Qiu Xiaoyu, Zeng Rong, Zhao Pengfei, Ding Heyu, Lv Han, Dai Chihang, Li Xiaoshuai, Yang Zhenghan, Gong Shusheng, Wang Zhenchang
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Quant Imaging Med Surg. 2025 Mar 3;15(3):2376-2384. doi: 10.21037/qims-24-426. Epub 2025 Feb 26.
Pulsatile tinnitus (PT) with sigmoid sinus wall anomalies (SSWAs) is often treated by surgical reconstruction. However, the effect of this surgical procedure on the PT-related blood flow is unclear. This study compared changes in the PT-related blood flow velocity and patterns in the transverse-sigmoid sinus junction (TSSJ) before and after surgical reconstruction using four-dimensional (4D) flow magnetic resonance imaging (MRI).
A retrospective study analyzed patients with unilateral pulse-synchronous PT confirmed to have ipsilateral SSWAs on preoperative CT, who underwent surgical reconstruction and had pre- and postoperative 4D flow MRI, with PT eliminated or significantly alleviated after at least 6 months of follow-up. Quantitative and qualitative data of the blood flow properties, including bilateral velocity, and the net flow upstream and downstream of the TSSJ, as well as vortices in the TSSJ, were obtained and compared before and after surgery.
In total, 19 patients were included in the study, of whom, 6 had sigmoid sinus wall dehiscence (SSWD), and 13 had a diverticulum. Significant differences were only observed in the ipsilateral upstream average velocity (V) in the SSWA group, and the contralateral downstream maximum velocity (V) in the SSWA group and diverticulum group before and after treatment (P=0.01, P=0.01, P=0.04, respectively). No significant changes were observed in the other quantitative indicators. Among the 19 patients, 17 had vortices on the surgical side before surgery; 8 showed vortex disappearance, and 9 showed a reduction in the vortex intensity after surgery. Vortices were observed in 11 of the 13 patients with diverticulum before surgery, but these disappeared or slowed after surgical intervention. The high-speed jet flow remained unchanged in 16 patients with transverse sinus stenosis (TSS) before and after treatment.
Surgical reconstruction does not appear to have a significant effect on PT-related blood flow properties, which suggests that this surgery is safe; however, the risk of ongoing recurrence remains.
伴有乙状窦壁异常（SSWAs）的搏动性耳鸣（PT）常通过手术重建进行治疗。然而，该手术对与PT相关的血流的影响尚不清楚。本研究使用四维（4D）血流磁共振成像（MRI）比较了手术重建前后横窦-乙状窦交界处（TSSJ）与PT相关的血流速度和模式的变化。
一项回顾性研究分析了术前CT证实患有同侧SSWAs的单侧脉搏同步性PT患者，这些患者接受了手术重建，并在术前和术后进行了4D血流MRI检查，且在至少6个月的随访后PT消失或明显缓解。获取并比较了血流特性的定量和定性数据，包括双侧速度、TSSJ上游和下游的净流量以及TSSJ中的涡流，手术前后各进行一次。
本研究共纳入19例患者，其中6例有乙状窦壁裂开（SSWD），13例有憩室。仅在治疗前后的SSWA组同侧上游平均速度（V）、SSWA组和憩室组对侧下游最大速度（V）方面观察到显著差异（分别为P = 0.01、P = 0.01、P = 0.04）。其他定量指标未观察到显著变化。19例患者中，17例术前手术侧有涡流；8例术后涡流消失，9例术后涡流强度降低。术前13例憩室患者中有11例观察到涡流，但手术干预后这些涡流消失或减弱。1
