Postoperative Imaging Findings following Sigmoid Sinus Wall Reconstruction for Pulse Synchronous Tinnitus

BACKGROUND AND PURPOSE

Transmastoid sigmoid sinus wall reconstruction is a surgical technique increasingly used for the treatment of pulsatile tinnitus arising from sigmoid sinus wall anomalies. The imaging appearance of the temporal bone following this procedure has not been well-characterized. The purpose of this study was to evaluate the postoperative imaging appearance in a group of patients who underwent this procedure.

MATERIALS AND METHODS

The medical records of 40 consecutive patients who underwent transmastoid sigmoid sinus wall reconstruction were reviewed. Thirteen of 40 patients underwent postoperative imaging. Nineteen CT and 7 MR imaging examinations were assessed for the characteristics of the materials used for reconstruction, the impact of these on the adjacent sigmoid sinus, and complications.

RESULTS

Tinnitus resolved in 38 of 40 patients. Nine patients were imaged postoperatively for suspected complications, including dural sinus thrombosis, facial swelling, and wound drainage. Two patients underwent imaging for persistent tinnitus, and 2, for development of tinnitus on the side contralateral to the side of surgery. The materials used for reconstruction (NeuroAlloderm, HydroSet, bone pate) demonstrated characteristic imaging appearances and could be consistently identified. In 5 of 13 patients, there was extrinsic compression of the sigmoid sinus by graft material. Dural sinus thrombosis occurred in 2 patients.

CONCLUSIONS

The imaging findings following sigmoid sinus wall repair are characteristic. Graft materials may result in extrinsic compression of the sigmoid sinus, and this finding may be confused with dural venous thrombosis. Awareness of the imaging characteristics of the graft materials used enables this differentiation.

Sulfonylurea receptor expression in rat brain: effect of chronic hypoxia during development

Sulfonylurea receptors are believed to be related to ATP-sensitive potassium channels and play a key role during hypoxia/ischemia in the CNS. Our previous work has shown that these receptors in rat brainstem neurons are more important in the adult rat than in the newborn during hypoxia. In the present study, we studied the time course of postnatal development of sulfonylurea receptors in detail and the effect of chronic hypoxia on receptor density in newborn pups and adult rats exposed to hypoxia either as fetuses or as 90-d-old rats using receptor binding and autoradiography. Our current results show that sulfonylurea receptor density 1) was very low at birth and developed fast within the first 2 postnatal wk and then gradually reached adult levels and 2) continued to increase in the cortex and cerebellum but decreased in the brainstem with little or no change in other areas after postnatal wk 5. Chronic hypoxia 1) decreased body weight, brain size, and brain protein concentration and 2) increased sulfonylurea receptor density in utero but had much less of an effect in the adult. From these data, we conclude that sulfonylurea receptors develop mostly in the first 2 wk postnatally and chronic hypoxia increases sulfonylurea receptor expression in utero in spite of the fact that overall protein decreases.