Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
World Neurosurg. 2022 Sep;165:100-105. doi: 10.1016/j.wneu.2022.06.106. Epub 2022 Jun 27.
The mastoid emissary vein (MEV) describes a transosseous connection between the sigmoid dural venous sinus and the suboccipital venous plexus. In cases of outflow stenosis or malformation, the MEV may become dilated and a source of pulsatile tinnitus (PT) amenable to treatment. We describe a case of PT secondary to MEV treated successfully via endovascular coil embolization and conduct a systematic review of the literature.
We performed a systematic review without meta-analysis of studies involving management of dilated MEV on January 14, 2022, and describe a case of PT secondary to an enlarged MEV treated via coil embolization.
A total of 13 studies were selected for full review. Reports identified MEV presenting as PT in 60% (12 of 20) of cases, intraoperative hemorrhage in mastoid surgery in 15% (3 of 20), a compressive scalp mass in 10% (2 of 20), and thrombophlebitis, facial swelling, or an incidental finding in 5% (1 of 20) each. Forty-five percent (9 of 20) underwent treatment, with all experiencing symptom resolution or improvement. Surgery included transvenous coil embolization in 33.3% (3 of 9), flap reconstruction in 22.2% (2 of 9), and surgical packing, ligation, and thrombectomy in 11.1% (1 of 9) each. Dilated MEV was reported concurrently with impeded drainage pathways in 35% (7 of 20) of reports.
Dilated MEV has been reported as an etiology of pulsatile tinnitus and appears amenable to treatment via open and endovascular means. Endovascular coil embolization appears to offer effective symptom resolution, however, available literature exists only in case reports and small series. Further investigation is highly warranted.
乳突导静脉 (MEV) 描述了乙状窦硬脑膜静脉窦和枕下静脉丛之间的经骨连接。在流出道狭窄或畸形的情况下，MEV 可能会扩张，并成为可治疗的搏动性耳鸣 (PT) 的来源。我们描述了一例因 MEV 扩张引起的 PT，通过血管内线圈栓塞治疗成功，并对文献进行了系统回顾。
我们于 2022 年 1 月 14 日进行了一项无荟萃分析的系统评价，纳入了关于 MEV 扩张治疗的研究，并描述了一例因 MEV 扩张引起的 PT 通过线圈栓塞治疗的病例。
共有 13 项研究被选为全文审查。报告中 MEV 以 PT 表现的占 60%（20 例中的 12 例），乳突手术中术中出血占 15%（20 例中的 3 例），头皮受压肿块占 10%（20 例中的 2 例），血栓性静脉炎、面部肿胀或偶然发现各占 5%（20 例中的 1 例）。45%（20 例中的 9 例）接受了治疗，所有患者的症状均得到缓解或改善。手术治疗包括经静脉线圈栓塞 33.3%（9 例中的 3 例）、皮瓣重建 22.2%（9 例中的 2 例）、手术填塞、结扎和血栓切除术各 11.1%（9 例中的 1 例）。35%（20 例中的 7 例）报告中同时存在 MEV 扩张和引流通路受阻。
扩张的 MEV 已被报道为搏动性耳鸣的病因，通过开放和血管内方法治疗似乎有效。血管内线圈栓塞似乎能有效缓解症状，但现有文献仅为病例报告和小系列研究。因此，非常需要进一步的研究。
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