人工耳蜗植入术相关的面神经隐窝及后鼓室应用解剖研究

Applied anatomy of facial recess and posterior tympanum related to cochlear implantation

目的:通过对人工耳蜗植入术相关的面神经隐窝及后鼓室解剖结构进行观察测量,为人工耳蜗植入术中避免面神经、鼓索神经等损伤及准确定位鼓阶开窗口提供理论参考。方法:对20侧成人颞骨标本进行解剖,模拟经面神经隐窝入路人工耳蜗植入术,在手术显微镜下观察、测量与人工耳蜗植入手术相关的解剖数据。结果:外耳道后上棘至砧骨短脚之间的距离为(12.44±0.51)mm;鼓索神经发出点至茎乳孔之间的距离为(2.67±0.51)mm;砧骨短脚至鼓索神经发出点之间的距离为(15.22±0.83)mm;面神经隐窝最宽处至砧骨短脚之间距离为(6.28±0.41)mm;面神经隐窝最宽处至鼓索神经发出点之间距离为(9.81±0.71)mm;面神经隐窝最大宽度为(2.73±0.20)mm;镫骨头水平面神经隐窝宽度为(2.48±0.20)mm;圆窗水平的面神经隐窝宽度为(2.24±0.18)mm;锥隆起至圆窗膜前缘之间的距离为(2.22±0.21)mm;镫骨头至圆窗膜下缘之间的距离为(2.16±0.14)mm。结论:利用面神经垂直段并非一条直线垂直下行,而是向后有一拱形的弧度,因此面神经垂直段弧度最大位置是打开并充分开放面神经隐窝起始位置;术中切开耳蜗底回的位置位于锥隆起前下方约2.22mm。

Objective： To investigate the related parameters of temporal bone structure in the surgery of co- chlear implantation through facial recess approach so as to offer a theoretical reference for the avoidance of facial nerve injury and the accurate localization. Method： In a surgical simulation experiment, twenty human temporal bones were studied. The correlation parameters were measured under surgical microscope. Result：Distance between suprameatal spine and short process of incus was（12.44±0.51）mm. Width from crotch of chorda tympani nerve to stylomastoid foramen was（2.67±0.51）mm. Distance between short process of incus and crotch of chorda tyropani nerve was（15.22±0.83）ram. The location of maximal width of the facial recess into short process 9f incus, cratch of chorda tympani nerve were（6.28±0.41）ram, （9.81±0.71）ram, respectively. The maximal width of the facial recess was（2.73±0.20）mm. The value at level of stapes and round window were（2.48±0.20 mm）and （2.24±0.18）ram, respectively. Distance between pyramidalis eminence and anterior round Window was（2.22±0.21） ram. Width from stapes to underneath round window was （ 2.16±0. 14） mm. Conclusion： These parameters provide a reference value to determine the position of cochlear inserting the electrode array into the scale tympani and opening facial recess firstly to avoid potential damage to facial nerve in surgery.