Laserstapedotomie
Tóm tắt
Standardbehandlung einer otosklerosebedingten Schwerhörigkeit ist neben der Hörgeräteversorgung die Stapesplastik. Dabei wird der Steigbügelüberbau durch eine Prothese ersetzt, die am langen Ambossfortsatz befestigt wird und die durch eine Perforation der Steigbügelfußplatte mit dem Perilymphraum des Innenohrs kommuniziert. Die Entfernung des Steigbügelüberbaus und die Perforation der Fußplatte sind die kritischen Schritte der Operation (Op.). Durch Einführung von laserassistierten Perforationstechniken hat sich die Op.-Sicherheit im Vergleich zur konventionellen Technik verbessert. KTP-, Argon-, Dioden-, Er:YAG- und CO2-Laser werden für die Stapedotomie eingesetzt. Durch Einsatz des CO2-Lasers, ausgerüsted mit einem Scanner, konnte die Anzahl der für die Fußplattenperforation erforderlichen Laserapplikationen deutlich reduziert werden. Im Gegensatz zu anderen Systemen wird mit dem CO2-Laser plus Scanner ein gut reproduzierbarer Perforationsdurchmesser der Stapesfußplatte erzielt. Durch den CO2-Laser-Einsatz konnten Komplikationsquellen wie unkontrollierte Perilymphleckage, eine Laserbestrahlung von Innenohrstrukturen oder das Auftreten von Druckwellen in der Perilymphe mit nachfolgendem Innenohrschaden reduziert werden. In diesem Übersichtsartikel wird die chirurgische Technik der CO2-Laser-Stapedotomie einschließlich klinisch etablierter Varianten unter besonderer Berücksichtigung der Ein-Schuss-Technik beschrieben und im Vergleich zu anderen Lasersystemen diskutiert.
Tài liệu tham khảo
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