“井喷”在内耳畸形人工耳蜗植入术中的发生率

The happening rate of the gusher in cochlear implantation with inner ear malformation

目的:探讨"井喷"在内耳畸形人工耳蜗植入术中的发生率,为有"井喷"现象的人工耳蜗植入术积累临床经验。方法:对680例行人工耳蜗植入术患者行术前高分辨CT检查,显示80例双耳有内耳畸形,其中20例并发内耳道底骨性缺损与内耳相通,行人工耳蜗植入术。结果:20例(25%)并发内耳道底骨性缺损与内耳相通者,术中发生了"井喷",其中大前庭导水管畸形者5例,Mondini畸形者11例,耳蜗前庭与内耳道共同腔畸形者4例;耳蜗、前庭、外半规管共同腔和前庭、外半规管共同腔畸形者无"井喷"发生。结论:①80例内耳畸形人工耳蜗植入术患者"井喷"的发生率为25%;②内耳畸形人工耳蜗植入术中"井喷"的发生率依次为:耳蜗、前庭与内耳道共同腔畸形,Mondini畸形,大前庭导水管畸形;③单纯前庭、耳蜗、外半规管共同腔畸形及半规管畸形者,人工耳蜗植入术中未发生"井喷";④80例内耳畸形人工耳蜗植入术中,发生"井喷"者均存在内耳道底骨缺损,与内耳形成共同开放的通道。

Objective： Summing up the happening rate of the gusher in cochlear implantation with inner ear malformation. Method：Six hundred and eighty profound hearing loss patients treated with cochlear implant were involved in this study. All of them received high resolution computed tomography （HRCT） preoperatively. Among them, 80 cases have inner ear malformation and Twenty cases were found with bony defect of the internal acoustic meatus fundus by HRCT. Result： The cerebrospinal fluid （CSF） gusher occurred in 20 cases with bony defect of the internal acoustic meatus fundus during the cochlear implantation. The CSF gusher was successfully controlled by reducing the cranial pressure naturally and sealing the cochleostomy with muscle tissue. Conclusion： Abnormal bony defect between the inner ear and subarachnoid is an important factor that cause the stapedial gusher during cochlear implantation. The abnormal bony defect between the inner ear and subarachnoid could be found by HRCT and the stapedial gusher could be predicted preoperatively. Appropriate management during the operation could control the stapedial gusher.