From the Department of Neurosurgery (S.H.S., A.D.R., M.M., F.D.), Division of Interventional NeuroRadiology, NY Presbyterian Hospital Weill Cornell Medicine, New York, New York.
GE Healthcare (V.K., R.D.), Buc, France.
AJNR Am J Neuroradiol. 2021 Jan;42(2):288-296. doi: 10.3174/ajnr.A6890. Epub 2021 Jan 7.
Dural venous sinus stenosis has been associated with idiopathic intracranial hypertension and isolated venous pulsatile tinnitus. However, the utility of characterizing stenosis as intrinsic or extrinsic remains indeterminate. The aim of this retrospective study was to review preprocedural imaging of patients with symptomatic idiopathic intracranial hypertension and pulsatile tinnitus, classify the stenosis, and assess a trend between stenosis type and clinical presentation while reviewing the frequencies of other frequently seen imaging findings in these conditions.
MRVs of 115 patients with idiopathic intracranial hypertension and 43 patients with pulsatile tinnitus before venous sinus stent placement were reviewed. Parameters recorded included the following: intrinsic or extrinsic stenosis, prominent emissary veins, optic nerve tortuosity, cephalocele, sella appearance, poststenotic fusiform enlargement versus saccular venous aneurysm, and internal jugular bulb diverticula. χ cross-tabulation statistics were calculated and recorded for all data.
Most patients with idiopathic intracranial hypertension (75 of 115 sinuses, 65%) had extrinsic stenosis, and most patients with pulsatile tinnitus (37 of 45 sinuses, 82%) had intrinsic stenosis. Marked optic nerve tortuosity was more common in idiopathic intracranial hypertension. Cephaloceles were rare in both cohorts, with an increased trend toward the presence in idiopathic intracranial hypertension. Empty sellas were more common in idiopathic intracranial hypertension. Cerebellar tonsils were similarly located at the foramen magnum level in both cohorts. Saccular venous aneurysms were more common in pulsatile tinnitus. Internal jugular bulb diverticula were similarly common in both cohorts.
In this cohort, most patients with idiopathic intracranial hypertension had extrinsic stenosis, and most patients with pulsatile tinnitus had intrinsic stenosis. Awareness and reporting of these subtypes may reduce the underrecognition of potential contributory stenoses in a given patient's idiopathic intracranial hypertension or pulsatile tinnitus.
硬脑膜静脉窦狭窄与特发性颅内高压和孤立性静脉搏动性耳鸣有关。然而，将狭窄归类为内在或外在的效用仍不确定。本回顾性研究的目的是回顾有症状的特发性颅内高压和搏动性耳鸣患者的术前影像学表现，对狭窄进行分类，并评估狭窄类型与临床表现之间的趋势，同时回顾这些情况下常见的其他影像学表现的频率。
回顾了 115 例特发性颅内高压和 43 例搏动性耳鸣患者在静脉窦支架置入前的 MRV。记录的参数包括：固有或外在狭窄、明显的导静脉、视神经迂曲、颅裂、鞍底外观、狭窄后梭形扩张与囊状静脉动脉瘤、颈内静脉球憩室。对所有数据进行了 χ 交叉表统计并记录。
大多数特发性颅内高压患者（115 个窦中的 75 个，65%）有外在狭窄，大多数搏动性耳鸣患者（45 个窦中的 37 个，82%）有内在狭窄。明显的视神经迂曲在特发性颅内高压中更为常见。颅裂在两个队列中都很少见，在特发性颅内高压中呈增加趋势。空鞍在特发性颅内高压中更为常见。小脑扁桃体在两个队列中同样位于枕骨大孔水平。囊状静脉动脉瘤在搏动性耳鸣中更为常见。颈内静脉球憩室在两个队列中同样常见。
在本队列中，大多数特发性颅内高压患者有外在狭窄，大多数搏动性耳鸣患者有内在狭窄。对这些亚型的认识和报告可能会减少在特定患者的特发性颅内高压或搏动性耳鸣中潜在狭窄的漏诊。
