高分辨率颞骨CT对人工耳蜗植入儿童面神经隐窝的测量

王宇; 邬海博; 潘滔

doi:10.16098/j.issn.0529-1356.2020.05.008

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解剖学报 ›› 2020, Vol. 51 ›› Issue (5) : 682-687. DOI: 10.16098/j.issn.0529-1356.2020.05.008

解剖学与耳鼻喉科学

高分辨率颞骨CT对人工耳蜗植入儿童面神经隐窝的测量

王宇¹ 邬海博^2* 潘滔^1*

作者信息 +

Measurement of facial recess in children with cochlear implant by high resolution temporal bone CT

WANG Yu¹ WU Hai-bo^2* PAN Tao^1*

Author information +

文章历史 +

摘要

目的通过高分辨率颞骨CT探讨人工耳蜗植入儿童面神经隐窝的解剖及其与圆窗龛的位置关系，从影像学角度为术中面隐窝的解剖提供参考。方法对78例人工耳蜗植入儿童（154侧耳）的术前高分辨率颞骨CT进行分析，在轴位圆窗龛层面测量以下参数：1. 面神经与外耳道后壁的距离d1；2. 面神经与圆窗龛的距离d2；3. 面神经与圆窗龛的相对角度a；4. 面隐窝中点与圆窗龛的距离d3；5. 面隐窝中点与圆窗龛的相对角度b。记录可能影响面隐窝解剖的因素，包括患儿的性别、年龄以及HRCT上的解剖变异（如乳突气化类型、乙状窦前移、颈静脉球高位、前庭水管扩张等），并分析以上因素与测得面隐窝参数的相关性。结果面-壁距d1平均值为(4.21±0.69)mm，面-龛距d2平均值为(5.95±0.62)mm，面-龛角a平均值为(94.61±9.04)°，窝-龛距d3平均值为(6.46±0.63)mm，窝-龛角b平均值为(113.47±7.83)°。患儿的性别、年龄以及乙状窦前移3个因素对面隐窝宽度d1有影响，前庭水管扩大对面神经相对圆窗龛的角度a和面隐窝相对圆窗龛的角度b有影响。结论人工耳蜗植入术前高分辨率颞骨CT可以显示面神经隐窝的重要解剖关系，测量结果对人工耳蜗植入手术操作具有临床参考价值。

Abstract

Objective To study the anatomy of facial recess(FR) and the relationship between the position of FR and the round window niche(RWN) in children who need cochlear implant by high resolution temporal bone CT. Methods Seventy-eight children (154 ears) with cochlear implant were analyzed with preoperative high-resolution temporal bone CT. The following parameters were measured at the RWN level of axial CT scan: 1. The distance between the facial nerve(FN) and the posterior wall of the external auditory canal (d1); 2. The distance between FN and RWN (d2); 3. The relative angle between FN and RWN (a); 4. The distance between the midpoint of FR and RWN (d3); 5. The relative angle between the midpoint of FR and RWN (b). The factors that might affect the anatomy of FR were recorded, including sex, age, and the anatomical variation on HRCT (such as the type of mastoid gasification, the position of sigmoid sinus and jugular bulb, the expansion of vestibular aqueduct). The correlation between the above factors and the measurements of FR was analyzed. Results The distance d1 was (4.21±0.69) mm, the distance d2 was (5.95±0.62) mm, the angle a was (94.61±9.04)°, the distance d3 was (6.46±0.63) mm, the angle b was (113.47±7.83)°. The width of FR (d1) was affected by three factors: age, gender and anteversion of sigmoid sinus. The angle a and the angle b were affected by expansion of vestibular aqueduct. Conclusion High resolution CT of temporal bone before cochlear implantation can show the important anatomical relationship of FR, and the measurements can be of clinical reference value for cochlear implant surgery.

导出引用

王宇邬海博潘滔. 高分辨率颞骨CT对人工耳蜗植入儿童面神经隐窝的测量[J]. 解剖学报. 2020, 51(5): 682-687 https://doi.org/10.16098/j.issn.0529-1356.2020.05.008

WANG Yu WU Hai-bo PAN Tao. Measurement of facial recess in children with cochlear implant by high resolution temporal bone CT[J]. Acta Anatomica Sinica. 2020, 51(5): 682-687 https://doi.org/10.16098/j.issn.0529-1356.2020.05.008

中图分类号： R76

参考文献

［1］ Vaid S, Vaid N. Imaging for cochlear implantation: structuring a clinically relevant report［J］. Clin Radiol, 2014, 69(7):e307-e322.
［2］ Bettman RH, Van Olphen AF, Zonneveld FW, et al. Preoperative imaging protocol for cochlear implant candidates［J］. Acta Otolaryngol, 2004, 124(9):1028-1032.
［3］ Yang QY. The estimated value of temporal bone CT for complexity and neurological injury in Cochlear Implantation［D］. Zhengzhou: Zhengzhou University, 2013. (in Chinese)
杨屈扬. 颞骨CT对人工耳蜗植入术难易程度及神经损伤风险的评估价值［D］. 郑州：郑州大学, 2013.
［4］ Xie LH, Tang J, Miao WJ, et al. Preoperative evaluation of cochlear implantation through the round window membrane in the facial recess using high-resolution computed tomography［J］. Surg Radiol Anat, 2018, 40(6):705-711.
［5］ Fouad YA, Elaassar AS, El-Anwar MW, et al. Role of multislice CT imaging in predicting the visibility of the round window in pediatric cochlear implantation［J］. Otol Neurotol, 2017, 38(8):1097-1103.
［6］ Tomura N, Sashi R, Kobayashi M, et al. Normal variations of the temporal bone on high-resolution:their incidence and clinical significance［J］. Clin Radio, 1995, 50(3),144-148.
［7］ Wadin K, Wibrand HF. The topographic relations of high jugular fossa to the inner ear: a radio-anatomic investigation［J］. Acta Radiol Diagn, 1986, 27(3):317-324.
［8］ Mafee MF, Charletta D, Kumar A, et al. Large vestibular aqueduct and congenital sensorineural hearing loss［J］. AJNR, 1992, 13(2):805-819.
［9］ Sennaroglu L, Saatci I. A new classification for cochleovestibular malformations［J］. Laryngoscope, 2002, 112(12):2230-2241.

［10］ Sennaroglu L. Cochlear implantation in inner ear malformations——A review article［J］. Cochlear Implants Int, 2010, 11(1):4-41.

［11］ Duan JR, Lin M, Xiong JP, et al. Thin sectional anatomy and the CT location on the internal part of facial nerve in temporal bone［J］. Chinese Journal of Clinical Anatomy, 2004, 22(3): 257-260. (in Chinese)

段菊如, 林敏, 熊俊平, 等. 面神经颞骨内段在横断薄层和CT上的定位及临床意义［J］. 中国临床解剖学杂志, 2004, 22(3):257-260.
［12］ Duan JR, Luo HQ, Lu ChJ, et al. Round window area temporal bone section versus CT［J］. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2004, 39(5): 269-272. (in Chinese)
段菊如, 罗红强, 鲁纯纠, 等. 圆窗区颞骨切片和CT对照观察［J］. 中华耳鼻咽喉头颈外科杂志, 2004, 39(5):269-272.
［13］ Mandour M, Tomoum M, El Zayat S, et al. Surgeon oriented preoperative radiologic evaluation in cochlear implantation-our experience with a proposed checklist［J］. Int Arch Otorhinolaryngol, 2019, 23:137-141.
［14］ Li LX, Duan JR, Zhang FSh, et al. Thin section anatomy and HRCT of facial recess and its adjecent structures［J］. Acta Anatomica Sinica, 2007, 38(5):621-624.［J］
李立新, 段菊如, 张丰收, 等. 面神经隐窝及其周围结构在耳的横断薄层和HRCT上的定位及毗邻关系［J］. 解剖学报, 2007, 38(5):621-624.
［15］ Sun ShP, Lu W, Lei YB, et al. Prediction of round window visibility in cochlear implantation with temporal bone high resolution computed tomography［J］. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2017, 52(8): 561-565. (in Chinese)
孙淑萍, 卢伟, 雷一波, 等. 颞骨高分辨率CT对人工耳蜗植入术中圆窗暴露难易的预判［J］. 中华耳鼻咽喉头颈外科杂志, 2017, 52(8):561-565.
［16］ Pendem SK, Rangasami R, Arunachalam RK, et al. HRCT Correlation with round window identification during cochlear implantation in children［J］. J Imaging Sci, 2014, 4:70.
［17］ Huang XZh, Wang JB, Kong WJ. Practice of otorhinolaryngology-head and neck surgery［M］. 2nd Ed. Beijing: People’s Medical Publishing House, 2007: 19. (in Chinese)
黄选兆，汪吉宝，孔维佳．实用耳鼻咽喉头颈外科学［M］. 第2版. 北京:人民卫生出版社，2007: 19.
［18］ Zhang F, He B, Ruan B, et al. The development of facial recess in cochlear implant recipients through measuring the width of facial recess guided by CT［J］. Journal of Kunming Medical University, 2015, 36(2):62-64. (in Chinese)
张帆, 何波, 阮标, 等. CT辅助下人工耳蜗植入患儿面神经隐窝发育研究［J］. 昆明医科大学学报, 2015, 36(2):62-64.
［19］ Zhang DX, Zhang YK, Tian H. Role of measuring facial recess in cochlear implantation［J］. Journal of Audiology and Speech Pathology, 2006, 14(3):182-184. (in Chinese)
张道行, 张岩昆, 田昊. 术前面隐窝气房CT测量对人工耳蜗植入术的意义［J］. 听力学及言语疾病杂志, 2006, 14(3):182-184.
［20］ Kiran AS, Varghese AM, Irodi A, et al. Radiological evaluation of cochlear orientation and its implications in cochlear implantation［J］. Indian J Otolaryngol Head Neck Surg, 2018, 70(1):1-9.
［21］ Park E, Amoodi H, Kuthubutheen J, et al. Predictors of round window accessibility for adult cochlear implantation based on pre-operative CT scan: a prospective observational study［J］. J Otolaryngol Head Neck Surg, 2015, 44(1):20.