外科治疗上半规管裂7例临床报告

Surgical Treatment of Superior Semicircular Canal Dehiscence

目的回顾性分析上半规管裂(Superior semicircular canal dehiscence,SSCD)住院手术病人临床资料,总结SSCD的外科治疗策略。方法2010年1月至2018年1月北京市首都医科大学附属北京同仁医院耳鼻咽喉头颈外科共收治确诊为SSCD并施行外科手术患者7例(男6例、女1例),年龄范围37~59岁(中位年龄52岁)。辅助检查中听力学检查包括纯音测听和声导抗检测等,平衡觉相关检查包括前庭诱发电位等。外科治疗术式有经乳突径路上半规管裂修补术6例、圆窗膜加固术1例。结果接受外科治疗的上SSCD患者在500-1000-2000Hz的气骨导差为12.9-10.7-3.6 d BnHL,上半规管裂的大小为4.69±1.16mm,统计学上未发现气骨导差和SSCD大小的相关性。按裂口的位置分类,外侧上坡型缺损1例、弓状隆起缺损1例、另外较大缺损即外侧上坡+弓状隆起缺损2例、内侧下坡型缺损0例、岩上窦相关半规管裂3例和弓状隆起缺损伴近裂开状态的岩上窦0例。圆窗膜加固术一例Tullio’s现象等症状缓解。结论对于上半规管裂特别是岩上窦相关半规管裂患者,圆窗膜加固术提供了一种新的微创治疗方法,但仍需要多的实践和经验来验证。

Objective To report outcomes of surgical treatment of superior semicircular canal dehiscence(SSCD).Methods Seven patients(six male and one female)with SSCD who received surgical treatment during January 2010 and January 2018 at the Department of Otolaryngology Head and Neck Surgery in Beijing Tongren Hospital were recruited in the study.The age ranged from 37 to 59 years(median=52 years).Audiological tests included pure tone audiometry(PTA)and impedance tympanometry.Cervical vestibular evoked myogenic potentials(cVEMP)were used to evaluate balance capability.SSCD was repaired via a transmastoid approach in 6 cases and with round window reinforcement in 1 case.Results Average air-bone gap(ABG)was 12.9,10.7 and 3.6 dB at 500,1000 and 2000 Hz,respectively.Mean size of SSCD was 4.69±1.16 mm and not correlated with ABG.SSCD involved lateral upslope(n=1),arcuate eminence(n=1),the superior petrosal sinus(SPS-SCD,n=3),or both lateral upslope and arcuate eminence(n=2).Round window reinforcement was applied in one case with resolution of Tullio phenomenon.Conclusion Round window reinforcement provides a new minimally invasive surgical treatment for SSCD,specifically when the superior petrosal sinus is involved.