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Zur G, Charbonnier G, Fageeh A, Diouf A, Brun-Vergara ML, Lesiuk H, Drake B, Santos M, Mikhael N, Budiansky D, Rhodes E, Fahed R, Mendes Pereira V. Stent-assisted Woven EndoBridge embolization for the treatment of pulsatile tinnitus caused by an ipsilateral high-riding jugular bulb. Interv Neuroradiol 2024:15910199241245156. [PMID: 38576332 DOI: 10.1177/15910199241245156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
PURPOSE Pulsatile tinnitus can be caused by a high-riding jugular bulb (HRJB), characterized by the superior position of the jugular bulb in the petrous temporal bone. The anatomical position and morphology of this entity make it challenging for endovascular treatment. We report our experience with two patients successfully treated with a stent-assisted Woven EndoBridge (WEB; Microvention, Tustin, CA, USA) device. MATERIALS AND METHODS We describe two cases of HRJB in patients presenting with disabling pulsatile tinnitus. Temporary balloon occlusion of the jugular bulb prior to the intervention reduced tinnitus intensity. Both patients were subsequently treated under general anesthesia with the WEB device deployed in the HRJB which was held by a stent deployed in the sigmoid sinus. RESULTS Both procedures were successful with good positioning of the WEB device and no procedural complications. Both patients had complete resolution of pulsatile tinnitus immediately after the procedure. Follow-up imaging showed successful occlusion of the venous cavity with a widely patent stent. CONCLUSION Among patients with pulsatile tinnitus caused by an ipsilateral HRJB, a stent-assisted WEB device seems to be a viable endovascular option with angiographic and clinical success.
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Affiliation(s)
- Gil Zur
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Guillaume Charbonnier
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Areej Fageeh
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Ange Diouf
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Maria Lucia Brun-Vergara
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Howard Lesiuk
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Drake
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Marlise Santos
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Nicole Mikhael
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Dan Budiansky
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Emily Rhodes
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurology, Department of Medicine, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Fahed
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurology, Department of Medicine, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Vitor Mendes Pereira
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Narsinh KH, Hui F, Duvvuri M, Meisel K, Amans MR. Management of vascular causes of pulsatile tinnitus. J Neurointerv Surg 2022; 14:1151-1157. [PMID: 35145036 DOI: 10.1136/neurintsurg-2021-018015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 01/23/2022] [Indexed: 12/13/2022]
Abstract
Pulsatile tinnitus is a debilitating symptom affecting millions of Americans and can be a harbinger of hemorrhagic or ischemic stroke. Careful diagnostic evaluation of pulsatile tinnitus is critical in providing optimal care and guiding the appropriate treatment strategy. When a vascular cause of pulsatile tinnitus has been established, attention must be focused on the patient's risk of hemorrhagic stroke, ischemic stroke, or blindness, as well as the risks of the available treatment options, in order to guide decision-making. Herein we review our approach to management of the vascular causes of pulsatile tinnitus and provide a literature review while highlighting gaps in our current knowledge and evidence basis.
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Affiliation(s)
- Kazim H Narsinh
- Neurointerventional Radiology, University of California San Francisco, San Francisco, California, USA
| | - Ferdinand Hui
- Neurointerventional Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Madhavi Duvvuri
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Karl Meisel
- Neurology, University of California San Francisco, San Francisco, California, USA
| | - Matthew R Amans
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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Essibayi MA, Oushy SH, Lanzino G, Brinjikji W. Venous Causes of Pulsatile Tinnitus: Clinical Presentation, Clinical and Radiographic Evaluation, Pathogenesis, and Endovascular Treatments: A Literature Review. Neurosurgery 2021; 89:760-768. [PMID: 34392338 DOI: 10.1093/neuros/nyab299] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/09/2021] [Indexed: 12/19/2022] Open
Abstract
Tinnitus is an abnormal perception of a sound without external stimulation. Venous pulsatile tinnitus (VPT) is a specific form of tinnitus characterized by an objective and often subjective bruit that occurs as a result of localized venous abnormalities. Clinical evaluation relies on sound quality, duration, and precipitating factors. Idiopathic intracranial hypertension (IIH) and transverse sinus stenosis (TSS) are among the most common causes of VPT. Other causes include sigmoid sinus wall abnormalities (SSWAs), jugular vein anomalies (JVAs), and emissary veins anomalies. These anomalies can be detected on magnetic resonance imaging, magnetic resonance angiography/magnetic resonance venography, and high-resolution temporal bone computed tomography. The pathogenesis behind the VPT includes turbulent blood flow as a result of luminal stenosis or abnormal dilation, amplification of internal sound due to temporal bone defects, and abnormal position of the venous sinus system structures adjacent to the bony structures of the auditive apparatus. Based on these theories, different interventional treatment modalities can be applied to treat the underlying causes. Endovascular treatments have shown high efficacy and safety among those treatments which include stenting of the lateral sinus stenosis in IIH and TSS, coiling of the SSWA and JVA, and embolization of emissary veins anomalies. Further studies are needed to understand the natural history of these anomalies and the efficacy of treatments of VPT, which-unlike other types of tinnitus-can be cured with proper treatment.
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Affiliation(s)
| | - Soliman H Oushy
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Waleed Brinjikji
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Internal Jugular Vein Injury by Fishbone Ingestion. Case Rep Med 2020; 2020:9182379. [PMID: 32636881 PMCID: PMC7321512 DOI: 10.1155/2020/9182379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/01/2020] [Indexed: 11/24/2022] Open
Abstract
Fishbone ingestion is a common occurrence in the Middle East countries. We present a patient with a unique complication of fishbone ingestion. A 65-year-old woman presented with left-sided neck pain and swelling since 5 days before admission. A linear foreign body with horizontal orientation was seen in CT scan at the superior part of the pharynx along with a collection around it which caused a laceration on the medial aspect of internal jugular vein and thrombosis inside the internal jugular vein.
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Xu MS, Li J, Wiseman SM. Major vessel invasion by thyroid cancer: a comprehensive review. Expert Rev Anticancer Ther 2018; 19:191-203. [DOI: 10.1080/14737140.2019.1559059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Michael S. Xu
- Department of Surgery, St. Paul’s Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Li
- Department of Surgery, St. Paul’s Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Sam M. Wiseman
- Department of Surgery, St. Paul’s Hospital & University of British Columbia, Vancouver, British Columbia, Canada
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Yen AJ, Conrad MB, Loftus PA, Kumar V, Nanavati SM, Wilson MW, Cooke DL. Internal Jugular Vein Embolization to Control Life-Threatening Hemorrhage after Penetrating Neck Trauma. J Vasc Interv Radiol 2018; 29:435-437. [PMID: 29455882 DOI: 10.1016/j.jvir.2017.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Adam J Yen
- School of Medicine, 505 Parnassus Avenue, San Francisco, CA 94143
| | - Miles B Conrad
- Department of Interventional Radiology, 505 Parnassus Avenue, San Francisco, CA 94143
| | - Patricia A Loftus
- Department of Otolaryngology - Head and Neck Surgery, 505 Parnassus Avenue, San Francisco, CA 94143
| | - Vishal Kumar
- Department of Interventional Radiology, 505 Parnassus Avenue, San Francisco, CA 94143
| | - Sujal M Nanavati
- Department of Interventional Radiology, 505 Parnassus Avenue, San Francisco, CA 94143
| | - Mark W Wilson
- Department of Interventional Radiology, 505 Parnassus Avenue, San Francisco, CA 94143
| | - Daniel L Cooke
- Department of Neurointerventional Radiology, 505 Parnassus Avenue, San Francisco, CA 94143
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Li Y, Zhang J, Yang K. Evaluation of the efficacy of a novel radical neck dissection preserving the external jugular vein, greater auricular nerve, and deep branches of the cervical nerve. Onco Targets Ther 2013; 6:361-7. [PMID: 23596353 PMCID: PMC3627341 DOI: 10.2147/ott.s43073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Conventional radical neck dissection often causes a variety of complications. Although the dissection method has been improved by retaining some tissues to reduce complications, the incomplete dissection may cause recurrence of disease. In the present study, we developed a novel radical neck dissection, which preserves the external jugular vein, the greater auricular nerve, and the deep branches of the cervical nerve, to effectively reduce complications and subsequently, to promote the postoperative survival quality. Methods A total of 100 cases of radical neck dissection were retrospectively analyzed to evaluate the efficacy, rate of complication, and postoperative dysfunction of patients treated with the novel radical neck dissection. Data analysis was performed using the Chi-square test. Results Compared with conventional radical neck dissection, the novel radical neck dissection could significantly reduce complications and promote postoperative survival quality. Particularly, the preservation of the external jugular vein reduced the surgical risk (ie, intracranial hypertension) and complications (eg, facial edema, dizziness, headache). Preservation of the deep branches of the cervical nerve and greater auricular nerve resulted in relatively ideal postoperative functions of the shoulders and ear skin sensory function (P < 0.05), while the two types of dissection procedures showed no differences in the recurrence rate (P > 0.05). Conclusion Our novel radical neck dissection procedure could effectively reduce the complications of intracranial hypertension, shoulder dysfunction, and ear sensory disturbances. It can be used as a regular surgical approach for oral carcinoma radical neck dissection.
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Affiliation(s)
- Yadong Li
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Marubashi S, Dono K, Nagano H, Gotoh K, Takahashi H, Hashimoto K, Miyamoto A, Takeda Y, Umeshita K, Kato T, Monden M. Living-Donor Liver Transplantation with Renoportal Anastomosis for Patients with Large Spontaneous Splenorenal Shunts. Transplantation 2005; 80:1671-5. [PMID: 16378059 DOI: 10.1097/01.tp.0000185087.93572.1d] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND End-stage liver disease is often accompanied by large spontaneous splenorenal shunts and thrombosed portal vein. Renoportal anastomosis for spontaneous splenorenal shunts in living-donor liver transplantations is one of the solutions for the treatment of these patients. However, the long-term outcome, portal venous hemodynamics after liver transplantation, and the effects of altering the renal venous drainage remained unknown. METHODS We performed three living-donor liver transplantations with renoportal anastomosis for the treatment of spontaneous splenorenal shunts between 1999 and 2004. We then evaluated the outcome of this procedure using short- and long-term follow-ups in which the postoperative graft function, renal function, radiological images and portal hemodynamics were examined. RESULTS All three patients who underwent a living-donor liver transplantation with renoportal anastomosis are alive with normal graft function and a patent renoportal anastomosis. The portal hemodynamics were similar to those in conventional living-donor liver transplantation recipients, and had no harmful effect on allograft function. Left renal function returned to normal after the temporal impairment in two cases, and remained slightly impaired in one, although it was negligible clinically. CONCLUSIONS Living-donor liver transplantation with renoportal anastomosis for the treatment of spontaneous splenorenal shunts in patients with end-stage liver disease is a life-saving and safe technique and should be discussed as a treatment option for patients with splenorenal shunts.
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Affiliation(s)
- Shigeru Marubashi
- Department of Surgery and Clinical Oncology, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
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Klein MD, Lessin MS, Whittlesey GC, Chang CH, Becker CJ, Meyer SL, Smith AM. Carotid artery and jugular vein ligation with and without hypoxia in the rat. J Pediatr Surg 1997; 32:565-70. [PMID: 9126755 DOI: 10.1016/s0022-3468(97)90708-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A continuing concern about the use of extracorporeal membrane oxygenation (ECMO) is the cannulation of the common carotid artery or the internal jugular vein. The authors investigated the changes that might occur in the brain with neck vessel ligation in the normal and the hypoxic rat. Two groups of 60 rats each were studied. The first group was divided into three subgroups of 20 animals each. Subgroup 1 (HH) was hypoxic both 24 hours before and 24 hours after operation. Subgroup 2 (HN) (the ECMO model) was hypoxic before operation and recovered for 24 hours in room air. Subgroup 3 (NN) underwent the entire procedure in room air. For each oxygen environment, four different operations were performed: carotid artery ligation, jugular vein ligation, carotid artery and jugular vein ligation, and dissection of the vessels without ligation (sham). Thus each subgroup was further divided into four sub-subgroups based on the operation performed. Rats were again anesthetized after a 24-hour recovery period and killed using low, blunt cervical dislocation. In the first group of 60 rats, the skull was opened and the brain was carefully removed from the cranial vault and placed in a fixative. The brains were placed in a small magnetic resonance imaging (MRI) head coil in groups of five and scans were obtained to provide T1 and T2 images that correlated with histological sections. MRI scans were reviewed in random, blinded fashion by an imager unaware of how these animals had been treated. The brains were then sectioned coronally at six corresponding levels: frontal, mid and posterior cerebrum, midbrain, pons, and medulla. Histological examination was performed in blinded fashion. The number of lesions (usually ischemic as noted by a decrease in the number of neurons) was totaled for each area of the brain. There were no differences that were consistent or statistically significant in the MR images of brains removed from the head, although it would appear that rats with jugular vein and carotid artery ligation were relatively protected. In the HN group jugular vein ligation was worst, and adding carotid artery ligation was best. In the histological studies the NN group had significantly more lesions than the HH group (P < .01). The second group of 60 rats was divided and treated as the first group in all respects except that MRI was conducted immediately after death on intact heads, and no histological studies were performed. This was done to control for lesions that might have been produced by removal of the brains from the skulls. In this group all findings were right sided. One animal in the HN group showed midcerebral white matter edema after jugular and carotid ligation. Focal anterior cerebral edema was seen in another animal (HH) after isolated carotid ligation. An occipital infarct was found in one animal (HH) after both carotid and jugular ligation. The authors conclude that neck vessel ligation in the hypoxic or normoxic rat causes only occasional and sporadic brain injury much as is seen clinically in newborn ECMO patients.
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Affiliation(s)
- M D Klein
- Department of Surgery, Wayne State University School of Medicine and the Children's Hospital of Michigan, Detroit 48201, USA
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Kotani J, Nitta K, Sakuma Y, Sugioka S, Fujita N, Ueda Y. Effects of bilateral jugular vein ligation on intracranial pressure and cerebrospinal fluid outflow resistance in cats. Br J Oral Maxillofac Surg 1992; 30:171-3. [PMID: 1622962 DOI: 10.1016/0266-4356(92)90151-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In order to study the effect of jugular venous outflow obstruction on intracranial pressure and cerebrospinal fluid (CSF) reabsorption capability, changes in epidural pressure (EDP) and CSF outflow resistance (Ro) were examined following bilateral jugular vein ligation in cats. EDP increased significantly (P less than 0.01) immediately after ligation from the control value of 4.9 +/- 0.5 mmHg (mean +/- SEM) to 15.9 +/- 0.9 mmHg. Thereafter, EDP gradually decreased back toward the control value. The pressure level had decreased to 6.7 +/- 0.5 mmHg by 20 minutes after ligation. The mean Ro was significantly (P less than 0.01) higher in the ligation group (200.4 +/- 9.7 mmHg/ml/min) that in the non-ligation group (120.0 +/- 9.9 mmHg/ml/min). These results suggest that bilateral jugular vein ligation impairs CSF reabsorption.
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Affiliation(s)
- J Kotani
- Department of Anesthesiology, Osaka Dental University, Japan
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Helms J. [The blood vessels of the posterior cranial fossa. anatomy, pathophysiology, clinic--a survey (author's transl)]. ARCHIVES OF OTO-RHINO-LARYNGOLOGY 1978; 219:179-96. [PMID: 350206 DOI: 10.1007/bf00456577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pathophysiology and tomography of the blood vessels of the posterior cranial fossa gain clinical interest in treatment of diseases of the inner ear, complications of middle ear inflammations, tumors of the pyramid and cerebello-pontine angle. Numerous variations in the arterial venous system restrict neuroradiological procedures. Techniques to treat a thrombosis of the sinuses were developed 50 years ago. Surgical procedures to remove glomus tumors of the pyramid could be improved by new anatomical and surgical experiences. Unilateral neck dissection occasionally alters the blood flow in the sinuses of the posterior cranial fossa causing serious complications.
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