Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA; Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA.
Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA.
World Neurosurg. 2024 Oct;190:e992-e999. doi: 10.1016/j.wneu.2024.08.048. Epub 2024 Aug 12.
Pulsatile tinnitus (PT) is a debilitating condition with substantial morbidity related to quality of life. Cerebral venous sinus stenosis has recently emerged as a noninfrequent cause of PT, either in the setting of concurrent idiopathic intracranial hypertension (IIH) or due to primary venous stenosis. Venous sinus stenting (VSS) is an endovascular technique that can be used to treat venous stenosis. However, it is unclear if outcomes are different between patients with primary venogenic PT and IIH associated PT.
A systematic literature review and pooled analysis was completed to evaluate the clinical outcomes of PT in patients undergoing cerebral VSS. Outcome measures included: Improved PT, complete resolution of PT, and PT recurrence at follow-up. Subgroup analysis between patients with IIH and primary PT was completed.
In total, 28 studies were identified with 616 patients. The proportion of improved PT symptoms after VSS had an overall pooled rate of 91.7% (confidence interval [CI]:88.1%-95.2%; I = 65%) and no difference between subgroups (P = 0.12). Complete resolution after VSS had an overall pooled rate of 88.6% (CI: 84.0%-93.3%; I = 68%) and no significant difference between subgroups (P = 0.35). Recurrent PT after stenting occurred in 6.5% of cases (CI: 1.7%-11.3%; I = 62%). Furthermore, subgroup analysis demonstrated that IIH patients had a significantly higher recurrence rate (10.6%; CI: 5.2%-16.1%; I = 26%) compared to patients treated with venous stenting for PT as the primary indication (2.0%; CI: 0.8%-4.7%; I = 0%) (P < 0.0001).
Venous stenting in patients with PT results in a substantial decrease and often complete resolution of symptoms. PT is more likely to recur in patients with IIH-associated PT.
搏动性耳鸣（PT）是一种使人虚弱的疾病，与生活质量相关的发病率很高。最近，脑静脉窦狭窄已成为搏动性耳鸣的一个非罕见病因，既可以是在特发性颅内高压（IIH）的情况下出现，也可以是由于原发性静脉狭窄引起。静脉窦支架置入术（VSS）是一种血管内技术，可用于治疗静脉狭窄。然而，尚不清楚原发性静脉源性 PT 和 IIH 相关 PT 患者的结局是否不同。
进行了系统的文献回顾和汇总分析，以评估接受脑 VSS 的 PT 患者的临床结局。观察指标包括：PT 改善、PT 完全缓解和随访时 PT 复发。对 IIH 患者和原发性 PT 患者进行了亚组分析。
共确定了 28 项研究，纳入了 616 名患者。VSS 后 PT 症状改善的比例总体汇总率为 91.7%（置信区间[CI]：88.1%-95.2%；I=65%），且亚组间无差异（P=0.12）。VSS 后完全缓解的总体汇总率为 88.6%（CI：84.0%-93.3%；I=68%），且亚组间无显著差异（P=0.35）。支架置入后出现复发性 PT 的比例为 6.5%（CI：1.7%-11.3%；I=62%）。此外，亚组分析显示，与因 PT 为主要适应证而接受静脉支架置入治疗的患者（2.0%，CI：0.8%-4.7%；I=0%）相比，IIH 患者的复发率显著更高（10.6%，CI：5.2%-16.1%；I=26%）（P<0.0001）。
PT 患者行静脉支架置入术可显著降低症状，且常可完全缓解。与 IIH 相关的 PT 患者更有可能复发。
