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Hsieh YL, Zuo B, Shi Y, Wang S, Wang W. Dynamics of cerebrospinal fluid pressure alterations and bilateral transverse-sigmoid sinus morphologies in Asian patients with venous pulsatile tinnitus. J Int Med Res 2023; 51:3000605231187949. [PMID: 37548322 PMCID: PMC10408352 DOI: 10.1177/03000605231187949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/21/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE This study was performed to investigate the dynamics of intracranial pressure (ICP) alterations and bilateral transverse-sigmoid sinus morphologies in patients with venous pulsatile tinnitus (PT). METHODS This retrospective study involved 27 patients with venous PT associated with sigmoid sinus wall anomalies. ICP and ICP metrics were measured by cerebrospinal fluid manometry and internal jugular vein compression tests. Correlation analysis was performed to determine the statistical correlation between ICP and the morphological metrics. RESULTS The mean ICP was 212.5 ± 47.3 mmH2O. The median Δ ICP total was 130 (range, 55-150) mmH2O. The Δ ICP total was linearly correlated with the open lumbar pressure, and a significant difference was found between patients with normal and elevated cerebrospinal fluid pressure. The Δ ICP difference was linearly correlated with the Len difference and Vol difference . Δ ICP was linearly correlated with Len difference . CONCLUSIONS Complete obstruction of flow patency should be avoided in patients with low ICP and large volumetric/patency differences in the bilateral transverse-sigmoid sinus systems.
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Affiliation(s)
- Yue-Lin Hsieh
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Bo Zuo
- Department of Neurology, Shanghai Xuhui District Central Hospital, Fudan University, Shanghai, 200031, China
| | - Yanhui Shi
- Department of Neurology, Shanghai Xuhui District Central Hospital, Fudan University, Shanghai, 200031, China
| | - Shenjiang Wang
- Department of Radiology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Wuqing Wang
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
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Gao X, Hsieh YL, Wang S, Shi S, Wang W. Intracranial pressure, lateral sinus patency, and jugular ultrasound hemodynamics in patients with venous pulsatile tinnitus. Front Neurol 2022; 13:992416. [PMID: 36188386 PMCID: PMC9523694 DOI: 10.3389/fneur.2022.992416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
The clinical and hemodynamic characteristics of venous pulsatile tinnitus (PT) patients with normal or elevated cerebrospinal fluid pressure (CSFP) have not been clearly differentiated. This study aimed to explore CSFP among patients with PT as the solitary symptom, as well as quantitatively and qualitatively assess the role of the degree of transverse sinus (TS) stenosis and jugular hemodynamics in venous PT patients. A total of 50 subjects with venous PT with or without sigmoid sinus wall anomalies (SSWAs) were enrolled in this study. In addition to radiologic assessments for TS stenosis and invagination of arachnoid granulation (AG) in TS, CSFP and jugular hemodynamics were measured via cerebrospinal fluid (CSF) manometry and Doppler ultrasound. Apart from group comparisons and correlation analyses, multivariate linear regression, and receiver operating characteristic (ROC) models were used to identify the sensitivity and specificity of the index of transverse sinus stenosis (ITSS) and hemodynamic variables with inferential significance. The mean CSFP of all cases was 199.5 ± 52.7 mmH2O, with no statistical difference in CSFP between the diverticulum and dehiscence groups. Multivariate linear regression analysis demonstrated that CSFP was linearly correlated with ITSS and pulsatility index (PI). ROC analysis showed that the area under the ROC curve of PI was 0.693 at 200 mmH2O threshold, and the best PI cut-off value was 0.467, with a sensitivity of 65.7% and specificity of 81.8%. For 250 mmH2O threshold, the area under the ROC curve of PI was 0.718, and the best PI cut-off value was 0.467 with a sensitivity of 68.4% and specificity of 75.0%. Additionally, the area under the ROC curve of ITSS was 0.757, and the best ITSS cutoff value was 8.5 (p = 0.002, 95% CI = 0.616–0.898) with a sensitivity of 72.4% and specificity of 75.0% at 200 mmH2O threshold. In conclusion, patients with venous PT as the only presenting symptom should be suspected of having borderline or increased CSFP when they present with high ITSS, BMI and low PI. Further, AG in TS without encephalocele and empty sellae are not limiting findings for differentiating the level of CSFP in patients with venous PT.
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Affiliation(s)
- Xiuli Gao
- Department of Radiology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
| | - Yue-Lin Hsieh
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Shanghai, China
| | - Shenjiang Wang
- Department of Radiology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
| | - Suming Shi
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Shanghai, China
| | - Wuqing Wang
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Shanghai, China
- *Correspondence: Wuqing Wang
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Hsieh Y, Xu X, Wu Y, Wang W. Evidence of air-conduction transmission pathway and strategized transtemporal operative techniques for venous pulsatile tinnitus: Combining water occlusion test and operative sensing applications. Laryngoscope Investig Otolaryngol 2021; 6:1436-1448. [PMID: 34938885 PMCID: PMC8665428 DOI: 10.1002/lio2.699] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/20/2021] [Accepted: 11/02/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES (1) To establish evidence of the transmission pathway of venous pulsatile tinnitus (PT) associated with sigmoid sinus wall anomalies (SSWAs) and (2) quantify the efficacy of transtemporal surgery. METHODS This retrospective study included 33 surgical cases of PT associated with SSWAs and 15 controls with venous PT without SSWAs. Quantitative water occlusion test (q-WOT) and imaging data were acquired for preoperative evaluation prior to strategized transtemporal osteovascular reconstruction surgery. A condenser microphone and hydrophone were intraoperatively deployed to assess and monitor in vivo amplitude variations of the PT in eight participants. RESULTS A total of 23 (69.6%) participants with SSWA responded to the q-WOT with a median solution volume of 1.3 (1.1/1.6), which significantly differed from that observed in controls (p < 0.01). The change in the operative peak amplitude of the acoustic data was statistically significant (p < 0.01), from a median of 57.6 (55.5/57.9) dB SPL to 34.3 (33.4/38.8) dB SPL. CONCLUSION Intraoperative application of acoustic sensors revealed that PT associated with SSWAs is predominantly transmitted via the air-conduction pathway. If objective findings such as q-WOT and sensing applications suggest that the transmission of venous PT is involved in middle ear air conduction, the reconstruction technique should be prioritized; if less involvement of middle ear air-conduction is indicated, addressing flow pathologies may be imperative for resolving venous PT. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Yue‐Lin Hsieh
- Department of Otology and Skull Base SurgeryEye Ear Nose & Throat Hospital, Fudan UniversityShanghaiChina
- Department of Otolaryngology‐Head and Neck SurgeryNHC Key Laboratory of Hearing MedicineShanghaiChina
| | - Xiaobing Xu
- Department of Otolaryngology‐Head and Neck SurgeryNHC Key Laboratory of Hearing MedicineShanghaiChina
- Department of RadiologyEye Ear Nose & Throat Hospital, Fudan UniversityShanghaiChina
| | - Yongzhen Wu
- Department of Otology and Skull Base SurgeryEye Ear Nose & Throat Hospital, Fudan UniversityShanghaiChina
- Department of Otolaryngology‐Head and Neck SurgeryNHC Key Laboratory of Hearing MedicineShanghaiChina
| | - Wuqing Wang
- Department of Otology and Skull Base SurgeryEye Ear Nose & Throat Hospital, Fudan UniversityShanghaiChina
- Department of Otolaryngology‐Head and Neck SurgeryNHC Key Laboratory of Hearing MedicineShanghaiChina
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Pereira VM, Cancelliere NM, Najafi M, MacDonald D, Natarajan T, Radovanovic I, Krings T, Rutka J, Nicholson P, Steinman DA. Torrents of torment: turbulence as a mechanism of pulsatile tinnitus secondary to venous stenosis revealed by high-fidelity computational fluid dynamics. J Neurointerv Surg 2020; 13:732-737. [PMID: 33219149 PMCID: PMC8292577 DOI: 10.1136/neurintsurg-2020-016636] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023]
Abstract
Background Pulsatile tinnitus (PT) is a debilitating condition that can be caused by a vascular abnormality, such as an arterial or venous lesion. Although treatment of PT-related venous lesions has been shown to successfully cure patients of the associated ‘tormenting’ rhythmical sound, much controversy still exists regarding their role in the etiology of PT. Methods A patient presented with a history of worsening, unilateral PT. A partial venous sinus obstruction related to the large arachnoid granulation was detected on the right side, and subsequently stented at the right transverse sinus. High-fidelity computational fluid dynamics (CFD) was performed on a 3D model digitally segmented from the pre-stent venogram, with assumed pulsatile flow rates. A post-stent CFD model was also constructed from this. Data-driven sonification was performed on the CFD velocity data, blinded to the patient’s self-reported sounds. Results The patient reported that the PT was completely resolved after stenting, and has had no recurrence of the symptoms after more than 2 years. CFD simulation revealed highly disturbed, turbulent-like flow at the sigmoid sinus close to auditory structures, producing a sonified audio signal that reproduced the subjective sonance of the patient’s PT. No turbulence or sounds were evident at the stenosis, or anywhere in the post-stent model. Conclusions For the first time, turbulence generated distal to a venous stenosis is shown to be a cause of PT. High-fidelity CFD may be useful for identifying patients with such ‘torrents’ of flow, to help guide treatment decision-making.
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Affiliation(s)
- Vitor M Pereira
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada .,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Mehdi Najafi
- Department of Mechanical & Industrial Engineering, University of Toronto Faculty of Applied Science and Engineering, Toronto, Ontario, Canada
| | - Dan MacDonald
- Department of Mechanical & Industrial Engineering, University of Toronto Faculty of Applied Science and Engineering, Toronto, Ontario, Canada
| | - Thangam Natarajan
- Department of Mechanical & Industrial Engineering, University of Toronto Faculty of Applied Science and Engineering, Toronto, Ontario, Canada
| | - Ivan Radovanovic
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - John Rutka
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - David A Steinman
- Mechanical & Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
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