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Sathya A, Nguyen TN, Klein P, Finitsis S, Setty BN, Dmytriw AA, Fargen KM, Hui FK, Weber P, Amans MR, Abdalkader M. Endovascular vs surgical treatment of sigmoid sinus diverticulum causing pulsatile tinnitus: A systematic review. Interv Neuroradiol 2024:15910199241231325. [PMID: 38515373 DOI: 10.1177/15910199241231325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Sigmoid sinus diverticulum (SSD) has been increasingly reported as a cause of pulsatile tinnitus (PT). While both endovascular and surgical treatments have been used, there is a lack of consensus on the treatment modality to treat SSD. We conducted a systematic review of the available literature to compare the clinical outcomes and safety of endovascular versus surgical approaches for treating SSD. METHODS A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify studies encompassing the management of SSD. Studies reporting the clinical outcomes and safety of endovascular or surgical treatments for SSD between January 2000 and January 2023 were included. Results were characterized using descriptive statistics. RESULTS Endovascular treatment (EVT) was reported by 17 articles, yielding 26 patients with 27 diverticula. Surgical treatment was reported by 20 articles, yielding 105 patients with 107 diverticula. EVT led to complete or near-complete resolution in all patients with SSD and PT. Complications occurred in 3.7% (1/27) with a return to baseline after 2 months. There were no permanent complications from EVT. Surgical treatment resulted in complete resolution in 77.6% (83/107) of cases, incomplete resolution in 11.2% (12/107), and no resolution in 11.2% (12/107). Significant complications occurred in 9.3% (10/107) of the surgical-treated patients. CONCLUSION EVT in patients with PT and venous diverticulum appears more effective and safer than surgical treatment, but large studies are lacking. Studies directly comparing endovascular and surgical treatment are needed.
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Affiliation(s)
- Anvitha Sathya
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Thanh N Nguyen
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Piers Klein
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Stephanos Finitsis
- Department of Neuroradiology, Aristotle University of Thessaloniki, Ahepa Hospital, Thessaoniki, Greece
| | - Bindu N Setty
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Adam A Dmytriw
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St Michael's Hospital, Toronto, ON, Canada
| | - Kyle M Fargen
- Departments of Neurological Surgery and Radiology, Atrium Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Ferdinand K Hui
- Division of Neurointerventional Surgery, Neuroscience Institute, Queen's Medical Center, Honolulu, HI, USA
| | - Peter Weber
- Department of Otolaryngology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Matthew R Amans
- Departments of Radiology and Neurological Surgery, University of California, San Francisco, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Shetty D, Seshadri H, Navalakhe M, Saraf R. Role of Digital Subtraction Angiography in the Preoperative Assessment of a Patient with a Petrosquamous Sinus: a Case Report. Indian J Otolaryngol Head Neck Surg 2024; 76:1208-1213. [PMID: 38440528 PMCID: PMC10908876 DOI: 10.1007/s12070-023-04222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 03/06/2024] Open
Abstract
We report a case of a 15-year-old Indian girl who presented with tinnitus, pain and ear discharge for one month and was preliminarily diagnosed with Chronic Suppurative Otitis Media (CSOM) with mastoiditis. She underwent a routine presurgical CT scan which revealed an aberrant vein, making it essential to exercise caution during surgery for CSOM. The aberrant vessel was identified as a Petrosquamous Sinus. A Petrosquamous Sinus is a persistent fetal vein that connects the transverse sinus with the retromandibular vein and may regress in an individual by birth. Its importance lies in the risk of haemorrhage it carries during otological surgeries. A Digital Subtraction Angiography proved to be a vital step in isolating the path of the vein for better visualisation of the course, thus giving a better idea about the anatomical relations of the vessel during the surgery. The tympanoplasty was performed with care to prevent damaging the vein. The patient had no complications in the postoperative period and made a quick recovery.
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Affiliation(s)
- Dhruv Shetty
- Seth G.S. Medical College and KEM Hospital, Mumbai, India
| | - Harini Seshadri
- Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, India
| | | | - Rashmi Saraf
- Seth G.S. Medical College and KEM Hospital, Mumbai, India
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Liu L, Mu Z, Kang Y, Huang S, Qiu X, Xue X, Fu M, Xue Q, Lv H, Gao B, Li S, Zhao P, Ding H, Wang Z. Hemodynamic mechanism of pulsatile tinnitus caused by venous diverticulum treated with coil embolization. Comput Methods Programs Biomed 2022; 215:106617. [PMID: 35021137 DOI: 10.1016/j.cmpb.2022.106617] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/31/2021] [Accepted: 01/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Coil embolization has become a new treatment method for pulsatile tinnitus (PT) caused by sigmoid sinus diverticulum (SSD). Although this therapy has achieved good results in clinical reports, the hemodynamic mechanism of coils in the treatment of PT in SSD remained unclear. METHODS Finite element method (FEM) and computational fluid dynamics (CFD) were combined to explore the hemodynamic mechanism of coil embolization in SSD treatment. Three personalized geometric models of sigmoid sinus were established according to the CTA data of patients. Coil model were established by FEM, and the hemodynamic differences of SSD before and after coiling were compared by transient CFD method. RESULTS Velocity streamlines disappeared in the SSD after coiling. At the peak time (t1 = 0.22 s), the SSD-average velocity decreased in every patient. The average value of the decreased in three patients was 0.154 ± 0.028 m/s (mean ± SD). Wall average pressure (Pavg) also showed a decline in every patient. Average of decrements of three patients was 17.69 ± 4.91 Pa (mean ± SD). Average WSS (WSSavg) was also reduced in every patient. The average value of WSS drop was 9.74 ± 3.02 Pa (mean ± SD). After coiling, the proportion of low-velocity region in the sigmoid sinus cortical plate dehiscence (SSCPD) area increased. Average of increments was 22.1 ± 5.36% (mean ± SD). CONCLUSIONS A reduction in SSD-average velocity, wall pressure, and WSS were the short-term hemodynamic mechanism of coil embolization for PT. Coil embolization increased the proportion of low-velocity region in the SSCPD area, thereby creating a hemodynamic environment that easily produced thrombus and protects blood vessels from the impact of blood flow. This phenomenon was the long-term effect of coil embolization.
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Affiliation(s)
- Li Liu
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Zhenxia Mu
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Yizhou Kang
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Suqin Huang
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Xiaoyu Qiu
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Xiaofei Xue
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Minrui Fu
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Qingxin Xue
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Bin Gao
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China.
| | - Shu Li
- National Institutes for Food and Drug Control Institute for Medical Device Control, China.
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| | - Heyu Ding
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
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Lekovic GP, Barnard ZR, Master A, Mehta GU, Maya MM, Wilkinson EP. Role of cerebral digital subtraction angiography in the evaluation of pulse synchronous tinnitus. J Otol 2021; 16:225-230. [PMID: 34548868 PMCID: PMC8438631 DOI: 10.1016/j.joto.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives The aim of this study was to evaluate the value of digital subtraction angiography (DSA) in the diagnostic evaluation of a highly selected patient population presenting with pulse-synchronous tinnitus (PST). Methods We retrospectively reviewed the charts of all patients referred for evaluation of possible vascular etiology of pulsatile tinnitus. Patients were evaluated with regards to presenting signs, comorbidities, non-invasive imaging results, angiographic findings and outcomes. Results Fifteen patients underwent cerebral DSA. Dural arteriovenous fistula (dAVF) was identified in six patients, and five patients had other significant vascular pathology identified on DSA. Seven patients with ‘negative’ non-invasive imaging were found to have significant pathology on DSA. Conclusions Catheter angiography may have a significant yield in appropriately selected patients presenting with pulse synchronous tinnitus.
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Affiliation(s)
- Gregory P Lekovic
- Division of Neurosurgery, House Institute, 2100 West 3rd Street, Los Angeles, CA, 90057, United States
| | - Zachary R Barnard
- Department of Neurosurgery, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, Los Angeles, CA, 90048, United States.,Division of Neurosurgery, House Institute, 2100 West 3rd Street, Los Angeles, CA, 90057, United States
| | - Adam Master
- Division of Neurosurgery, House Institute, 2100 West 3rd Street, Los Angeles, CA, 90057, United States
| | - Gautam U Mehta
- Division of Neurosurgery, House Institute, 2100 West 3rd Street, Los Angeles, CA, 90057, United States
| | - M Marcel Maya
- Department of Imaging, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, Los Angeles, CA, 90048, United States
| | - Eric P Wilkinson
- Division of Neurotology, House Institute, 2100 West 3rd Street, Los Angeles, CA, 90057, United States
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Keshary SR, Everett T, Alvarado AM, Abraham MG. Stent-assisted coiling of dural sinus diverticula: a case series. J Neurointerv Surg 2021; 14:920-924. [PMID: 34544827 DOI: 10.1136/neurintsurg-2020-016937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/31/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Dural sinus diverticula are a rare vascular etiology of pulsatile tinnitus. Patients typically present with disabling symptoms and undergo an extensive workup for common causes of pulsatile tinnitus. Endovascular treatment has been shown to be effective in several case reports. We present the largest case series of eight patients treated with endovascular therapy using stent-assisted coiling and describe the unique details of intervention. METHODS A retrospective chart review was performed on all patients who underwent endovascular dural sinus stenting. RESULTS One-hundred-twenty patients underwent dural sinus stetnting from August 2012 to February 2020. Eight of these had symptomatic pulsatile tinnitus secondary to a dural sinus diverticulum and were successfully treated with stent-assisted coil embolization. No complications occurred. CONCLUSION Our case series demonstrates that endovascular dural sinus stent-assisted coil embolization for symptomatic dural sinus diverticula is a safe and effective treatment.
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Affiliation(s)
| | - Travis Everett
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | | | - Michael G Abraham
- Departments of Neurology and Radiology, University of Kansas Medical Center, Kansas City, KS, USA
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Essibayi MA, Oushy SH, Lanzino G, Brinjikji W. Venous Causes of Pulsatile Tinnitus: Clinical Presentation, Clinical and Radiographic Evaluation, Pathogenesis, and Endovascular Treatments: A Literature Review. Neurosurgery 2021; 89:760-768. [PMID: 34392338 DOI: 10.1093/neuros/nyab299] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/09/2021] [Indexed: 12/19/2022] Open
Abstract
Tinnitus is an abnormal perception of a sound without external stimulation. Venous pulsatile tinnitus (VPT) is a specific form of tinnitus characterized by an objective and often subjective bruit that occurs as a result of localized venous abnormalities. Clinical evaluation relies on sound quality, duration, and precipitating factors. Idiopathic intracranial hypertension (IIH) and transverse sinus stenosis (TSS) are among the most common causes of VPT. Other causes include sigmoid sinus wall abnormalities (SSWAs), jugular vein anomalies (JVAs), and emissary veins anomalies. These anomalies can be detected on magnetic resonance imaging, magnetic resonance angiography/magnetic resonance venography, and high-resolution temporal bone computed tomography. The pathogenesis behind the VPT includes turbulent blood flow as a result of luminal stenosis or abnormal dilation, amplification of internal sound due to temporal bone defects, and abnormal position of the venous sinus system structures adjacent to the bony structures of the auditive apparatus. Based on these theories, different interventional treatment modalities can be applied to treat the underlying causes. Endovascular treatments have shown high efficacy and safety among those treatments which include stenting of the lateral sinus stenosis in IIH and TSS, coiling of the SSWA and JVA, and embolization of emissary veins anomalies. Further studies are needed to understand the natural history of these anomalies and the efficacy of treatments of VPT, which-unlike other types of tinnitus-can be cured with proper treatment.
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Affiliation(s)
| | - Soliman H Oushy
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Waleed Brinjikji
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Abdalkader M, Nguyen TN, Norbash AM, Raz E, Shapiro M, Lenck S, Brinjikji W, Weber P, Sakai O. State of the Art: Venous Causes of Pulsatile Tinnitus and Diagnostic Considerations Guiding Endovascular Therapy. Radiology 2021; 300:2-16. [PMID: 34032509 DOI: 10.1148/radiol.2021202584] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Venous variants and pathologic abnormalities are the most common causes of pulsatile tinnitus. These conditions include causes of turbulence within normally located veins and sinuses, and abnormally enlarged or abnormally located veins in close transmissive proximity to the conductive auditory pathway. Such disorders include pathologic abnormalities of the lateral sinus (transverse sinus stenosis and sigmoid sinus wall anomalies), abnormalities and variants of the emissary veins, and anomalies of the jugular bulb and jugular vein. Despite being the most common causes for pulsatile tinnitus, venous variants and pathologic abnormalities are often overlooked in the workup of pulsatile tinnitus. Such oversights can result in delayed patient care and prolonged patient discomfort. Advances in both cerebrovascular imaging and endovascular techniques allow for improved diagnostic accuracy and an increasing range of endovascular therapeutic options to address pulsatile tinnitus. This review illustrates the venous causes of pulsatile tinnitus and demonstrates the associated endovascular treatment. © RSNA, 2021.
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Affiliation(s)
- Mohamad Abdalkader
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Thanh N Nguyen
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Alexander M Norbash
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Eytan Raz
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Maksim Shapiro
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Stéphanie Lenck
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Waleed Brinjikji
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Peter Weber
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Osamu Sakai
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
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Liu Z, He X, Du R, Wang G, Gong S, Wang Z. Hemodynamic Changes in the Sigmoid Sinus of Patients With Pulsatile Tinnitus Induced by Sigmoid Sinus Wall Anomalies. Otol Neurotol 2020; 41:e163-7. [PMID: 31663989 DOI: 10.1097/MAO.0000000000002512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study is to investigate the hemodynamic changes of pulsatile tinnitus (PT) patients induced by sigmoid sinus wall anomalies (SSWA). STUDY DESIGN Prospective study. SETTING Tertiary referral university hospital. PATIENTS Fifteen unilateral PT patients with SSWA identified on computed tomography images and surgery and 15 age-, sex-, and body mass index-matched healthy volunteers underwent velocity-encoded, cine magnetic resonance imaging. INTERVENTION Hemodynamic data in sigmoid sinus were obtained from velocity-encoded, cine magnetic resonance imaging, and compared between PT patients and controls. MAIN OUTCOME MEASURES Heart rate was recorded. Cross-sectional area (CSA), peak positive velocity (PPV), average positive flow volume per beat (APFV/beat), average flow volume per beat (AFV/beat), peak negative velocity (PNV), and average negative flow volume per beat (ANFV/beat) were measured. Average flow volume per minute (AFV/min), average positive flow volume per minute (APFV/min), average negative flow volume per minute (ANFV/min), average positive velocity (APV), average negative velocity (ANV), and regurgitation fraction (RF) were calculated. RESULTS APV at PT side of patients was 13.4 ± 3.3 cm/s, which was significantly slower than that at corresponding side of controls (15.8 ± 2.6 cm/s). PNV and RF at PT side of patients were 21.0 ± 15.4 cm/s and 2.4% respectively, which were significantly higher than those values at corresponding side of controls (both of them were 0). HR, CSA, PPV, APFV/beat, APFV/min, AFV/beat, AFV/min, ANV, ANFV/beat, and ANFV/min were 69.8 ± 9.4 beat/min, 48.4 ± 17 mm, 31.4 ± 5.9 cm/s, 5.4 ± 1.8 ml/beat, 373.9 ± 117.7 ml/min, 5.1 ± 2.0 ml/beat, 352.0 ± 134.6 ml/min, 2 (0-4.9) cm/s, 1 (0-2.7) ml/beat, and 4.1 (0-141.3) ml/min at PT side of patients, and 67.4 ± 7.8 beat/min, 38.2 ± 18 mm, 29.9 ± 3.9 cm/s, 5.3 ± 2.0 ml/beat, 350.3 ± 125.3 ml/min, 5.1 ± 1.9 ml/beat, 340.5 ± 117.9 ml/min, 0 (0-2.1) cm/s, 0 (0-0.8) ml/beat, and 0 (0-55.4) ml/min at corresponding side of controls. These hemodynamics were not significantly different between groups. CONCLUSION APV, PNV, and RF changes take place in SSWA patients, which may be associated with the occurrence of PT and have the potential value to improve accurate etiological diagnosis and predict treatment success.
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Fiani B, Kondilis A, Doan T, Runnels J, Fiani NJ, Sarno E. Venous sinus stenting for intractable pulsatile tinnitus: A review of indications and outcomes. Surg Neurol Int 2021; 12:81. [PMID: 33767885 PMCID: PMC7982104 DOI: 10.25259/sni_1_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/09/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Pulsatile tinnitus presents as a unique variation of tinnitus in which a conscious perception of the heartbeat is localized to the ears in either unilateral or bilateral fashion. The sensation is typically caused by an increase in turbulent blood flow in the affected ear, in most cases, due to a structural abnormality of the venous sinuses – the most common of which being stenosis. Herein, we discuss the etiology of pulsatile tinnitus followed by indications for treatment of various pathologies which have been successfully treated with venous sinus stenting and have led to resolution of auditory symptoms. Methods: The authors queried PubMed database using combinations of the keywords “venous sinus stenting,” “endovascular treatment,” and “pulsatile tinnitus” to identify relevant studies published in English after 2001 and before December 1, 2020 and verified selected. Results: Our results corroborate those published in prior reviews reporting a high rate of pulsatile tinnitus resolution with venous sinus stenting. Conclusion: The success of venous sinus stenting is clinically relevant as an effective treatment option for patients suffering from pulsatile tinnitus. Future applications and studies are needed and are currently being developed to further demonstrate the effectiveness of stents in the treatment of pulsatile tinnitus.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, CA, United States
| | - Athanasios Kondilis
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States
| | - Thao Doan
- University of Texas Medical Branch, Galveston, Texas, United States
| | - Juliana Runnels
- School of Medicine, University of New Mexico, Albuquerque, New Mexico, United States
| | - Nicholas J Fiani
- University of Medicine and Health Sciences Medical School, New York, NY, United States
| | - Erika Sarno
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States
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Han Y, Xia J, Jin L, Qiao A, Su T, Li Z, Xiong J, Wang H, Zhang Z. Computational fluid dynamics study of the effect of transverse sinus stenosis on the blood flow pattern in the ipsilateral superior curve of the sigmoid sinus. Eur Radiol 2021; 31:6286-6294. [PMID: 33492472 DOI: 10.1007/s00330-020-07630-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/18/2020] [Accepted: 12/11/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effect of different types of transverse sinus stenosis on blood flow patterns in the ipsilateral superior curve of the sigmoid sinus. METHODS According to the morphology of transverse and sigmoid sinus sections in pulsatile tinnitus patients, ten idealized models with different degrees and positions of transverse sinus stenosis were constructed. Computational fluid dynamics simulations were performed to compare the hemodynamic characteristics among these models. Follow-up images of previous cases were included, which preliminarily confirmed the hypothesis that bone plate erosion of the sigmoid sinus sulcus is related to blood flow impingement. RESULTS Blood flow impingement on the superior curve of the sigmoid sinus wall intensified with increasing degree of stenosis and decreased with increasing distance between the stenosis and the sigmoid sinus. The impact zone was generally confined to the anterior and lateral walls of the superior curve of the sigmoid sinus. When the stenosis was located far from the middle of the transverse sinus, the blood flow impingement on the sigmoid sinus wall was very weak. CONCLUSIONS When stenosis is located far from the sigmoid sinus, the causes of tinnitus should be comprehensively considered instead of assuming that stenosis is the main cause. Bone plate erosion of the sigmoid sinus sulcus was promoted by blood flow impingement. KEY POINTS • Ten idealized models with different degrees and positions of stenosis were constructed. • The causes of pulsatile tinnitus should be comprehensively considered. • Sigmoid sinus plate dehiscence was promoted by blood flow impingement.
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Affiliation(s)
- Yanjing Han
- Department of Interventional Radiography, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Jun Xia
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, 100124, China
| | - Long Jin
- Department of Interventional Radiography, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
| | - Aike Qiao
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, 100124, China.
| | - Tianhao Su
- Department of Interventional Radiography, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - ZhenFeng Li
- Department of Interventional Radiography, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Jianping Xiong
- Department of Interventional Radiography, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Haochen Wang
- Department of Interventional Radiography, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Zhiyuan Zhang
- Department of Interventional Radiography, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
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Pereira VM, Cancelliere NM, Najafi M, MacDonald D, Natarajan T, Radovanovic I, Krings T, Rutka J, Nicholson P, Steinman DA. Torrents of torment: turbulence as a mechanism of pulsatile tinnitus secondary to venous stenosis revealed by high-fidelity computational fluid dynamics. J Neurointerv Surg 2020; 13:732-737. [PMID: 33219149 PMCID: PMC8292577 DOI: 10.1136/neurintsurg-2020-016636] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023]
Abstract
Background Pulsatile tinnitus (PT) is a debilitating condition that can be caused by a vascular abnormality, such as an arterial or venous lesion. Although treatment of PT-related venous lesions has been shown to successfully cure patients of the associated ‘tormenting’ rhythmical sound, much controversy still exists regarding their role in the etiology of PT. Methods A patient presented with a history of worsening, unilateral PT. A partial venous sinus obstruction related to the large arachnoid granulation was detected on the right side, and subsequently stented at the right transverse sinus. High-fidelity computational fluid dynamics (CFD) was performed on a 3D model digitally segmented from the pre-stent venogram, with assumed pulsatile flow rates. A post-stent CFD model was also constructed from this. Data-driven sonification was performed on the CFD velocity data, blinded to the patient’s self-reported sounds. Results The patient reported that the PT was completely resolved after stenting, and has had no recurrence of the symptoms after more than 2 years. CFD simulation revealed highly disturbed, turbulent-like flow at the sigmoid sinus close to auditory structures, producing a sonified audio signal that reproduced the subjective sonance of the patient’s PT. No turbulence or sounds were evident at the stenosis, or anywhere in the post-stent model. Conclusions For the first time, turbulence generated distal to a venous stenosis is shown to be a cause of PT. High-fidelity CFD may be useful for identifying patients with such ‘torrents’ of flow, to help guide treatment decision-making.
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Affiliation(s)
- Vitor M Pereira
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada .,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Mehdi Najafi
- Department of Mechanical & Industrial Engineering, University of Toronto Faculty of Applied Science and Engineering, Toronto, Ontario, Canada
| | - Dan MacDonald
- Department of Mechanical & Industrial Engineering, University of Toronto Faculty of Applied Science and Engineering, Toronto, Ontario, Canada
| | - Thangam Natarajan
- Department of Mechanical & Industrial Engineering, University of Toronto Faculty of Applied Science and Engineering, Toronto, Ontario, Canada
| | - Ivan Radovanovic
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - John Rutka
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - David A Steinman
- Mechanical & Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
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Sun J, Sun J. Sandwich technique for sigmoid sinus wall reconstruction for treatment of pulsatile tinnitus caused by sigmoid sinus diverticulum/dehiscence. Acta Otolaryngol 2019; 139:1063-1066. [PMID: 31561720 DOI: 10.1080/00016489.2019.1668960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: If the pulsatile tinnitus caused by sigmoid sinus diverticulum/dehiscence cannot be diagnosed and treated, it can lead to significant morbidity and mortality.Aim: To assess the sandwich surgical technique for sigmoid sinus wall reconstruction for the treatment of pulsatile tinnitus caused by sigmoid sinus diverticulum/dehiscence.Methods: A chart review was conducted with 17 patients suffering from pulsatile tinnitus caused by sigmoid sinus diverticulum/dehiscence who underwent sinus wall reconstruction surgery between January 2014 and July 2019.Results: Of the total patients studied, 16 were female, and one was male. The procedure was performed on the right ear of 15 patients and on the left ear of 2 patients. The pulsatile tinnitus disappeared in all patients following the sinus wall reconstruction surgery using the sandwich technique. The mean follow-up time was 25 months (a range of 8-55 months). In the follow-up period, no recurrence of pulsatile tinnitus was found. None of the patients experienced major complications such as thrombosis.Conclusions: The sandwich surgical technique for sinus wall reconstruction as a treatment for pulsatile tinnitus caused by sigmoid sinus diverticulum is safe and effective.
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Affiliation(s)
- Jiaqiang Sun
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of University of Science and Technique of China, Anhui Provincial Hospital, Hefei, China
| | - Jingwu Sun
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of University of Science and Technique of China, Anhui Provincial Hospital, Hefei, China
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Yang IH, Pereira VM, Lenck S, Nicholson P, Orru E, Klostranec JM, Krings T, Tsang ACO. Endovascular treatment of debilitating tinnitus secondary to cerebral venous sinus abnormalities: a literature review and technical illustration. J Neurointerv Surg 2019; 11:841-846. [DOI: 10.1136/neurintsurg-2019-014725] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 12/17/2022]
Abstract
Background and objectivePulsatile tinnitus (PT) can be debilitating and lead to significant morbidity. Cerebral venous sinus lesions, such as venous sinus stenosis, diverticula, and high-riding jugular bulb, are uncommon causes of PT, for which there is no standard treatment. Endovascular interventions have shown promising results for PT secondary to idiopathic intracranial hypertension, and may be a valid therapeutic option for isolated venous PT.MethodsWe conducted a systematic literature review on the outcome and safety of endovascular treatment for patients with isolated, debilitating venous PT. The venous lesion characteristics, endovascular techniques, complications, and clinical outcomes were assessed. In addition, an illustrative case of endovascular stenting for PT caused by venous sinus stenosis was included.ResultsA total of 41 patients (90.2% female) from 26 papers were included. The median age was 46 years (IQR 23; range 25–72 years). Focal venous sinus stenosis (20 patients) and sinus diverticula (14 patients) were the most common culprit lesions. Endovascular treatment included venous sinus stenting in 35 patients, 11 of whom had adjuvant coil embolization, and coil embolization alone in six patients. Complete resolution of the tinnitus was achieved in 95.1% of patients. There was one complication of cerebellar infarct, and no procedure-related mortality.ConclusionsIn patients with debilitating PT secondary to venous sinus lesions, endovascular treatment by stenting and/or coil embolization appears to be safe and effective. Prospective randomized studies with objective outcome assessments are needed to confirm the treatment benefits.
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Amans MR, Haraldsson H, Kao E, Kefayati S, Meisel K, Khangura R, Leach J, Jani ND, Faraji F, Ballweber M, Smith W, Saloner D. MR Venous Flow in Sigmoid Sinus Diverticulum. AJNR Am J Neuroradiol 2018; 39:2108-2113. [PMID: 30309843 DOI: 10.3174/ajnr.a5833] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/20/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Case reports demonstrate that coiling of a sigmoid sinus diverticulum can treat pulsatile tinnitus. We hypothesized that MR imaging 4D flow and computational fluid dynamics would reveal distinct blood flow patterns in the venous outflow tract in these patients. MATERIALS AND METHODS Patients with pulsatile tinnitus of suspected venous etiology underwent MR imaging at 3T, using venous phase contrast-enhanced MR angiography, 4D flow, and 2D phase contrast. The contrast-enhanced MRA contours were evaluated to determine the presence and extent of a sigmoid sinus diverticulum. Computational fluid dynamics analysis was performed using the 4D flow inlet flow and the luminal contours from contrast-enhanced MRA as boundary conditions. In addition, computational fluid dynamics was performed for the expected post treatment conditions by smoothing the venous geometry to exclude the sigmoid sinus diverticulum from the anatomic boundary conditions. Streamlines were generated from the 4D flow and computational fluid dynamics velocity maps, and flow patterns were examined for the presence of rotational components. RESULTS Twenty-five patients with pulsatile tinnitus of suspected venous etiology and 10 control subjects were enrolled. Five (20%) of the symptomatic subjects had sigmoid sinus diverticula, all associated with an upstream stenosis. In each of these patients, but none of the controls, a stenosis-related flow jet was directed toward the opening of the sigmoid sinus diverticulum with rotational flow patterns in the sigmoid sinus diverticulum and parent sigmoid sinus on both 4D flow and computational fluid dynamics. CONCLUSIONS Consistent patterns of blood flow can be visualized in a sigmoid sinus diverticulum and the parent sinus using 4D flow and computational fluid dynamics. Strong components of rotational blood flow were seen in subjects with sigmoid sinus diverticula that were absent in controls.
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Affiliation(s)
- M R Amans
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - H Haraldsson
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - E Kao
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - S Kefayati
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - K Meisel
- Neurology (K.M., W.S.), University of California, San Francisco, San Francisco, California
| | - R Khangura
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - J Leach
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - N D Jani
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - F Faraji
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - M Ballweber
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - W Smith
- Neurology (K.M., W.S.), University of California, San Francisco, San Francisco, California
| | - D Saloner
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
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Cuellar H, Maiti T, Patra DP, Savardekar A, Sun H, Nanda A. Endovascular Treatment of Pulsatile Tinnitus by Sigmoid Sinus Aneurysm: Technical Note and Review of the Literature. World Neurosurg 2018; 113:238-43. [DOI: 10.1016/j.wneu.2018.02.087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 11/23/2022]
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Yeo W, Xu S, Tan T, Low Y, Yuen H. Surgical management of pulsatile tinnitus secondary to jugular bulb or sigmoid sinus diverticulum with review of literature. Am J Otolaryngol 2018; 39:247-252. [PMID: 29336902 DOI: 10.1016/j.amjoto.2017.12.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 12/29/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Jugular bulb and sigmoid sinus anomalies are well-known causes of vascular pulsatile tinnitus. Common anomalies reported in the literature include high-riding and/or dehiscent jugular bulb, and sigmoid sinus dehiscence. However, cases of pulsatile tinnitus due to diverticulosis of the jugular bulb or sigmoid sinus are less commonly encountered, with the best management option yet to be established. In particular, reports on surgical management of pulsatile tinnitus caused by jugular bulb diverticulum have been lacking in the literature. OBJECTIVES To report two cases of pulsatile tinnitus with jugular bulb and/or sigmoid sinus diverticulum, and their management strategies and outcomes. In this series, we describe the first reported successful case of pulsatile tinnitus due to jugular bulb diverticulum that was surgically-treated. SUBJECTS AND METHODS Two patients diagnosed with either jugular bulb and/or sigmoid sinus diverticulum, who had presented to the Otolaryngology clinic with pulsatile tinnitus between 2016 and 2017, were studied. Demographic and clinical data were obtained, including their management details and clinical outcomes. RESULTS Two cases (one with jugular bulb diverticulum and one with both sigmoid sinus and jugular bulb diverticula) underwent surgical intervention, and both had immediate resolution of pulsatile tinnitus post-operatively. This was sustained at subsequent follow-up visits at the outpatient clinic, and there were no major complications encountered for both cases intra- and post-operatively. CONCLUSION Transmastoid reconstruction/resurfacing of jugular bulb and sigmoid sinus diverticulum with/without obliteration of the diverticulum is a safe and effective approach in the management of bothersome pulsatile tinnitus arising from these causes.
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Wang AC, Nelson AN, Pino C, Svider PF, Hong RS, Chan E. Management of Sigmoid Sinus Associated Pulsatile Tinnitus: A Systematic Review of the Literature. Otol Neurotol 2017; 38:1390-6. [DOI: 10.1097/mao.0000000000001612] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shastri RK, Chaudhary N, Pandey AS, Telian SA, Gemmete JJ. Venous Diverticula Causing Pulsatile Tinnitus Treated With Coil Embolization and Stent Placement With Resolution of Symptoms: Report of Two Cases and Review of the Literature. Otol Neurotol 2017; 38:e302-7. [DOI: 10.1097/mao.0000000000001540] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Han Y, Yang Q, Yang Z, Xia J, Su T, Yu J, Jin L, Qiao A. Computational Fluid Dynamics Simulation of Hemodynamic Alterations in Sigmoid Sinus Diverticulum and Ipsilateral Upstream Sinus Stenosis After Stent Implantation in Patients with Pulsatile Tinnitus. World Neurosurg. 2017;106:308-314. [PMID: 28698087 DOI: 10.1016/j.wneu.2017.06.168] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/27/2017] [Accepted: 06/29/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the relationships between upstream venous sinus stenosis and pulsatile tinnitus (PT), and to assess the correlation with diverticulum growth and the effectiveness of stent implantation. METHODS Patient-specific geometric models were constructed using computed tomography venography images from a patient with PT, with sigmoid sinus diverticulum, and with upstream transverse sinus stenosis, in whom stenting of the upstream sinus stenosis alone achieved complete remission of PT. Computational fluid dynamics simulation based on this patient-specific geometry was performed using commercially available finite element software (ANSYS-14) to qualitatively and quantitatively compare the flow velocity, flow rate, velocity vector, pressure, vorticity, and wall shear stress on the affected side transverse and sigmoid sinuses, before and after stent implantation. RESULTS Stenting improved the flow direction and magnitude. After stenting, the flow pattern became smoother and more regular. High-speed blood flow at the level of the diverticulum neck was confined to a smaller area, and its direction changed from approximately perpendicular to the diverticular dome to the distal side of the diverticular neck. The diverticulum showed obvious flow reduction, with decreases of 80.7%, 68.7%, 96.1%, and 91.3% in peak velocity, inflow rate, pressure gradient, and peak vorticity, respectively. The abnormally low wall shear stress at the dome of diverticulum was eliminated. CONCLUSIONS Our findings strongly support a major role of diverticulum stenosis before in PT development and suggest that such stenosis is a causative factor of diverticulum growth. They also confirm the effectiveness of stent implantation for the treatment of PT.
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Thomassin JM, Rossi ME, Reyre A. Acufeni oggettivi. Neurologia 2017. [DOI: 10.1016/s1634-7072(17)83855-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Kim CS, Kim SY, Choi H, Koo JW, Yoo SY, An GS, Lee K, Choi I, Song JJ. Transmastoid reshaping of the sigmoid sinus: preliminary study of a novel surgical method to quiet pulsatile tinnitus of an unrecognized vascular origin. J Neurosurg 2016; 125:441-9. [DOI: 10.3171/2015.6.jns15961] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
A dominant sigmoid sinus with focal dehiscence or thinning (DSSD/T) of the overlying bony wall is a commonly encountered, but frequently overlooked, cause of vascular pulsatile tinnitus (VPT). Also, the pathophysiological mechanism of sound perception in patients with VPT remains poorly understood. In the present study, a novel surgical method, termed transmastoid SS-reshaping surgery, was introduced to ameliorate VPT in patients with DSSD/T. The authors reviewed a case series, analyzed the surgical outcomes, and suggested the pathophysiological mechanism of sound perception. The theoretical background underlying VPT improvement after transmastoid SS-reshaping surgery was also explored.
METHODS
Eight patients with VPT that was considered attributable to DSSD/T underwent transmastoid SS-reshaping surgery between February 2010 and February 2015. The mean postoperative follow-up period was 9.5 months (range 4–13 months). Transmastoid SS-reshaping surgery featured simple mastoidectomy, partial compression of the SS using harvested cortical bone chips, and reinforcement of the bony SS wall with bone cement. Perioperative medical records, imaging results, and audiological findings were comprehensively reviewed.
RESULTS
In 7 of the 8 patients (87.5%), the VPT abated immediately after surgery. Statistically significant improvements in tinnitus loudness and distress were evident on numeric rating scales. Three patients with preoperative ipsilesional low-frequency hearing loss exhibited postoperative improvements in their low-frequency hearing thresholds. No major postoperative complications were encountered except in the first subject, who experienced increased intracranial pressure postoperatively. This subsided after a revision operation for partial decompression of the SS.
CONCLUSIONS
Transmastoid SS-reshaping surgery may be a good surgical option in patients with DSSD/T, a previously unrecognized cause of VPT. Redistribution of severely asymmetrical blood flow, reinforcement of the bony SS wall with bone cement to reconstruct a soundproof barrier, and disconnection of a problematic sound conduction route via simple mastoidectomy silence VPT.
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Affiliation(s)
- Chong Sun Kim
- 1Seoul National University College of Medicine
- 2Soree Ear Clinic
| | - So Young Kim
- 3Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea; and
| | - Hyunseok Choi
- 3Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea; and
| | - Ja-Won Koo
- 3Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea; and
| | | | - Gwang Seok An
- 5Graduate School of Convergence Science and Technology, Seoul National University, Seoul
| | - Kyogu Lee
- 5Graduate School of Convergence Science and Technology, Seoul National University, Seoul
| | - Inyong Choi
- 6Department of Communication Sciences and Disorders, The University of Iowa, Iowa City, Iowa
| | - Jae-Jin Song
- 3Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea; and
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Abstract
Sigmoid sinus diverticulum (SSD) is a rare vascular disorder due to dehiscence of the sigmoid plate. It may be associated with prediverticular venous sinus stenosis (SS) and usually presents as pulsatile tinnitus. The mechanism of development of the SSD and tinnitus from a sinus diverticulum and associated SS is unclear. Previous case reports have suggested that remodeling of the venous system targeting the stenosis, elimination of the diverticulum, or both, have resulted in symptom relief. We present a case of SSD with SS, treated by stenting of the stenosis along with coil embolization of the diverticulum, resulting in complete relief of symptoms. We have also reviewed the literature and discussed the evolution of management from open surgical treatment to endovascular treatment.
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Affiliation(s)
- Srinivasan Paramasivam
- Center for Cerebrovascular Surgery, Department of Neurosurgery, Mount Sinai Hospital, New York, N.Y., USA
| | - Sunil Furtado
- Center for Cerebrovascular Surgery, Department of Neurosurgery, Mount Sinai Hospital, New York, N.Y., USA
| | - Tomoyoshi Shigamatsu
- Center for Cerebrovascular Surgery, Department of Neurosurgery, Mount Sinai Hospital, New York, N.Y., USA
| | - Eric Smouha
- Department of Otolaryngology, Mount Sinai Hospital, New York, N.Y., USA
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Hui FK, Abruzzo T, Ansari SA. Endovascular Interventions for Idiopathic Intracranial Hypertension and Venous Tinnitus. Neuroimaging Clin N Am 2016; 26:289-99. [DOI: 10.1016/j.nic.2015.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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26
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Affiliation(s)
| | | | | | - Shu-Sheng Gong
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Song JJ, Kim YJ, Kim SY, An YS, Kim K, Lee SY, Koo JW. Sinus Wall Resurfacing for Patients With Temporal Bone Venous Sinus Diverticulum and Ipsilateral Pulsatile Tinnitus. Neurosurgery 2015. [DOI: 10.1227/neu.0000000000000902] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Pulsatile tinnitus (PT) caused by venous sinus diverticulum is a relatively common, potentially incapacitating condition. Although treatment via an external approach or endovascular coiling has been reported, much remains unknown about the possible pathophysiological mechanisms and appropriate management of PT.
OBJECTIVE:
To review our case series of PT resulting from either sigmoid sinus diverticulum (SSD) or middle cranial fossa venous sinus diverticulum (MFD-VS) and to discuss the possible pathophysiological mechanisms and desirable treatment options.
METHODS:
Four PT patients with either SSD or MFD-VS were treated with transmastoid resurfacing. In 1 case, a revision operation was performed as a result of recurrence of PT 4.5 years after the initial operation. The medical records and temporal bone imaging findings were retrospectively reviewed.
RESULTS:
PT was resolved in all cases immediately after transmastoid resurfacing, but 1 patient in whom bone wax was used for initial resurfacing experienced PT 4.5 years later. The PT was successfully managed with revision resurfacing with autologous bone chips/bone cement. In the other cases, the resolution of PT lasted throughout a median follow-up of 5.75 years. Notably, 2 of 4 cases had preoperative low-frequency hearing loss (LFHL) and experienced immediate postoperative improvement in LFHL.
CONCLUSION:
PT resulting from either SSD or MFD-VS can be treated successfully with transmastoid resurfacing of the venous wall. Preoperative ipsilesional LFHL and the improvement of hearing threshold after surgical intervention may be preoperative and postoperative surrogate objective signatures of PT. To ensure the resolution of symptoms, secure reconstruction with firm materials and long-term follow-up are mandatory.
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Affiliation(s)
- Jae-Jin Song
- Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Jin Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - So Young Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun Suk An
- Department of Otorhinolaryngology–Head and Neck Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Kanghyeon Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Sang-Yeon Lee
- Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ja-Won Koo
- Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Trivelato FP, Araújo JFS, Dos Santos Silva R, Rezende MTS, Ulhôa AC, Castro GD. Endovascular treatment of pulsatile tinnitus associated with transverse sigmoid sinus aneurysms and jugular bulb anomalies. Interv Neuroradiol 2015; 21:548-51. [PMID: 26111983 DOI: 10.1177/1591019915590367] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pulsatile tinnitus of vascular origin may arise in arterial or venous structures. Many authors have reported the association of pulsatile tinnitus with anomalies of dural venous sinuses and the jugular bulb. In such circumstances, mainly concomitantly with disabling tinnitus, endovascular treatment has been successfully employed. We describe here a new case of jugular bulb diverticulum associated with transverse sigmoid sinus stenosis, in a patient presenting with disabling pulsatile tinnitus. She was treated with dural sinus stenting and selective embolization of the diverticulum. In addition, we performed a literature review aiming to identify possible risk factors for developing the symptoms, as well as the safety and results of endovascular treatment.
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Abstract
The sigmoid sinus diverticulum (SSD) is an increasingly recognized cause of pulsatile tinnitus (PT). Surgical reconstruction of the sigmoid sinus wall has been found to be highly effective for SSD; however, surgical techniques still need to be refined to reduce the incidence of serious postoperative complications. Moreover, scrutinizing more cases of SSD is desirable for establishing the diagnostic criteria and standardizing the surgical technique. This study was retrospectively undertaken in 28 patients who were diagnosed with SSD upon computed tomography angiography (CTA) and digital subtraction angiography findings at Beijing Tongren Hospital in China. A majority of patients (20/28) presented with SSD and accompanying sigmoid sinus wall dehiscence (SSWD). Twenty-five patients opted to undergo sigmoid sinus wall reconstruction, and 3 patients refused surgery. Following surgery, 17 patients experienced complete resolution of PT, 3 patients experienced partial resolution, and 5 patients experienced no change in PT. No serious complications were found postoperatively. A comparative analysis of the preoperative and postoperative CTA findings suggested that completely resolving SSD and the accompanying SSWD resulted in the elimination of PT. In conclusion, SSD is generally accompanied by SSWD. Sigmoid sinus wall reconstruction is a safe and effective approach for the treatment of SSD. During surgery, completely resolving both SSD and SSWD is advisable, and maintaining the normal diameter of the sigmoid sinus is imperative.
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Affiliation(s)
- Guo-Peng Wang
- From the Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China (G-PW, RZ, S-SG); Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China (G-PW, RZ, X-BM, S-SG); Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China (Z-HL); and Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China (Z-CW)
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Mondel PK, Udare AS, Saraf R, Limaye US. Retromandibular Vein Diverticulum: Unique Imaging Findings with a Novel Therapeutic Strategy. Cardiovasc Intervent Radiol 2014; 37:1376-1380. [DOI: 10.1007/s00270-014-0866-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
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31
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Baomin L, Xiangyu C, Xinfeng L, Sheng L, Jun W, Yongping L, Aili G, Alan Z, Huimin F. Interventionai Diagnosis and Treatment of Vasculogeneic Pulsatile Tinnitus. J Otol 2014. [DOI: 10.1016/s1672-2930(14)50002-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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32
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Baomin L, Yongbing S, Xiangyu C. Angioplasty and Stenting for Intractable Pulsatile Tinnitus Caused by Dural Venous Sinus Stenosis: A Case Series Report. Otol Neurotol 2014; 35:366-70. [DOI: 10.1097/mao.0b013e3182990d52] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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33
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Harvey RS, Hertzano R, Kelman SE, Eisenman DJ. Pulse-Synchronous Tinnitus and Sigmoid Sinus Wall Anomalies: Descriptive Epidemiology and the Idiopathic Intracranial Hypertension Patient Population. Otol Neurotol 2014; 35:7-15. [DOI: 10.1097/mao.0b013e3182a4756c] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grewal AK, Kim HY, Comstock RH, Berkowitz F, Kim HJ, Jay AK. Clinical Presentation and Imaging Findings in Patients With Pulsatile Tinnitus and Sigmoid Sinus Diverticulum/Dehiscence. Otol Neurotol 2014; 35:16-21. [DOI: 10.1097/mao.0b013e31829ab6d7] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Liu Z, Chen C, Wang Z, Gong S, Xian J, Wang Y, Liang X, Ma X, Li Y. Sigmoid sinus diverticulum and pulsatile tinnitus: analysis of CT scans from 15 cases. Acta Radiol 2013; 54:812-6. [PMID: 23550183 DOI: 10.1177/0284185113481698] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the imaging features of sigmoid sinus diverticulum induced pulsatile tinnitus (PT) have been presented in some extent, detailed imaging findings still have not been systematically evaluated and precise diagnostic radiographic criteria has not been established. PURPOSE To examine the computed tomography (CT) characteristics of sigmoid sinus diverticulum accompanied with PT. MATERIAL AND METHODS Fifteen PT patients with sigmoid sinus diverticula proven by surgery were recruited after consenting. CT images of 15 patients were obtained and analyzed, including features of diverticula, brain venous systems, integrity of the sigmoid plate, and the degree of temporal bone pneumatization. RESULTS Sigmoid sinus diverticulum was located on the same side of PT in 15 patients. Diverticula originated at the superior curve of the sigmoid sinus in 11 patients and the descending segment of the sigmoid sinus in four patients. Sigmoid sinus diverticula focally eroded into the adjacent mastoid air cells in 12 patients and mastoid cortex in three patients. Among eight patients with unilateral dominant brain venous systems, the diverticula were seen on the dominant side in seven patients and non-dominant side in one patient. In contrast, the other seven patients showed co-dominant brain venous systems, with three presenting diverticula on the right side and four on the left. More notably, dehiscent sigmoid plate on the PT side was demonstrated in all patients. In addition, temporal bone hyper-pneumatization was found in nine patients, good and moderate pneumatization in three patients, respectively. CONCLUSION Dehiscent sigmoid plate and extensive temporal bone pneumatization are two important imaging characteristics of the PT induced by sigmoid sinus diverticulum.
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Affiliation(s)
| | - Chengfang Chen
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, China
| | | | - Shusheng Gong
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, China
| | | | | | | | - Xiaobo Ma
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, China
| | - Yi Li
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, China
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36
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Lenck S, Mosimann PJ, Labeyrie MA, Houdart E. Pulsatile tinnitus caused by an aneurysm of the transverse-sigmoid sinus: A new case report and review of literature. J Neuroradiol 2012; 39:276-9. [DOI: 10.1016/j.neurad.2012.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 02/06/2012] [Accepted: 02/15/2012] [Indexed: 11/29/2022]
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Santos-Franco JA, Lee A, Nava-Salgado G, Zenteno M, Vega-Montesinos S, Pane-Pianese C. Hybrid Carotid Stent for the Management of a Venous Aneurysm of the Sigmoid Sinus Treated by Sole Stenting. Vasc Endovascular Surg 2012; 46:342-6. [DOI: 10.1177/1538574412442593] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J. A. Santos-Franco
- Department of Neurosurgery, Specialties Hospital, Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social. Universidad Nacional Autónoma de México, Mexico
| | - A. Lee
- Department of Endovascular Therapy, Comprehensive Stroke Unit, Hospital Angeles of the Pedregal, Mexico
- Department of Neurosurgery, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City
| | - G. Nava-Salgado
- Department of Radiology, Specialties Hospital, Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social, Mexico
| | - M. Zenteno
- Department of Endovascular Therapy, Comprehensive Stroke Unit, Hospital Angeles of the Pedregal, Mexico
- Department of Neurological Endovascular Therapy, Instituto Nacional de Neurología y de Neurocirugía, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - S. Vega-Montesinos
- Department of Neurological Endovascular Therapy, Instituto Nacional de Neurología y de Neurocirugía, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Signorelli F, Mahla K, Turjman F. Endovascular treatment of two concomitant causes of pulsatile tinnitus: sigmoid sinus stenosis and ipsilateral jugular bulb diverticulum. Case report and literature review. Acta Neurochir (Wien) 2012; 154:89-92. [PMID: 22065197 DOI: 10.1007/s00701-011-1202-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 10/03/2011] [Indexed: 11/30/2022]
Abstract
We describe a rare case of highly invalidating pulsatile tinnitus associated with both stenosis of the sigmoid sinus and ipsilateral jugular bulb diverticulum. Both conditions were successfully treated by positioning a stent across the sigmoid sinus and jugular bulb. To our knowledge, the present clinical case represents the first report of such an approach. The therapeutic decision-making is discussed in relation to the etiopathologic hypothesis put forward.
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Affiliation(s)
- Francesco Signorelli
- Division of Neurosurgery, Department of Experimental and Clinical Medicine, University "Magna Graecia", Catanzaro, Italy
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