Qiu Xiao-Yu, Zhao Peng-Fei, Ding He-Yu, Li Xiao-Shuai, Lv Han, Yang Zheng-Han, Gong Shu-Sheng, Jin Long, Wang Zhen-Chang
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
Department of Otolaryngology-Head & Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
World J Clin Cases. 2021 Apr 6;9(10):2320-2325. doi: 10.12998/wjcc.v9.i10.2320.
Pulsatile tinnitus (PT) is a potentially disabling symptom that has received increasing attention. Multiple causes of PT have been confirmed by targeted treatment. However, dynamic changes of related structures in PT patients with multiple causes after stenting for ipsilateral transverse sinus stenosis (TSS) have not been previously reported. We report such a case and present postoperative computed tomography venography (CTV) follow-up findings to demonstrate the decreased sigmoid sinus diverticulum and bone remodeling.
A 45-year-old man suffered from left-sided PT for 15 years that was occasionally accompanied by headache and dizziness. Pre-operative CTV revealed left-sided sigmoid sinus wall anomalies (SSWAs), TSS, outflow dominance, large posterior condylar emissary vein, and an empty sella turcica. A cerebrospinal fluid pressure of 270 mmHO was further detected. The sound disappeared immediately after stenting for ipsilateral TSS, with no recurrence during 2 years of follow-up. After the procedure, the patient underwent four consecutive CTV examinations. The diverticulum decreased 6 mo after the procedure with new bone remodeling. The density of the remodeled bone was further increased 1 year later, and a hardened edge was formed 2 years later.
PT associated with SSWAs, TSS, and idiopathic intracranial hypertension can be cured by stenting for TSS alone. And bone remodeling around SSWAs is a more significant finding.
搏动性耳鸣（PT）是一种可能导致功能障碍的症状，已受到越来越多的关注。多种病因导致的PT已通过针对性治疗得到证实。然而，此前尚未报道过因同侧横窦狭窄（TSS）行支架置入术后多病因PT患者相关结构的动态变化。我们报告了这样一例病例，并展示术后计算机断层扫描静脉造影（CTV）随访结果，以证明乙状窦憩室减小和骨质重塑。
一名45岁男性左侧搏动性耳鸣15年，偶尔伴有头痛和头晕。术前CTV显示左侧乙状窦壁异常（SSWAs）、TSS、血流优势、粗大的后髁导静脉和空蝶鞍。进一步检测脑脊液压力为270 mmH₂O。同侧TSS支架置入术后耳鸣立即消失，随访2年无复发。术后患者连续进行了4次CTV检查。术后6个月憩室减小，有新的骨质重塑。1年后重塑骨密度进一步增加，2年后形成硬化边缘。
与SSWAs、TSS和特发性颅内高压相关的PT仅通过TSS支架置入即可治愈。并且SSWAs周围的骨质重塑是一个更显著的发现。
