relationship between the microdissected accessory canal housing the inferior cochlear vein and the RW was analyzed. Results: The lateral vestibular wall and the cochlear 'hook' displayed large anatomic variations that greatly influenced the size of the potential surgical area. Results showed that only very inferiorly located CO entered the scala tympani without causing trauma to the spiral ligament and spiral lamina. An inferior approach may challenge the inferior cochlear vein. Conclusion: Preoperative assessment of the distance between the round and oval windows may direct the surgeon before CI hearing- preservation surgery. CO techniques, especially in 'small' ears, may lead to frequent damage to the inner ear structures. In those cases with substantial residual hearing, CI surgery may be better performed through a RW approach. (C) 2014 S. Karger AG, Basel