Kochleaimplantat: systematischer Ansatz zur präoperativen radiologischen Evaluation

Kochleaimplantate werden zunehmend zur Hörrehabilitation eingesetzt. Ein Verständnis der Anatomie des Schläfenbeins und der Erkrankungen, die das Innenohr betreffen, ist von höchster Relevanz, um den Chirurgen auf Varianten und Bildgebungsbefunde aufmerksam zu machen, die die Operationstechnik sowie die Wahl des Kochleaimplantats und des Elektrodentyps beeinflussen und dazu beitragen können, unbeabsichtigte Komplikationen zu vermeiden.

Kernaussagen

• Die vollständige Labyrinthaplasie kann einer Labyrinthitis ossificans mit Kochleaobliteration und kalkhaltigen oder verknöcherten Ablagerungen ähneln. In diesem Fall helfen ein flaches Promontorium der Kochlea und ein stenotischer oder atretischer innerer Gehörgang bei der Unterscheidung.

• Bei einer Labyrinthitis ossificans mit isolierter Beteiligung der Scala tympani kann ein Kochleaimplantat in die Scala vestibuli eingesetzt werden. Eine Beteiligung der Basalwindung würde eine mittlere oder apikale Kochleostomie und eine zirkummodioläre Bohrung erfordern. Eine ausgedehnte Labyrinthitis ossificans ist eine Kontraindikation für eine Kochleaimplantatoperation.

• Otospongiotischen Plaques, insbesondere in der Nische des runden Fensters, sollte besondere Aufmerksamkeit gewidmet werden, da sie mit chirurgischen Schwierigkeiten einhergehen können. Die Beteiligung der basalen Windung ist eine relative Kontraindikation für eine Kochleaimplantatoperation.

• Eine verminderte Mastoidpneumatisierung und ein tiefliegendes Tegmen (Höhe geringer als 3,5 mm) sind mit einer technisch schwierigen kortikalen Mastoidektomie verbunden. Darüber hinaus besteht ein erhöhtes Risiko für eine Duraexposition, eine Meningoenzephalozele, Liquorlecks und eine Meningitis.

• Das Mittelohr muss auf chronische Otomastoiditis, Cholesteatom und Tympanosklerose untersucht werden. Eine Tympanoplastik oder eine subtotale Petrosektomie kann bei einer chronischen Otomastoiditis mit oder ohne Cholesteatom durchgeführt werden. Eine optimale Entfernung der erkrankten Strukturen ist unerlässlich, um eine Labyrinthitis und eine Meningitis zu vermeiden, die möglicherweise eine Explantation des Kochleaimplantats erfordern könnten.

Schlüsselwörter

Kochleaimplantat - Bildgebung - sensorineuraler Hörverlust - Innenohrfehlbildungen - Operationstechniken

Publication History

Article published online:
01 July 2024

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