经外耳道后上径路人工耳蜗植入的手术入路和相关解剖关系研究

Surgical approaches and related microsurgical anatomy about Suprameatal approach: new surgical approach for cochlear implantation

目的:探讨一种新的通过外耳道后上径路(SMA)植入电极的人工耳蜗植入方法。方法:对8例(16侧)尸头模拟SMA的人工耳蜗植入法,对该手术径路进行了相关解剖数据的测量,并且在术前、术后进行HRCT扫描及重建加以对照和证实。结果:SMA的人工耳蜗植入术电极通过颞骨区隧道、外耳道骨槽,从鼓索神经下方、锤骨柄和砧骨长脚之间植入耳蜗底周,隧道与颞线向前延伸假想水平线平均角度成人为(28.0±1.3)°儿童为29.0°±1.7°,电极植入耳蜗入口的定位为成人距圆窗龛(1.31±0.13)mm,儿童为(1.19±0.12)mm。结论:SMA的人工耳蜗植入术是一种简便,安全的方法,可以达到人工耳蜗植入术的预期要求,并且距离面神经和鼓索神经足够的安全距离,临床上应根据患者的年龄、术前情况、相关病史选择不同的手术入路。

Objective：To study a new surgical approach for cochlear implantation. Method：We operated on 8 cadaver heads （16 side） use Suprameatal approach for cochlear implantation, describe related anatomic mark. Resuit：The electrode is passed through the suprameatal tunnel, the EAC groove, the space underneath the chorda tymani between the malleal and the long process of the incus, and the cochleostomy. Angle between tunnel and temperal imaginary line is 28.0±1.3° in adult, 29.0± 1.7°in children, the location of inserting electrode into cochleostomy is （1.31±0.13） mm to round window in adult, （1.19±0.12）mm in child. Conclusion：The SMA approach is a safe technique, maintaining a safe distance to facial nerve and chorda tympani. So We should make right decision in clinic.