CAJ | 학술논문

　　目的探讨面神经隐窝进路人工耳蜗植入术骨性通路的显微解剖和鼓阶开窗的立体定位方法,该手术进路骨性通路大小对人工耳蜗植入术的影响。方法对6例成人尸头12侧颞骨行颞骨高分辨率CT扫描，在手术显微镜下模拟经面神经隐窝进路行人工耳蜗植入术，观察和测量面神经隐窝进路骨性通路和鼓阶开窗口的大小以及鼓阶开窗处与面神经、镫骨头、锥隆起、圆窗、匙突等解剖结构的距离，数据进行统计学处理。结果12侧颞骨标本中，颞骨CT观察到面神经隐窝气房11侧（91.7%），1侧无明显气房。面神经隐窝进路骨性通路内外宽度为（2.94±0.28）mm，上下高度为（8.79±0.88）mm，深度为（3.54±0.17）mm，面积为（20.32±3.19）mm2；鼓阶开窗口直径为（1.27±0.21）mm，植入鼓阶内电极长度为（26.2±1.82）mm，鼓阶开窗点与面神经水平段、面神经乳突段、锥隆起、镫骨头、匙突的距离分别为（4.22±0.39）mm、（7.25±0.26）mm、（3.40±0.44）mm、（3.82±0.46）mm和（5.10±0.60）mm。结论颞骨CT可了解面神经隐窝气房情况，面神经隐窝进路骨性通路的大小影响人工耳蜗植入术电极插入，圆窗龛、圆窗、镫骨头、锥隆起、匙突等解剖结构可作为鼓阶开窗的参考标志。
　　목적탐토면신경은와진로인공이와식입술골성통로적현미해부화고계개창적입체정위방법,해수술진로골성통로대소대인공이와식입술적영향。방법대6례성인시두12측섭골행섭골고분변솔CT소묘，재수술현미경하모의경면신경은와진로행인공이와식입술，관찰화측량면신경은와진로골성통로화고계개창구적대소이급고계개창처여면신경、등골두、추륭기、원창、시돌등해부결구적거리，수거진행통계학처리。결과12측섭골표본중，섭골CT관찰도면신경은와기방11측（91.7%），1측무명현기방。면신경은와진로골성통로내외관도위（2.94±0.28）mm，상하고도위（8.79±0.88）mm，심도위（3.54±0.17）mm，면적위（20.32±3.19）mm2；고계개창구직경위（1.27±0.21）mm，식입고계내전겁장도위（26.2±1.82）mm，고계개창점여면신경수평단、면신경유돌단、추륭기、등골두、시돌적거리분별위（4.22±0.39）mm、（7.25±0.26）mm、（3.40±0.44）mm、（3.82±0.46）mm화（5.10±0.60）mm。결론섭골CT가료해면신경은와기방정황，면신경은와진로골성통로적대소영향인공이와식입술전겁삽입，원창감、원창、등골두、추륭기、시돌등해부결구가작위고계개창적삼고표지。
Objective To study micro-anatomy of the bony entrance relevant to cochlear implantation through the facial recess approach and three dimensional positioning of cochleostomy, and to analyze the influence of bony entrance sizes on the operation. Methods Twelve human temporal bones from six adult cadaveric heads underwent high-resolution CT scans and were dissected under surgical microscope to simulate cochlear implantation through facial recess approach. Relevant anatomic structures were examined and measured, including the sizes of the bony entrance via facial recess approach and of the cochleos-tomy, and the distances from the cochleostomy to the facial nerve, stapes, round window, pyramidal eminence, cochleariform process, etc. Results Air cells around the facial recess were found on temporal bone CT scans in 11 of the 12 temporal bones (91.7%). The width, height and depth of the bony entrance via facial recess approach were 2.94±0.28 mm, 8.79±0.88 mm and 3.54±0.17 mm, respectively, and the area was 20.32±3.19 mm2. The diameter of cochleostomy was 1.27±0.21 mm, and the length of the cochlear electrode array insertion into the scala tympani was 26.2±1.82 mm. The distances from the cochleostomy to the tympanic,and mastoid segments of the facial nerve, the pyramidal eminence, stapes, cochleariform process and the center of round window were 4.22±0.39 mm, 7.25±0.26 mm, 3.40±0.44 mm, 3.82±0.46 mm, 5.10±0.60 mm and 2.13±0.15 mm, re-spectively. Conclusion Air cells near the facial recess can be visualized by high-resolution CT scans of the temporal bone. The implantation of electrode can be affected by the size of the bony entrance in facial recess approach. Some structures, in-cluding the round window niche, round window, stapes, pyramidal eminence and cochleariform process, can be used as refer-ence landmarks for cochleostomy.