人工耳蜗植入术中常见的先天性中耳及邻近解剖异常

摘要

Cochlear implantation (CI) is the most effective approach to severe to profound sensorineural hearing loss so far. Since the performance of CI relies on the AN population that encodes and transmits acoustic signals to the higher au-ditory processing stations, strict and comprehensive patient selection, surgical skills, effective rehabilitation training and post-implantation psychotherapy are of great importance for the best effects of CI. Based on the surgical approach, structur-al issues relevant to facial recess access and electrode insertion, such as abnormal mastoid pneumatization, malformation of the ossicular chain, vestibular window, round window or facial canal, anteriorly displaced sigmoid sinus and high jugular bulb, have been studied in order to provide a basis for selection of surgical approaches and evaluation of surgical risks. It is of great significance to reduce complications and improve surgery efficacy.%人工耳蜗植入（cochlear implantation, CI）是双耳重度、极重度感音神经性聋患者获得听力的最有效的途径。CI的成功实施需要依靠术前准确的临床诊断及对耳内解剖结构的详尽的影像学评估。国内外学者根据CI手术入路要求，对围绕面神经隐窝开放和耳蜗电极植入相关的结构如乳突气化及病变情况、颈静脉球高位及裸露、乙状窦前移或过大、面神经走行异常、听骨链及两窗等问题进行了研究，为术前对CI术式选择及手术难易、风险评估提供了依据，对减少CI及其他耳内手术的术中术后并发症及后遗症，增加手术成功率有重要意义。本文对CI术中常见的中耳及其邻近解剖异常，如乳突气化异常、先天性听骨畸形、先天性两窗畸形、面神经管畸形及走行异常、乙状窦前移或过大、颈静脉球高位、颈静脉球憩室及颈静脉球裸露等先天性畸形进行综述。