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Patency of the cochlear aqueduct.

The patency of the cochlear aqueduct is discussed against the background of radioanatomic studies of 225 plastic casts of temporal bone specimens and additional experimental and clinical observations. The occasional presence of a wide venous channel running parallel with the cochlear aqueduct, as well as the existence of up to three accompanying venous channels can simulate a pathologically wide cochlear aqueduct radiographically. This could constitute a diagnostic pitfall in the absence of other clinical and radiographic signs of malformation.

Adolescent

[Cochlear aqueduct].

The morphology and structure within the cochlear aqueduct have been investigated on the basis of a histological analysis of 234 temporal bones ranging from 12-week old to adult. Barrier membrane was found in 28.6% of the temporal bones examined, and fibrous reticular tissues of the inner opening of the cochlear aqueduct in 38.1% of the temporal bones. No any tissue in the inner opening of the cochlear aqueduct was seen in 33.3%. Periotic duct was filled with loose reticular tissue. The clinical significance of contents in the cochlear aqueduct was discussed.

Adult

Anatomic variations of the human cochlear aqueduct. A radioanatomic investigation.

The cochlear aqueduct follows a course through the petrous pyramid that varies from straight and steeply vertical to a curvilinear and horizontal. Its course and length are correlated to the pneumatization of the pyramid and also to the volume of the jugular fossa. These two factors influence the radiographic reproduction of the cochlear aqueduct, especially in computed tomography in the axial transverse projection but to a far lesser degree in multidirectional tomography.

Cochlea

Effects of hypobaric pressure on the labyrinth. Cochlear aqueduct patent.

Cats with the cochlear aqueduct patent were placed in a pressure chamber and exposed for 10 min to hypobaric pressures of 5.1 and 6.8 kPa relative to atmospheric pressure. The experiments were designed according to a program used for treatment of Meniere's disease. The perilymph, middle ear, cerebrospinal fluid (CSF), venous, arterial and chamber pressures were recorded. The results demonstrated that hypobaric effects on the labyrinth were mediated via pressure changes in the middle ear and not via a systemic vascular or CSF influence. A reduction in chamber pressure induced a relative increase in middle ear pressure. It was the rate of the hypobaric change as well as the patency of the cochlear aqueduct and the Eustachian tube function that determined the magnitude of the initial perilymph peak pressure and the duration of this pressure increase. A rapid versus a slow rate induced an initial perilymph increase of 3.4 and 2.2 kPa, respectively. This relative pressure increase was eliminated within 1 min via the patent aqueduct. Thus, neither did a longstanding perilymph pressure increase occur during the hypobaric exposure, nor did a prolonged significant reduction in perilymph pressure occur after atmospheric pressure was restored.

Animals

Obliteration of vestibular and cochlear aqueducts in animals.

The right vestibular aqueduct was obliterated in guinea pigs, chinchillas, and monkeys, and the right cochlear aqueduct and both the right vestibular and right cochlear aqueducts were obliterated in guinea pigs and chinchilas. Changes in auditory acuity were monitored by determining averaged temporal-response thresholds, and temporal-bone histologic studies were performed. Obliteration of the vestibular aqueduct or both the vestibular and cochlear aqueducts consistently produced endolymphatic hydrops in guinea pigs. In these animals, the auditory acuity gradually deteriorated. The low tones consistently were depressed more than the high tones. The auditory changes corresponded to the severity of endolymphatic hydrops. On the other hand, no significant histologic or audiometric changes were demonstrated in monkeys after obliteration of the vestibular aqueduct or in chinchillas after obliteration of the vestibular aqueduct or of both the vestibular and cochlear aqueducts. No significant histologic or audiometric changes were demonstrated in guinea pigs and chinchillas after obliteration of the cochlear aqueduct.

Animals

The surgical approach to the endolymphatic sac and the cochlear aqueduct in the guinea pig.

The endolymphatic sac and cochlear aqueduct are primary passages of the endolymphatic and perilymphatic fluid compartments in the labyrinth. Closure of the endolymphatic sac and duct in the guinea pig will result in the development of endolymphatic hydrops. Although obstruction of the cochlear aqueduct in this species does not seem to result in any dysfunction, this structure may serve in the dynamics of inner ear fluid physiology. The anatomy of the guinea pig temporal bone is described with special emphasis on the endolymphatic sac and cochlear aqueduct. Surgical techniques to gain access to these structures through both a middle and posterior cranial fossa approach are described.

Animals

Studies on cochlear aqueduct patency.

Complex studies on the patency of the cochlear aqueduct were made on 250 human cadavers and the temporal bones isolated from these, using a chemical method (staining reaction) as well as filling the aqueduct with fluid plastics and exposing the whole of its course under an operating microscope. The disappearance of patency in the cochlear aqueduct is a progressive phenomenon reflecting the biological process of aging in the organism. Patency of the cochlear aqueduct renders possible a two-way spread of infection from the cerebrospinal fluid (CSF) to the inner ear and vice versa, CSF otorrhea, and sudden sensorineural hearing inpairment through rises in CSF pressure, while in the absence of patency, the accumulation of harmful products of metabolism in the perilymph has a deleterious effect on the sensory elements of the inner ear.

Adolescent

Venous communications of the cochlea after acute occlusion of the vein of the cochlear aqueduct.

The vein of the cochlear aqueduct (VCAQ) is the principal drainage vein of the cochlea in the guinea pig. Morphological observations of the VCAQ and its adjacent structures were made by studying serial sections of the cochlea. We detected the presence of two collateral vessels from the mucoperiosteal veins of the middle ear which communicated with the VCAQ. Following acute occlusion of the VCAQ, marked dilatations of these vessels were observed in corrosion cast preparations. Our findings suggest that these vessels act as collateral veins following acute venous congestion of the inner ear.

Animals

Ultrastructure of the guinea pig cochlear aqueduct. An electron microscopic study of decalcified temporal bones.

The ultrastructure of the guinea pig cochlear aqueduct was examined using semi-thin and thin sections. The lumen of the cochlear aqueduct was occupied by a sparse meshwork of fibroblasts and delicate connective tissue trabeculae. The periotic tissue lining the bony wall of the aqueduct was composed of multiple layers of both elongated cells and densely arranged laminae of collagen fibrils. These structures were identical to those of the dura mater and the arachnoid. The opening to the perilymphatic space of the scala tympani also contained connective tissue trabeculae, but the arrangement of fibroblasts was more compact here than in the main part of the duct. These structural features suggest that fluid can move freely through cochlear aqueduct, and that the effects of sudden pressure changes in the CSF may be protected against by the densely and perpendicularly arranged fibroblast at the opening to the perilymphatic space.

Animals

Morphological changes in the cochlear aqueduct following herpes simplex virus inoculation into the subarachnoid space.

Type 1 herpes simplex virus (HSV-1) was inoculated into the subarachnoid space through the cisterna magna of guinea pigs to study morphological changes of the inner ear and the ability of the cochlear aqueduct to protect the inner ear. Although most of the animals developed clinical manifestations of meningoencephalitis within a few days after inoculation, Preyer's reflex remained intact. Scanning electron microscopy revealed some significant changes in the cochlear aqueduct. Lymphocytes and macrophages were predominant, with narrowing of reticular tissue spaces caused by the swelling of the periotic duct tissue. The cribriform structure of the internal orifice of the cochlear aqueduct appeared to be completely obstructed, whereas it was normal in the presence of bacterial infection as previously reported (1). The morphological changes were confined to the cochlear aqueduct.

Animals

Fluid flow in the cochlear aqueduct and cochlea-hydrodynamic considerations in perilymph fistula, stapes gusher, and secondary endolymphatic hydrops.

There is convincing evidence that the cochlear aqueduct is normally patent in humans and is of relatively constant size. It probably plays an important role in the balance between the perilymphatic, endolymphatic, and cerebrospinal fluid pressures. The flow rate of liquids through tubes is a linear function of pressure, viscosity, and length of the tube but is a fourth degree power function of the radius of the lumen. For this reason, the radius is the most critical factor determining the flow rate. Small variations in size of the cochlear aqueduct can cause very large variations in flow rate through it.

Cochlea

Computer-aided three-dimensional reconstruction of guinea pig cochlear aqueduct.

A computer-aided method of three-dimensional reconstruction was applied to the determination of the overall spatial configuration of the guinea pig cochlear aqueduct. The rotation function of the reconstructed images was useful in showing the individual small parts of the duct. A semi-translucent display of the segmental reconstruction of the duct demonstrated a difference in the density of the cellular components between the opening to the perilymphatic space and the duct portion. We propose that the cochlear aqueduct serves as a protective mechanism against a sudden change in CSF pressure in the subarachnoid space.

Animals

Human cochlear aqueduct and its accessory canals.

The anatomy of the adult human cochlear aqueduct and its surrounding structures, and their normal variations at tomography, microdissection and plastic molding are described. The mean length of the aqueduct is 12.9 mm and the mean width of its funnel-shaped external aperture 4.2 mm. The mean width of the narrowest portion is 0.14 mm. No difference in aqueductal width was found between the youngest and oldest age groups. Complete bony obstruction was revealed at microdissection in 3 out of 82 specimens. In the remaining 79 the entire aqueduct was patent. The aqueduct usually runs parallel to the internal auditory canal when seen from above, and the AP projection is therefore most suitable for tomography. At tomography the entire aqueduct was visualized in 60% of the specimens. The isthmic portion was not visible in 40%. Major reasons for nonvisualization of the entire aqueduct are: 1) a luminal width less than 0.1 mm, 2) a high jugular fossa, 3) a posteriorly directed aqueductal convexity (10%), and 4) bony obliteration (4)%). Accessory canals close to and often wider than the aqueduct may complicate tomographic evaluation of the aqueductal patency. Nonvisualization of the aqueduct at tomography does not necessarily indicate nonpatency.

Adult

[The cochlear aqueduct and congenital perilymphatic fistula. An initial report].

The authors present 3 preliminary case reports of congenital perilymphatic fistula and describe their approach, which in the presence of clinical symptoms composed of progressive or fluctuating deafness, should suggest the diagnosis of congenital perilymphatic fistula leading to examination of the cochlear aqueduct by high resolution computed tomography. An anomaly detected on the CT scan, particularly on the intermediate and internal segments, is a decisive argument in the decision to operate on these congenital perilymphatic fistulae.

Adolescent

[Blockage of cochlear aqueduct for examination of perilymph (guinea pig) (author's transl)].

To prevent the perilymph (guinea pig) from contamination with CSF during the sampling the aqueductus cochleae (AC) was blocked by injection of tissue adhesive into the meningeal aperture. The control of an exact blockage of AC was carriedout by examination of perilymph-outflow after opening the cochlea (injection of fluorescein-Na into the CSF-space), analysis of perilymph-protein-concentration, macroscopic and microscopic examination of the temporal bones. In all cochleae we have found the same morphological structures, notwithstanding whether the AC was blocked (for a time from 30 min to 7 weeks) or not: The cochlear aqueduct is filled with a mesh of mesenchymal tissue, which grows more dense towards the cochlear aperture andcontinues into the round window membrane. From scala tympani the AC is always limited by one layer of cells forming a sort of membrane (under light microscope). It seems possible that CSF moves in the inner of the round window membrane between AC and subepithelian space of middle ear mucosa, whereas perilymph of scala tympani is not in direct contact with the flow of CSF. The scala tympanic side of the round window membrane may be a big area for diffusion and there also may be an exchange between CSF and perilymph. The outflow of CSF into the cochlea after experimental opening of the cochlea is an artifact, caused by damage of pressure equilibration between CSF-space and cochlea. 30 min and 5--7 weeks after blockage no morphologicaland electrophysiological alterations from those of the control ears were to be seen. The protein concentration, however, increased significantly 5--7 weeks after blockage from normally about 200 mg/100 ml toalmost the double especially in the scala tympani (see Table 1).

Action Potentials

Repair of a cerebrospinal fluid perilymph fistula primarily through the middle ear and secondarily by occluding the cochlear aqueduct.

A 35-year-old man had a 5-year history of fluctuating hearing loss in his only hearing ear. History and diagnostic tests indicated a perilymph fistula, a diagnosis subsequently confirmed by exploration. Primary and secondary repairs temporarily ameliorated symptoms. A spinal fluid to middle ear fluid pathway was identified by radioactive tracer. A patent cochlear aqueduct indicated on computed tomography scan was found and repaired through a posterior cranial fossa approach. Hearing was preserved, remaining relatively stable during the 2-year follow-up period.

Adult

[Scanning electron microscopy studies of the structure of tissue in the cochlear opening of the cochlear aqueduct].

The structure of the internal and external tissue of the cochlear opening of the cochlear aquaeduct was examined by light microscopy on semithin sections and by scanning electron microscopy. The whole area is filled with a net of mesenchymal cells. The cell axes are randomly orientated inside the aquaeduct. On the outside of the cochlear aquaeduct fibrocytic tissue fills a space which is triangular in cross-section between the basal part of the cochlea wall of the tympanic scala and the middle portion of the round window membrane. In this area the direction of the net is uniform and it gives the impression of anchorage of the round window membrane on the perilymphatic side. The rim bordering the perilymphatic space is a dense net but not fully closed. The scanning electron microscopic pictures taken perpendicular to this border structure show clearly a texture of mesenchymal cells with open spaces. No closed "membrana limitans" was found. The possible function of the fixation of the round window membrane to the perilymphatic space giving rise to an asymmetric perilymph movement is discussed with regard to the physiology of sound transmission.

Animals