锥形束CT评估人工耳蜗植入术后电极位置与植入损伤的研究

Assessment of Electrode Position and Inner Ear Trauma by Cone Beam CT in Patients with Cochlear Implantation

目的 通过锥形束CT评估感音神经性耳聋患者人工耳蜗植入术(cochlear implantation,CI)后电极位置与植入损伤,为CBCT的应用提供参考。方法 选取在我科行人工耳蜗植入术的35名成人重度或极重度感音神经性耳聋患者为研究对象,年龄13-73岁,在术后3-4天均行植入侧颞骨CBCT扫描。使用NNT Viewer软件对扫描所得的DICOM数据进行后处理。观察电极位置以及植入后内耳损伤程度。结果 两款直电极植入耳蜗后均贴于耳蜗管外侧壁,81%(17/21)诺尔康CS-10A标准电极完全植入,75%(12/16)MED-EL SONATATI100标准电极完全植入。诺尔康CS-10A标准电极的平均植入深度角为366.46°±46.24°,平均植入长度为19.85mm±1.56mm,MED-EL SONATATI100标准电极的平均植入深度角为575.72°±100.33°,平均植入长度为26.66mm±4.02mm。诺尔康CS-10A标准电极植入后有1例发生骨螺旋板升高,1例发生电极从鼓阶进入前庭阶,MED-EL SONATATI100标准电极植入后有2例发生电极从鼓阶进入前庭阶。结论 CBCT具有高空间分辨率、低金属伪影、低辐射量以及成像时间短的优势,可用来评估人工耳蜗术后电极植入深度角、植入长度、电极位置、显示电极与周围结构的关系及植入后内耳损伤程度,具有较大的临床应用价值。

Objective To assess electrode position and inner ear trauma in patients with cochlear implantation using cone beam CT(CBCT) to determine its appropriateness in clinical application.Method Thirty-five patients aged from 13 to 73 years with bilateral profound sensorineural hearing loss who received cochlear implantation were enrolled.All the patients had CBCT scanning of the operated side 3 to 4 days after operation.The NNT Viewer software was used to process original DICOM data of CBCT scanning in order to assess electrode position and inner ear trauma.Results Both types of straight electrodes studied were located on the lateral wall of cochlea.Seventeen of the 21 Nurotron CS-10A standard electrodes(81%) and 12 of the 16 MED-EL SONATATI100 standard electrodes(75%) were completely implanted.The mean implanted depth angle(IDA) and implanted length(IL) were 366.46 ± 46.24° and19.85 ± 1.56 mm for the Nurotron CS-10A standard electrode,and 575.72 ± 100.33° and 26.66 ± 4.02 mm for the MEDEL SONATATI100 standard electrode.Grade I(n=1) and grade III inner ear trauma(n=1) was identified with Nurotron CS-10A standard electrodes,while grade III inner ear trauma(n=2) was identified with MED-EL SONATATI100 standard electrodes.Conclusion CBCT has the advantages of high resolution,low metal artifact,low radiative dose and short-image time,while clearly showing cochlear fine structures.It can therefore be used to assess electrode position,inner ear trauma and the size of cochlea following cochlear implantation.