脑白质异常小儿人工耳蜗植入手术适应证的讨论

目的讨论小儿人工耳蜗植入术前常规MRI检查中发现脑白质异常的手术适应证，为小儿人工耳蜗植入手术适应证选择的准确性提供依据。方法对2004年10月-2006年12月期间，351例年龄在0．9-3．0岁的重度或极重度感音性聋小儿，人工耳蜗植入术前进行常规影像学MRI检查，通过检查结果发现MRI形态有异常改变，对有脑白质异常的病例提出总结讨论，选择手术适应证，进行术后随访。结果351例患儿中选择了347例进行了人工耳蜗植入手术。351例患儿常规MRI检查提示：脑白质形态异常20例，占5．7％，其中轻、中度异常16例，进行了人工耳蜗植入手术，术后随访2年以上未见恶化趋势。严重异常4例，取消了人工耳蜗植入手术，进行长期随访。结论幼小儿人工耳蜗植入术前常规MRI检查不可忽视，通过术前的常规MRI检查可以了解患儿的脑形态和发育状况，从中发现听力障碍患儿伴有脑部罹患。轻度脑白质异常进行人工耳蜗植入手术未发现预后恶化，严重脑白质异常由于临床经验不足，采取MRI长期随访，如有明显影像学和症状的改善方可慎重考虑人工耳蜗植入手术。

Cochlear implantation indications of children with white matter abnormalities

Objective To investigate the surgical indications of the children with MRI abnormal white matter findings. Methods Preoperation brain MRI scan were performed in 351 children with severe to profound sensorineural hearing loss. According to the abnormal white matter findings ,we proposed the surgical indications of cochlear implantation in children with abnormal white matter. Results 347 patients received cochlear implantation of all 351 patients, of all the patients 20 patients with abnormal white matter findings（5.7%）, 16 patients with mild to moderate white matter abnormalities were received cochlear implantation without deterioration ,other 4 patients with sever white matter abnormalities were excluded for cochlear implantation and follow-up. Conclusion Preoperation brain MRI scan can help ue to evaluate the development of brain and find the white matter abnormalities which may preclude the successful post-implant rehabilitation, cochlear implantation can be performed in pediatric implant candidates with mild to moderate white matter abnormalities routinely, but the surgery is not recommended to the children with sever white matter abnormalities.