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Sathya A, Nguyen TN, Klein P, Finitsis S, Setty BN, Dmytriw AA, Fargen KM, Hui FK, Weber P, Amans MR, Abdalkader M. Endovascular vs surgical treatment of sigmoid sinus diverticulum causing pulsatile tinnitus: A systematic review. Interv Neuroradiol 2024:15910199241231325. [PMID: 38515373 DOI: 10.1177/15910199241231325] [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: 03/23/2024] Open
Abstract
INTRODUCTION Sigmoid sinus diverticulum (SSD) has been increasingly reported as a cause of pulsatile tinnitus (PT). While both endovascular and surgical treatments have been used, there is a lack of consensus on the treatment modality to treat SSD. We conducted a systematic review of the available literature to compare the clinical outcomes and safety of endovascular versus surgical approaches for treating SSD. METHODS A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify studies encompassing the management of SSD. Studies reporting the clinical outcomes and safety of endovascular or surgical treatments for SSD between January 2000 and January 2023 were included. Results were characterized using descriptive statistics. RESULTS Endovascular treatment (EVT) was reported by 17 articles, yielding 26 patients with 27 diverticula. Surgical treatment was reported by 20 articles, yielding 105 patients with 107 diverticula. EVT led to complete or near-complete resolution in all patients with SSD and PT. Complications occurred in 3.7% (1/27) with a return to baseline after 2 months. There were no permanent complications from EVT. Surgical treatment resulted in complete resolution in 77.6% (83/107) of cases, incomplete resolution in 11.2% (12/107), and no resolution in 11.2% (12/107). Significant complications occurred in 9.3% (10/107) of the surgical-treated patients. CONCLUSION EVT in patients with PT and venous diverticulum appears more effective and safer than surgical treatment, but large studies are lacking. Studies directly comparing endovascular and surgical treatment are needed.
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Affiliation(s)
- Anvitha Sathya
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Thanh N Nguyen
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Piers Klein
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Stephanos Finitsis
- Department of Neuroradiology, Aristotle University of Thessaloniki, Ahepa Hospital, Thessaoniki, Greece
| | - Bindu N Setty
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Adam A Dmytriw
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St Michael's Hospital, Toronto, ON, Canada
| | - Kyle M Fargen
- Departments of Neurological Surgery and Radiology, Atrium Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Ferdinand K Hui
- Division of Neurointerventional Surgery, Neuroscience Institute, Queen's Medical Center, Honolulu, HI, USA
| | - Peter Weber
- Department of Otolaryngology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Matthew R Amans
- Departments of Radiology and Neurological Surgery, University of California, San Francisco, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Chen J, Su Y, Dai J, Zhang C, Wu J, Wang W, Han D. Treatment of venous pulsatile tinnitus by compression reconstruction of sigmoid sinus. Acta Otolaryngol 2021; 141:242-249. [PMID: 33402008 DOI: 10.1080/00016489.2020.1859612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Surgical intervention can effectively treat venous pulsatile tinnitus. AIM/OBJECTIVES To assess the effectiveness of treating of venous pulsatile tinnitus (VPT) by compression reconstruction of sigmoid sinus (SSCR) under local anesthesia. MATERIAL AND METHODS This study retrospectively reviewed 41 patients with VPT in our otolaryngology department between September 2009 and February 2019. Under local anesthesia, all patients were received SSCR. Pre- and postoperative Tinnitus Handicap Inventory (THI) degree and scores were used to evaluate the efficacy of SSCR for VPT. RESULTS Of the 41 patients, 36 patients were followed up from 9 months to 8 years and 5 patients were lost to follow-up and were excluded from the data analysis. SSCR was clinically effective in 86% of patients with complete disappearance in 18 patients (50%), partial remission in 10 patients (28%), slight alleviation in 3 patients (8%), and no change in 5 patients (14%). The pre- and postoperative THI degree and scores were significantly different (p < .001 and p = .002, respectively). CONCLUSIONS AND SIGNIFICANCE SSCR under local anesthesia is effective for treating patients with VPT. It is critical to perform a rigorous pre-operative clinical and radiological evaluation to reduce intra- and postoperative complications.
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Affiliation(s)
- Jiyue Chen
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment Hospital, Beijing, China
| | - Yu Su
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment Hospital, Beijing, China
| | - Jing Dai
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment Hospital, Beijing, China
| | - Chi Zhang
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment Hospital, Beijing, China
| | - Jie Wu
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment Hospital, Beijing, China
| | - Wenjia Wang
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment Hospital, Beijing, China
| | - Dongyi Han
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment Hospital, Beijing, China
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Sotoudeh H, Elsayed G, Ghandili S, Shafaat O, Bernstock JD, Chagoya G, Atchley T, Talati P, Segar D, Gupta S, Singhal A. Prevalence of Sigmoid Sinus Dehiscence and Diverticulum among Adults with Skull Base Cephaloceles. AJNR Am J Neuroradiol 2020; 41:1251-1255. [PMID: 32499246 DOI: 10.3174/ajnr.a6602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/24/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cephaloceles are relatively rare conditions caused by a congenital and/or acquired skull defect. The incidence of associated venous brain anomalies with regard to cephaloceles remains to be fully elucidated. Accordingly, we sought to assess the prevalence of sigmoid sinus dehiscence and diverticula in patients with spontaneous skull base cephaloceles. MATERIALS AND METHODS Our institutional data base was retrospectively queried from 2005 to 2018. Patients in whom spontaneous skull base cephaloceles were identified were ultimately included in the study cohort. These patients subsequently had their sigmoid sinuses re-evaluated with focused attention on the possible presence of dehiscence and/or diverticula. RESULTS We identified 56 patients: 12 men and 44 women. After re-evaluation of the sigmoid sinuses, evidence of dehiscence and/or diverticula was noted in 21 patients. The right sigmoid sinus was involved in 11 patients, and the left sigmoid sinus was involved in 7 patients, including 3 cases of diverticulum. In 3 patients, evidence of bilateral sigmoid sinus dehiscence and diverticula was noted. Female sex was associated with sigmoid sinus dehiscence and diverticula by univariate analysis (P = .019). By linear regression, cephalocele volume was negatively associated with sigmoid sinus dehiscence and diverticula (coefficient, -2266, P value < .007, adjusted R 2 = 0.1077). By univariate logistic regression using average cephalocele volume as a cutoff, we demonstrate a statistically significant finding of lower volumes being associated with sigmoid sinus dehiscence and diverticula with an odds ratio of 3.58 (P = .05). CONCLUSIONS The prevalence of sigmoid sinus dehiscence and diverticula in patients with cephalocele is high. Female sex is associated with sigmoid sinus dehiscence and diverticula. The cephalocele volume appears to be inversely proportional to sigmoid sinus dehiscence and diverticula.
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Affiliation(s)
- H Sotoudeh
- From the Division of Neuroradiology, Departments of Radiology (H.S., A.S.)
| | - G Elsayed
- Neurosurgery (G.E., G.C., T.A.), University of Alabama at Birmingham, Birmingham, Alabama
| | - S Ghandili
- Department of Radiology (S. Ghandili), Aventura Hospital, Miami, Florida
| | - O Shafaat
- Department of Radiology and Interventional Neuroradiology (O.S.), Isfahan University of Medical Sciences, Isfahan, Iran.,Russell H. Morgan Department of Radiology and Radiological Science (O.S.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - J D Bernstock
- Department of Neurological Surgery (J.D.B., D.S., S. Gupta), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - G Chagoya
- Neurosurgery (G.E., G.C., T.A.), University of Alabama at Birmingham, Birmingham, Alabama
| | - T Atchley
- Neurosurgery (G.E., G.C., T.A.), University of Alabama at Birmingham, Birmingham, Alabama
| | - P Talati
- Department of Neurological Surgery (P.T.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - D Segar
- Department of Neurological Surgery (J.D.B., D.S., S. Gupta), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - S Gupta
- Department of Neurological Surgery (J.D.B., D.S., S. Gupta), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - A Singhal
- From the Division of Neuroradiology, Departments of Radiology (H.S., A.S.)
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Sun J, Sun J. Sandwich technique for sigmoid sinus wall reconstruction for treatment of pulsatile tinnitus caused by sigmoid sinus diverticulum/dehiscence. Acta Otolaryngol 2019; 139:1063-1066. [PMID: 31561720 DOI: 10.1080/00016489.2019.1668960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: If the pulsatile tinnitus caused by sigmoid sinus diverticulum/dehiscence cannot be diagnosed and treated, it can lead to significant morbidity and mortality.Aim: To assess the sandwich surgical technique for sigmoid sinus wall reconstruction for the treatment of pulsatile tinnitus caused by sigmoid sinus diverticulum/dehiscence.Methods: A chart review was conducted with 17 patients suffering from pulsatile tinnitus caused by sigmoid sinus diverticulum/dehiscence who underwent sinus wall reconstruction surgery between January 2014 and July 2019.Results: Of the total patients studied, 16 were female, and one was male. The procedure was performed on the right ear of 15 patients and on the left ear of 2 patients. The pulsatile tinnitus disappeared in all patients following the sinus wall reconstruction surgery using the sandwich technique. The mean follow-up time was 25 months (a range of 8-55 months). In the follow-up period, no recurrence of pulsatile tinnitus was found. None of the patients experienced major complications such as thrombosis.Conclusions: The sandwich surgical technique for sinus wall reconstruction as a treatment for pulsatile tinnitus caused by sigmoid sinus diverticulum is safe and effective.
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Affiliation(s)
- Jiaqiang Sun
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of University of Science and Technique of China, Anhui Provincial Hospital, Hefei, China
| | - Jingwu Sun
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of University of Science and Technique of China, Anhui Provincial Hospital, Hefei, China
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Liu GS, Boursiquot BC, Blevins NH, Vaisbuch Y. Systematic Review of Temporal Bone-Resurfacing Techniques for Pulsatile Tinnitus Associated with Vascular Wall Anomalies. Otolaryngol Head Neck Surg 2019; 160:749-761. [PMID: 30667295 DOI: 10.1177/0194599818823205] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To systematically review literature evidence on temporal bone-resurfacing techniques for pulsatile tinnitus (PT) associated with vascular wall anomalies. DATA SOURCES We searched PubMed, Embase, and the Cochrane Database. The period covered was from 1962 to 2018. REVIEW METHODS We included studies in all languages that reported resurfacing outcomes for patients with PT and radiographic evidence or direct visualization of sigmoid sinus wall anomaly, jugular bulb wall anomaly, or dehiscent or aberrant internal carotid artery. RESULTS Of 954 citations retrieved in database searches and 5 citations retrieved from reference lists, 20 studies with a total of 141 resurfacing cases involving 138 patients were included. Resurfacing outcomes for arterial sources of PT showed 3 of 5 cases (60%) with complete resolution and 2 (40%) with partial resolution. Jugular bulb sources of PT showed 11 of 14 cases (79%) with complete resolution and 1 (7%) with partial resolution. Sigmoid sinus sources of PT showed 91 of 121 cases (75%) with complete resolution and 12 (10%) with partial resolution. Symptoms occurred more in females and on the right side. Most cases (94%) used hard-density materials for resurfacing. Material density did not appear to be associated with resurfacing outcomes. Use of autologous materials was associated with improved outcomes for arterial sources resurfacing. Major complications involving sigmoid sinus thrombosis or compression were reported in 4% of cases without long-term morbidity or mortality. CONCLUSIONS Resurfacing surgery is likely effective and well tolerated for select patients with PT associated with various vascular wall anomalies.
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Affiliation(s)
- George S Liu
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
- 2 School of Medicine, Stanford University, Stanford, California, USA
| | | | - Nikolas H Blevins
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Yona Vaisbuch
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
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Amans MR, Haraldsson H, Kao E, Kefayati S, Meisel K, Khangura R, Leach J, Jani ND, Faraji F, Ballweber M, Smith W, Saloner D. MR Venous Flow in Sigmoid Sinus Diverticulum. AJNR Am J Neuroradiol 2018; 39:2108-2113. [PMID: 30309843 DOI: 10.3174/ajnr.a5833] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/20/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Case reports demonstrate that coiling of a sigmoid sinus diverticulum can treat pulsatile tinnitus. We hypothesized that MR imaging 4D flow and computational fluid dynamics would reveal distinct blood flow patterns in the venous outflow tract in these patients. MATERIALS AND METHODS Patients with pulsatile tinnitus of suspected venous etiology underwent MR imaging at 3T, using venous phase contrast-enhanced MR angiography, 4D flow, and 2D phase contrast. The contrast-enhanced MRA contours were evaluated to determine the presence and extent of a sigmoid sinus diverticulum. Computational fluid dynamics analysis was performed using the 4D flow inlet flow and the luminal contours from contrast-enhanced MRA as boundary conditions. In addition, computational fluid dynamics was performed for the expected post treatment conditions by smoothing the venous geometry to exclude the sigmoid sinus diverticulum from the anatomic boundary conditions. Streamlines were generated from the 4D flow and computational fluid dynamics velocity maps, and flow patterns were examined for the presence of rotational components. RESULTS Twenty-five patients with pulsatile tinnitus of suspected venous etiology and 10 control subjects were enrolled. Five (20%) of the symptomatic subjects had sigmoid sinus diverticula, all associated with an upstream stenosis. In each of these patients, but none of the controls, a stenosis-related flow jet was directed toward the opening of the sigmoid sinus diverticulum with rotational flow patterns in the sigmoid sinus diverticulum and parent sigmoid sinus on both 4D flow and computational fluid dynamics. CONCLUSIONS Consistent patterns of blood flow can be visualized in a sigmoid sinus diverticulum and the parent sinus using 4D flow and computational fluid dynamics. Strong components of rotational blood flow were seen in subjects with sigmoid sinus diverticula that were absent in controls.
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Affiliation(s)
- M R Amans
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - H Haraldsson
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - E Kao
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - S Kefayati
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - K Meisel
- Neurology (K.M., W.S.), University of California, San Francisco, San Francisco, California
| | - R Khangura
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - J Leach
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - N D Jani
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - F Faraji
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - M Ballweber
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - W Smith
- Neurology (K.M., W.S.), University of California, San Francisco, San Francisco, California
| | - D Saloner
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
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CTA/V detection of bilateral sigmoid sinus dehiscence and suspected idiopathic intracranial hypertension in unilateral pulsatile tinnitus. Neuroradiology 2018; 60:365-372. [PMID: 29417173 DOI: 10.1007/s00234-018-1987-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/22/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE This aimed to evaluate the prevalence and extent of bilateral sigmoid sinus dehiscence (SSD) and to explore the presence of idiopathic intracranial hypertension (IIH) in patients with unilateral pulsatile tinnitus (PT) with CTA/V. METHODS Sixty PT patients (52 females; 40.4 ± 11.6 years [20-72]) who underwent CTA/V and 30 non-PT patients (27 females; 38.4 ± 14.7 years [12-62]) were enrolled in this study. The primary outcome measure was the radiographic presence of SSD. The index of transverse sinus stenosis (ITSS) was obtained by multiplying the stenosis scale values for each transverse sinus, and once was ≥ 4, the presence of IIH was suspected. RESULTS The prevalence and extent of SSD on symptomatic side (78%; maximum transverse diameter, MTD 0.49 ± 0.23; maximum vertical diameter, MVD 0.50 ± 0.26 cm) were significantly higher and larger than those on asymptomatic side (50%, P < 0.001; MTD 0.35 ± 0.18, P = 0.006; MVD 0.30 ± 0.15 cm, P < 0.001) in the study group and those (20%, P < 0.001; MTD 0.36 ± 0.18, P = 0.073; MVD 0.30 ± 0.22 cm, P < 0.048) in the control group. The presence of SSD showed significant correlation with both PT (logistic regression analysis, OR 4.167 [1.450-11.97]; P = 0.008) and suspected IIH (OR 16.25 [1.893-139.5]; P = 0.011). CONCLUSION In PT patients, SSD has a significant correlation with PT and a potential correlation with IIH.
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Management of Sigmoid Sinus Associated Pulsatile Tinnitus: A Systematic Review of the Literature. Otol Neurotol 2017; 38:1390-1396. [DOI: 10.1097/mao.0000000000001612] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Liu Z, Dong C, Wang X, Han X, Zhao P, Lv H, Li Q, Wang Z. Association between idiopathic intracranial hypertension and sigmoid sinus dehiscence/diverticulum with pulsatile tinnitus: a retrospective imaging study. Neuroradiology 2015; 57:747-53. [PMID: 25845808 DOI: 10.1007/s00234-015-1517-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/17/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The mechanism of occurrence of sigmoid sinus dehiscence/diverticulum (SSDD) in pulsatile tinnitus (PT) patients remains under debate. Its association with idiopathic intracranial hypertension (IIH) lacks evidence, which is important for therapeutic planning and improving the clinical outcome. This study aimed to evaluate the association between SSDD and IIH by comparing the prevalence of several established imaging features of IIH between PT patients with SSDD and healthy volunteers. METHODS Thirty-three unilateral PT patients with SSDD identified on CT images and 33 age- and sex-matched healthy volunteers underwent T1-weighted volumetric magnetic resonance imaging (MRI). The optic nerve, pituitary gland, transverse sinus, and ventricles were assessed. The prevalence of established IIH imaging features was compared between the two groups. Furthermore, the PT patients were divided into two subgroups: PT patients with dehiscence only and PT patients with diverticulum. The same statistical analysis was performed on each pathophysiologic entity respectively. RESULTS The PT patients with SSDD showed a significantly higher prevalence of empty sella (P < 0.001), flattened posterior sclera (P = 0.001), vertical tortuosity of the optic nerve (P = 0.001), protrusion of the optic nerve (P = 0.006), transverse sinus stenosis (P = 0.011), and distension of the optic nerve sheath (P = 0.000). There were no significant differences between the PT and control groups in the maximum widths of the third and fourth ventricles and the lateral ventricle size. In contrast to controls, the imaging findings persisted in both of pathophysiologic entities, except for transverse sinus stenosis. CONCLUSIONS Several IIH imaging features occur more frequently in PT patients with SSDD than in healthy individuals, which suggests a potential correlation between SSDD with PT and IIH.
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Affiliation(s)
- Zhaohui Liu
- Department of Radiology, Capital Medical University, Beijing Tongren Hospital, NO.1, Dongjiaominxiang Road, Beijing, 100730, China,
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Liu Z, Li J, Zhao P, Lv H, Dong C, Liu W, Wang Z. Sigmoid plate dehiscence: congenital or acquired condition? Eur J Radiol 2015; 84:862-4. [PMID: 25660638 DOI: 10.1016/j.ejrad.2014.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 12/08/2014] [Accepted: 12/18/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE The imaging features of sigmoid plate dehiscence-induced pulsatile tinnitus have been presented. The origin of the sigmoid plate dehiscence, however, remains unclear. Our aim was to assess the prevalence and extent of sigmoid plate dehiscence on computed tomography (CT) images in multiple age groups to determine whether this condition is more likely to be congenital or acquired. MATERIALS AND METHODS We retrospectively reviewed contrast-enhanced CT images of sigmoid plates of temporal bones in 504 patients. Each temporal bone was characterized as normal or dehiscent. Patients were then subcategorized into four age groups, and the prevalence and extent of dehiscent sigmoid plates in each group were calculated and compared. RESULTS Overall, 80 patients had sigmoid plate dehiscence, nine of whom had it bilaterally. In successively older age groups, the prevalences of sigmoid plate dehiscence were 18.9%, 20.1%, 14.5%, and 12.7%, respectively. Respective average anteroposterior bony defect diameters were 3.7±1.7, 3.0±1.3, 3.1±1.5, and 3.0±1.1 mm. Respective average vertical bony defect diameters were 3.6±2.3, 2.6±1.2, 3.2±1.5, and 3.0±1.7 mm. The prevalence and extent of sigmoid plate dehiscence were not statistically different among the four age groups. CONCLUSIONS The similar radiologic prevalence and extent of dehiscent sigmoid plates among the age groups suggest that the dehiscence is more commonly a congenital than an acquired condition.
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Affiliation(s)
- Zhaohui Liu
- Capital Medical University, Beijing Tongren Hospital, No 1 Dong Jiao Min Street, Dongcheng District, Beijing 100730, China.
| | - Jing Li
- Capital Medical University, Beijing Tongren Hospital, No 1 Dong Jiao Min Street, Dongcheng District, Beijing 100730, China.
| | - Pengfei Zhao
- Capital Medical University, Beijing Friendship Hospital, No 95 Yongan Road, Xicheng District, Beijing 100050, China.
| | - Han Lv
- Capital Medical University, Beijing Friendship Hospital, No 95 Yongan Road, Xicheng District, Beijing 100050, China.
| | - Cheng Dong
- Capital Medical University, Beijing Friendship Hospital, No 95 Yongan Road, Xicheng District, Beijing 100050, China.
| | - Wenjuan Liu
- Jining No. 1 People's Hospital, No. 6 Health Street, Jining 272100, China.
| | - Zhenchang Wang
- Capital Medical University, Beijing Friendship Hospital, No 95 Yongan Road, Xicheng District, Beijing 100050, China.
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Wang GP, Zeng R, Liu ZH, Liang XH, Xian JF, Wang ZC, Gong SS. Clinical characteristics of pulsatile tinnitus caused by sigmoid sinus diverticulum and wall dehiscence: a study of 54 patients. Acta Otolaryngol 2014; 134:7-13. [PMID: 24032538 DOI: 10.3109/00016489.2013.831479] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS CT angiography (CTA) and digital subtraction angiography (DSA) are valuable tools in imaging work-ups for the diagnosis of sigmoid sinus diverticulum (SSD) and sigmoid sinus wall dehiscence (SSWD). The development of pulsatile tinnitus (PT) resulting from SSD and SSWD may be associated with the dominance of venous systems. OBJECTIVE Our goal was to evaluate the clinical characteristics of PT caused by SSD and SSWD. METHODS This was a retrospective chart review undertaken in a tertiary academic referral center. Fifty-four patients with PT due to SSD and SSWD were recruited. Hospital files of these patients were assessed. Data included medical history, physical examinations, auxiliary examinations, and radiographic findings of CTA and DSA. RESULTS The study population comprised 51 females and 3 males. Most patients with PT caused by SSD and SSWD were middle-aged women. All had normal otoscopy results. Anomalies occurred in or adjacent to the region of the transverse-sigmoid sinus junction in 52 patients. Half of the patients (27/54) presented abnormal results of examination of blood lipids. There were 57.41% (31/54) cases with ipsilateral dominance of the venous system, 9.26% (5/54) cases with contralateral dominance, and 33.33% (18/54) cases with co-dominance of the venous system.
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