颅中窝径路人工耳蜗植入手术解剖学

An anatomy study of middle fossa approach in cochlea implantation

目的从解剖学角度探讨颅中窝径路人工耳蜗植入的可行性及安全性。方法对19侧成人尸头行局部解剖学研究,辨认岩浅大神经和面神经管裂孔并将其作为解剖标志,暴露骨性耳蜗基底转距离颅中窝底最近的部位,即耳蜗基底转表浅部。测量①耳蜗基底转表浅部与颅中窝底板间距离;②耳蜗基底转表浅部到面神经膝状神经节内缘距离;③耳蜗基底转表浅部到岩浅大神经距离;④耳蜗基底转表浅部到面神经迷路段距离。结果由颅中窝底板到达耳蜗基底转表浅部,其间未遇到任何重要结构。耳蜗基底转表浅部在颅中窝底板下的平均深度为3.03(3.03±0.97)mm;耳蜗基底转表浅部到面神经膝状神经节内缘平均距离1.68(1.68±0.33)mm;耳蜗基底转表浅部到岩浅大神经平均距离1.72(1.72±0.39)mm;耳蜗基底转表浅部到面神经迷路段平均距离1.77(1.77±0.50)mm。结论颅中窝径路人工耳蜗植入时进行耳蜗造孔是可行的,有手术操作空间,对于特殊病例该径路可供替代选择。

To study the safety and feasibility of cochlear implant via the floor of the middle fossa approach（MCF）. METHODS Nineteenhuman adult temporal bones were studied. The greater superficial petrosal nerve and the facial hiatus were used as landmarks in order to expose the superficial point of the cochlea. The following distances were measured： O The distance between the floor of the middle cranial fossa and the superficial point of the basal turn （SPBT）;② The distance between the superficial point of the basal turn and the medial wall of the first genu of the facial nerve; ③The distance between the superficial point of the basal turn and the greater superfical petrosal nerve（GSPN）; ④ The distance between the superficial point of the basal turn and the labyrinthine portion of the facial canal. RESULTS There was not any very important structures encountered in the space between MCF and SPBT. The mean distance between SPBT and MCF was 3.03 mm （range 1.66 mm～4.76 mm, SD0.97 mm）. The mean distance between SPBT and the medial wall of the first genu of the facial nerve was 1.68 mm （range 1.18 mm～2.28 mm, SD0.33 mm）. The mean distance between GSPN and SPBT was 1.72mm （range 1.08 mm～2.48 mm, SD0.39 mm）. The mean distance between SPBT and the labyrinthine portion of the facial canal was 1.77mm （range1.10 mm～3.18 mm, SD 0.50 mm）. CONCLUSION The middle fossa approach could provide adequate space to the basal turn without a serious threat on adjacent structures. Cochlear implant via middle fossa approach will be an alternative approach to patients who is difficult to use the traditional approach to perform a cochlear implant.