Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada.
J Neurointerv Surg. 2019 Aug;11(8):841-846. doi: 10.1136/neurintsurg-2019-014725. Epub 2019 Mar 14.
Pulsatile 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.
We 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.
A 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.
In 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.
搏动性耳鸣（PT）可能使人衰弱，并导致严重的发病率。脑静脉窦病变，如静脉窦狭窄、憩室和高位颈内静脉球，是 PT 的罕见原因，目前尚无标准的治疗方法。血管内介入治疗已显示出对特发性颅内高压引起的 PT 有良好的效果，并且可能是孤立性静脉 PT 的有效治疗选择。
我们对孤立性、使人衰弱的静脉性 PT 患者的血管内治疗的结果和安全性进行了系统的文献回顾。评估了静脉病变特征、血管内技术、并发症和临床结果。此外，还包括了一例静脉窦狭窄引起的 PT 的血管内支架置入术的说明性病例。
共有 26 篇论文中的 41 名患者（90.2%为女性）纳入研究。中位年龄为 46 岁（IQR 23；范围 25-72 岁）。局灶性静脉窦狭窄（20 例）和窦憩室（14 例）是最常见的致病病变。血管内治疗包括 35 例静脉窦支架置入术，其中 11 例患者进行了辅助线圈栓塞，6 例患者单独进行了线圈栓塞。95.1%的患者耳鸣完全缓解。有一例小脑梗死的并发症，无手术相关死亡。
对于由静脉窦病变引起的使人衰弱的 PT 患者，支架置入术和/或线圈栓塞的血管内治疗似乎是安全有效的。需要进行前瞻性随机研究，以客观评估治疗效果，来证实这种治疗方法的益处。
