Ionescu Eugen C, Coudert Aurelie, Reynard Pierre, Truy Eric, Thai-Van Hung, Ltaief-Boudrigua Aicha, Turjman Francis
Service Audiologie et Explorations Otoneurologiques, Hospices Civils de Lyon, Lyon, France.
Service ORL, de Chirurgie Cervico-Faciale et d'Audiophonologie, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France.
Front Neurol. 2018 Aug 20;9:689. doi: 10.3389/fneur.2018.00689. eCollection 2018.
Patients presenting superior semicircular canal dehiscence (SSCD) can experience symptoms such as conductive hearing loss, pulsatile tinnitus, autophony, and pressure-induced vertigo. Decreased cervical vestibular-evoked myogenic potentials (cVEMPs) thresholds and high-resolution computed tomography (HRCT) of the petrous bone are essential for diagnosis of SSCD syndrome. We report the case of a 43-year-old man suffering from constant right pulsatile tinnitus, intermittent autophony, and unsteadiness induced by physical exercise. An SSCD by the superior petrosal sinus (SPS) was confirmed on the right side by axial HRCT of the temporal bone reformatted in the plane of Pöschl and ipsilateral abnormally low elicited cVEMPs. Treatment options were discussed with the patient since the pulsatile tinnitus progressively became debilitating. Two options were considered: surgery or a new endovascular treatment; the patient chose the latter option. After stenting the right SPS, the intensity of the pulsatile tinnitus dramatically decreased. As there was no complication the patient was discharged at Day 1. The other symptoms improved progressively. By the 60-day follow-up visit the patient only reported a slight tinnitus worsened by physical exercise. Angiographic follow-up at 5 months confirmed the patency of the SPS. Stenting the SPS in patients with SSCD by the SPS appears to be an alternative to the existing surgical treatments.
患有上半规管裂（SSCD）的患者可能会出现传导性听力损失、搏动性耳鸣、自听增强和压力性眩晕等症状。颈前庭诱发肌源性电位（cVEMPs）阈值降低以及颞骨高分辨率计算机断层扫描（HRCT）对于SSCD综合征的诊断至关重要。我们报告了一例43岁男性患者的病例，该患者患有持续性右搏动性耳鸣、间歇性自听增强以及运动诱发的不稳感。通过在Pöschl平面重新格式化的颞骨轴向HRCT以及同侧异常低引出的cVEMPs，证实右侧存在由岩上窦（SPS）导致的SSCD。由于搏动性耳鸣逐渐变得使人衰弱，因此与患者讨论了治疗方案。考虑了两种选择：手术或一种新的血管内治疗；患者选择了后者。在对右侧SPS进行支架置入术后，搏动性耳鸣的强度显著降低。由于没有并发症，患者在第1天出院。其他症状逐渐改善。到60天随访时，患者仅报告在运动时耳鸣略有加重。5个月时的血管造影随访证实了SPS的通畅。对由SPS导致SSCD的患者进行SPS支架置入术似乎是现有手术治疗的一种替代方法。
