Abdalkader Mohamad, Klein Piers, Nguyen Thanh N
Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
Neurology, Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA.
J Neurointerv Surg. 2025 Jan 3. doi: 10.1136/jnis-2024-022638.
Transverse sinus stenosis (TSS) and sigmoid sinus wall anomalies (SSWAs) are the most common causes of pulsatile tinnitus (PT). While these conditions may co-occur, they usually require different management approaches. This study aims to evaluate whether TSS stenting alone, without targeted treatment of SSWAs, is sufficient to resolve PT in patients presenting with PT, TSS, and SSWAs.
We conducted a retrospective study of consecutive patients diagnosed with PT, TSS, and SSWAs who underwent transvenous endovascular treatment between September 2020 and January 2024. The primary outcome was treatment success at 3 months, defined as complete resolution of baseline PT. Secondary outcomes included treatment success at 24 hours and 1 year, PT recurrence within 1 year, and major complications.
Thirty-three patients with PT, TSS, and SSWAs underwent 38 procedures. Among these, 14 cases (36.8%) had dehiscence alone, 3 cases (7.9%) with diverticulum alone, and 20 cases (52.6%) involved both dehiscence and diverticulum. Stenting alone was performed in 25 cases (65.8%), stent-assisted coiling in 9 cases (23.7%), and coiling alone in 4 cases (10.5%). The primary outcome of complete resolution of PT at 3 months was achieved in 86.1% (31/36) of cases, with partial resolution in an additional 13.9% (5/36) of cases. There was no difference in outcomes between cases of isolated stenting and those involving coiling or stent-assisted coiling.
Transverse sinus stenting alone, without dedicated treatment of SSWAs, resolves PT in patients with TSS and SSWAs. These results support the growing evidence that SSWAs are secondary to TSS in patients with PT and/or idiopathic intracranial hypertension, suggesting that additional interventions like coiling or surgery of SSWAs may be unnecessary.
横窦狭窄（TSS）和乙状窦壁异常（SSWAs）是搏动性耳鸣（PT）最常见的病因。虽然这些情况可能同时出现，但它们通常需要不同的治疗方法。本研究旨在评估在伴有PT、TSS和SSWAs的患者中，单纯进行TSS支架置入术而不对SSWAs进行针对性治疗，是否足以解决PT问题。
我们对2020年9月至2024年1月期间连续诊断为PT、TSS和SSWAs并接受经静脉血管内治疗的患者进行了一项回顾性研究。主要结局是3个月时的治疗成功，定义为基线PT完全缓解。次要结局包括24小时和1年时的治疗成功、1年内PT复发以及主要并发症。
33例患有PT、TSS和SSWAs的患者接受了38次手术。其中，14例（36.8%）仅存在裂开，3例（7.9%）仅存在憩室，20例（52.6%）同时存在裂开和憩室。25例（65.8%）仅进行了支架置入术，9例（23.7%）进行了支架辅助弹簧圈栓塞术，4例（10.5%）仅进行了弹簧圈栓塞术。86.1%（31/36）的病例在3个月时实现了PT完全缓解，另有13.9%（5/36）的病例部分缓解。单纯支架置入术病例与涉及弹簧圈栓塞术或支架辅助弹簧圈栓塞术的病例在结局上没有差异。
在伴有TSS和SSWAs的患者中，单纯进行横窦支架置入术，不对SSWAs进行专门治疗，也能解决PT问题。这些结果支持了越来越多的证据，即在患有PT和/或特发性颅内高压的患者中，SSWAs继发于TSS，这表明可能无需对SSWAs进行额外的弹簧圈栓塞术或手术干预。
