Gologorsky Yakov, Meyer Scott A, Post Alexander F, Winn H Richard, Patel Aman B, Bederson Joshua B
Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York, USA.
Neurosurgery. 2009 Feb;64(2):E393-4; discussion E394. doi: 10.1227/01.NEU.0000338255.93266.00.
Pulsatile tinnitus is a relatively common, potentially incapacitating condition that is often vascular in origin. We present a case of disabling pulsatile tinnitus caused by a transverse-sigmoid sinus aneurysm that was surgically treated with self-tying U-clips (Medtronic, Inc., Memphis, TN). We also review the literature and discuss other described interventions.
A 48-year-old woman presented with a 5-year history of progressive pulsatile tinnitus involving the right ear. Her physical examination was consistent with a lesion that was venous in origin. Angiography demonstrated a wide-necked venous aneurysm of the transverse-sigmoid sinus that had eroded the mastoid bone.
The patient underwent a retromastoid suboccipital craniectomy to expose the aneurysm and surrounding anatomy. The aneurysm dome was tamponaded and the aneurysm neck was coagulated until the dome had shrunk to a small remnant. The linear defect in the transverse sigmoid junction was then reconstructed with a series of U-clips and covered with Gelfoam hemostatic sponge (Pfizer, Inc., New York, NY). The patient awakened without neurological deficit and with immediate resolution of her tinnitus. A postoperative angiogram demonstrated obliteration of the aneurysm, with minimal stenosis in the region of the repair and good flow through the dominant right transverse-sigmoid junction.
This technical case report describes a novel definitive surgical treatment of venous sinus aneurysms. This technique does not necessitate long-term anticoagulation, has a low likelihood of reintervention, and provides immediate resolution of pulsatile tinnitus.
搏动性耳鸣是一种相对常见且可能使人丧失能力的病症，其起源通常为血管性。我们报告一例由横窦 - 乙状窦动脉瘤引起的致残性搏动性耳鸣病例，该病例通过自缚式U形夹（美敦力公司，田纳西州孟菲斯）进行了手术治疗。我们还回顾了文献并讨论了其他已描述的干预措施。
一名48岁女性，有5年进行性搏动性耳鸣病史，累及右耳。她的体格检查结果与起源于静脉的病变相符。血管造影显示横窦 - 乙状窦有一个宽颈静脉动脉瘤，该动脉瘤已侵蚀乳突骨。
患者接受了乳突后枕下颅骨切除术，以暴露动脉瘤及周围解剖结构。用棉塞填塞动脉瘤穹顶，对动脉瘤颈部进行凝固，直到穹顶缩小为一小残余部分。然后用一系列U形夹重建横窦 - 乙状窦交界处的线性缺损，并用明胶海绵止血海绵（辉瑞公司，纽约州纽约）覆盖。患者术后苏醒，无神经功能缺损，耳鸣立即消失。术后血管造影显示动脉瘤闭塞，修复区域狭窄最小，右侧横窦 - 乙状窦交界处血流良好。
本技术病例报告描述了一种新型的静脉窦动脉瘤确定性手术治疗方法。该技术无需长期抗凝，再次干预的可能性低，并能立即消除搏动性耳鸣。
