术中CT在疑难人工耳蜗植入手术中的应用
|
摘要
目的通过对术中CT引导下的疑难人工耳蜗植入患者的手术结果观察分析,探讨术中CT在该类手术中的应用价值。方法本研究采用回顾性分析方法,将术中CT引导下行人工耳蜗植入的疑难病例47例(50耳),分为内耳畸形、耳蜗骨化和二次修正手术组,观察记录其术中脑脊液"井喷"、术中调整电极次数及其他并发症情况。结果本研究中内耳畸形42例(44耳),包括共同腔畸形17耳(38.6%)、不完全分隔I型(imcomplete partition type I,IP-I)14耳(31.8%)、不完全分隔II型(imcomplete partition type II,IP-II)4耳(9.1%)和不完全分隔III型(imcom-plete partition type III,IP-III)9耳(20.5%);耳蜗骨化2例(3耳),包括耳蜗骨化Ⅱ级1例2耳、耳蜗骨化Ⅲ级1耳;因植入电极异位行修正手术3例。本研究中所有病例在植入人工耳蜗后即刻行术中CT检查,均证实电极植入到耳蜗内,术中出现脑脊液"井喷"21耳(42.0%),术中需再次调整电极位置7耳(14.0%),所有患者术后均未出现脑脊液漏、脑膜炎及面瘫等严重手术并发症。结论术中CT不仅可以保证电极的精准耳蜗内植入,而且还能帮助术者根据手术中实际情况调整决策,避免了因电极异位需二次手术的风险。术中CT极大地提高了疑难人工耳蜗植入手术的精确性,保证了手术的安全性和可靠性,具有广泛的应用前景。
Objective To report utility of intraoperative CT in difficult CI cases and surgical outcomes. Methods This study reviewed 47 difficult CI cases(50 ears) with guidance by intraoperative CT, regarding intraoperative CSF "gusher", number of intraoperative electrode adjustment needed and surgical complications. Results Inner ear malformation was identified in 42 cases(44 ears), including common cavity malformation(17 ears, 38.6%), IP-I(14 ears, 31.8%),IP-II(4 ears, 9.1%) and IP-III(9 ears, 20.5%). Cochlear ossification was seen in 2 cases(3 ears) and 3 cases were revision surgeries. Correctly implanted electrodes into the cochlea were confirmed in all cases. Intraoperative CSF"gusher"occurred in 21 ears(42.0%) with no CSF leakage, meningitis, facial paralysis or other serious complications postoperatively. Conclusion Intraoperative CT can not only ensure accurate implantation of electrodes, but also help surgeons adjust surgical plans as required by the actual situation during the operation to minimize the need for revision surgery due to electrode misplacement. Intraoperative CT technology has greatly improved the accuracy of electrode implantation in difficult CI, elevating safety and reliability of the surgery.
Objective To report utility of intraoperative CT in difficult CI cases and surgical outcomes. Methods This study reviewed 47 difficult CI cases(50 ears) with guidance by intraoperative CT, regarding intraoperative CSF "gusher", number of intraoperative electrode adjustment needed and surgical complications. Results Inner ear malformation was identified in 42 cases(44 ears), including common cavity malformation(17 ears, 38.6%), IP-I(14 ears, 31.8%),IP-II(4 ears, 9.1%) and IP-III(9 ears, 20.5%). Cochlear ossification was seen in 2 cases(3 ears) and 3 cases were revision surgeries. Correctly implanted electrodes into the cochlea were confirmed in all cases. Intraoperative CSF"gusher"occurred in 21 ears(42.0%) with no CSF leakage, meningitis, facial paralysis or other serious complications postoperatively. Conclusion Intraoperative CT can not only ensure accurate implantation of electrodes, but also help surgeons adjust surgical plans as required by the actual situation during the operation to minimize the need for revision surgery due to electrode misplacement. Intraoperative CT technology has greatly improved the accuracy of electrode implantation in difficult CI, elevating safety and reliability of the surgery.
引文
1 Kim C S,Maxfield A Z,Foyt D,et al.Utility of intraoperative computed tomography for cochlear implantation in patients with difficult anatomy[J].Cochlear Implants International,2017:1-10.
2 Sennaroglu L.Classification and current management of inner ear malformations[J].Balkan Medical Journal,2017,34(5):397-411.
3 Balkany T,Gantz BJ,Steenerson RL,et al.Systematic approach to electrode insertion in the ossified cochlea[J].Otolaryngol Head Neck Surg,1996,114(1):4-11.
4 Yuan YY,Song YS,Chai CM,et al.Intraoperative CT-guided cochlear implantation in congenital ear deformity.Acta Otolaryngol(Stockh)2012;132:951-958.
5 Sennaroglu L.Cochlear implantation in inner ear malformations-a review article.Cochlear Implants Int 2010;11:4-41.
6龚树生,熊伟.疑难病例人工耳蜗植入[J].山东大学耳鼻喉眼学报,2017,31(05):4-9.Gong SH,Xiong W.Cochlear implantation in difficult cases[J].JOtolaryngol Ophthal Shandong Univ,2017,31(05):4-9.
7 Jia H,Torres R,Nguyen Y,et al.Intraoperative conebeam CTfor assessment of intracochlear positioning of electrode arrays in adult recipients of cochlear implants[J].AJNR Am J Neuroradiol,2018,39(4):768-774.
8 Gnagi SH,Baker TR,Pollei TR,et al.Analysis of intraoperative radiographic electrode placement during cochlear implantation[J].Otology&Neurotology,2015,36(6).
9 Daly MJ,Siewerdsen JH,Moseley DJ,et al.Intraoperative cone-beam CT for guidance of head and necksurgery:assessment of dose and image quality using a C-armprototype.Med Phys2006;10:3767-80.
2 Sennaroglu L.Classification and current management of inner ear malformations[J].Balkan Medical Journal,2017,34(5):397-411.
3 Balkany T,Gantz BJ,Steenerson RL,et al.Systematic approach to electrode insertion in the ossified cochlea[J].Otolaryngol Head Neck Surg,1996,114(1):4-11.
4 Yuan YY,Song YS,Chai CM,et al.Intraoperative CT-guided cochlear implantation in congenital ear deformity.Acta Otolaryngol(Stockh)2012;132:951-958.
5 Sennaroglu L.Cochlear implantation in inner ear malformations-a review article.Cochlear Implants Int 2010;11:4-41.
6龚树生,熊伟.疑难病例人工耳蜗植入[J].山东大学耳鼻喉眼学报,2017,31(05):4-9.Gong SH,Xiong W.Cochlear implantation in difficult cases[J].JOtolaryngol Ophthal Shandong Univ,2017,31(05):4-9.
7 Jia H,Torres R,Nguyen Y,et al.Intraoperative conebeam CTfor assessment of intracochlear positioning of electrode arrays in adult recipients of cochlear implants[J].AJNR Am J Neuroradiol,2018,39(4):768-774.
8 Gnagi SH,Baker TR,Pollei TR,et al.Analysis of intraoperative radiographic electrode placement during cochlear implantation[J].Otology&Neurotology,2015,36(6).
9 Daly MJ,Siewerdsen JH,Moseley DJ,et al.Intraoperative cone-beam CT for guidance of head and necksurgery:assessment of dose and image quality using a C-armprototype.Med Phys2006;10:3767-80.