Eisenman David J, Raghavan Prashant, Hertzano Ronna, Morales Robert
Department of Otorhinolaryngology - Head & Neck Surgery, Divsion of Otology and Neurotology, University of Maryland School of Medicine, Baltimore, Maryland, U.S.A.
Department of Diagnostic Radiology and Nuclear Medicine, Division of Neuroradiology, University of Maryland School of Medicine, Baltimore, Maryland, U.S.A.
Laryngoscope. 2018 Oct;128 Suppl 2:S1-S13. doi: 10.1002/lary.27218. Epub 2018 May 14.
Describe clinical and radiographic features of sigmoid sinus wall anomalies (SSWA) associated with pulsatile tinnitus (PT) and determine factors predictive of response to surgery.
Preoperative diagnostic imaging and treatment response were reviewed after surgical repair of 40 ears among 38 consecutive patients presenting with PT associated with SSWA who underwent transtemporal sinus wall reconstruction.
Twenty-three ears had isolated sigmoid sinus dehiscence, and 17 had diverticulum. The rates of transverse sinus stenosis (TSS) and empty sella, 66% and 32% respectively, were significantly higher than in historical controls (P = 0.02 and 0.001). Thirty-six out of 40 subjects (90%) had complete resolution of their PT following surgery, including all those with a diverticulum. For subjects with dehiscence alone without diverticulum, a favorable response to surgery was strongly associated with the presence of TSS (P = 0.01) and empty sella (P = 0.02).
Sigmoid sinus diverticulum and dehiscence are a clinically important cause of PT. Women of childbearing age with an elevated body mass index (BMI) are commonly affected, and there is a high rate of associated TSS and empty sella. Transtemporal sinus wall reconstruction has a high rate of success in appropriately selected patients. Patients with isolated sinus wall dehiscence without diverticulum, TSS, or empty sella are less likely to respond to transtemporal sinus wall reconstruction. These data imply a multifactorial cause of PT in at least some patients with SSWA.
4 Laryngoscope, 128:S1-S13, 2018.
描述与搏动性耳鸣（PT）相关的乙状窦壁异常（SSWA）的临床和影像学特征，并确定手术反应的预测因素。
对38例连续出现与SSWA相关的PT并接受经颞窦壁重建的患者中的40耳进行手术修复后的术前诊断成像和治疗反应进行回顾。
23耳为孤立性乙状窦裂，17耳为憩室。横窦狭窄（TSS）和空蝶鞍的发生率分别为66%和32%，显著高于历史对照组（P = 0.02和0.001）。40例患者中有36例（90%）术后PT完全缓解，包括所有有憩室的患者。对于仅有无憩室的裂的患者，手术的良好反应与TSS（P = 0.01）和空蝶鞍（P = 0.02）的存在密切相关。
乙状窦憩室和裂是PT的重要临床病因。体重指数（BMI）升高的育龄女性常受影响，且TSS和空蝶鞍的发生率较高。经颞窦壁重建在适当选择的患者中有很高的成功率。孤立性窦壁裂而无憩室、TSS或空蝶鞍的患者对经颞窦壁重建的反应较小。这些数据表明至少在一些SSWA患者中PT存在多因素病因。
4 喉镜，128:S1 - S13，2018年。
