影像学评估对耳蜗骨化患者人工耳蜗植入手术及术后效果的影响

The Effects of Imaging Evaluation on the Cochlear Implantation and the Postoperative Outcomes of Patients with Cochlear Ossification

目的探讨影像学评估对耳蜗骨化患者人工耳蜗植入手术及术后效果的影响。方法回顾性研究解放军总医院2009～2012年间7例耳蜗骨化的人工耳蜗植入患者的影像学检查结果、手术方式等资料，总结分析其术后康复效果。结果术前颞骨高分辨率CT和MRI检查，特别是耳蜗MRI仿真内窥镜可判断耳蜗骨化范围及程度。植入时1例患者因一侧耳蜗完全骨化而失败，另一侧植入顺利，其余6例均手术顺利，无手术并发症。人工耳蜗开机后7例患者均有听觉反应，但CAP）及SIR分级不同（因病例数量少未做统计学分析）。结论耳蜗骨化患者的术前影像学评估需将颞骨高分辨率CT和MRI结合，MRI仿真内窥镜重建可清晰显示耳蜗病变程度及范围。对于耳蜗轻度骨化患者，经典面神经隐窝入路一圆窗龛前方开窗术可顺利植入电极。人工耳蜗植入术可以作为伴有耳蜗骨化的极重度感音性聋患者的治疗手段，术后康复效果影响因素较多。

Obloctive To explore the effects of imaging evaluation on the cochlear implantation and postoperative outcomes of patients with cochlear ossification. Mothods Seven cochlear implantees with cochlear ossification were retrospectively studied,including the imaging results, surgical approaches and postoperative rehabilitation outcomes. Results Temporal bone high-resolution（HR）CT and MRI scans, especially the virtual endoscopy of the inner ear, can help diagnose the cochlear ossification. The implantation failed in 1 case at the first time due to complete cochlear ossification in one ear and then was performed to the other ear successfully, while the electrodes were inserted completely in the rest cases. No serious complications occurred after implantation.The patients all had auditory sensations, but had different CAP and SIR scores. Conclusion Both HRCT and MRI are necessary for assessing the potential risks associated with cochlear implantation. Tlae virtual endoscopy based on inner ear MRI is able to observe the structure and function of cochlea.Patients with mild ossified cochleae can benefit from cochlear implantation through mastoid-facial recess.The cochlear implantation can be performed to profoundly hearing-impaired patients with cochlear ossification and many factors may affect the postoperative rehabilitation outcomes.