Abstract：
The mastoid emissary vein (MEV) describes a transosseous connection between the sigmoid dural venous sinus and the suboccipital venous plexus. In cases of outflow stenosis or malformation, the MEV may become dilated and a source of pulsatile tinnitus (PT) amenable to treatment. We describe a case of PT secondary to MEV treated successfully via endovascular coil embolization and conduct a systematic review of the literature.
We performed a systematic review without meta-analysis of studies involving management of dilated MEV on January 14, 2022, and describe a case of PT secondary to an enlarged MEV treated via coil embolization.
A total of 13 studies were selected for full review. Reports identified MEV presenting as PT in 60% (12 of 20) of cases, intraoperative hemorrhage in mastoid surgery in 15% (3 of 20), a compressive scalp mass in 10% (2 of 20), and thrombophlebitis, facial swelling, or an incidental finding in 5% (1 of 20) each. Forty-five percent (9 of 20) underwent treatment, with all experiencing symptom resolution or improvement. Surgery included transvenous coil embolization in 33.3% (3 of 9), flap reconstruction in 22.2% (2 of 9), and surgical packing, ligation, and thrombectomy in 11.1% (1 of 9) each. Dilated MEV was reported concurrently with impeded drainage pathways in 35% (7 of 20) of reports.
Dilated MEV has been reported as an etiology of pulsatile tinnitus and appears amenable to treatment via open and endovascular means. Endovascular coil embolization appears to offer effective symptom resolution, however, available literature exists only in case reports and small series. Further investigation is highly warranted.
We performed a systematic review without meta-analysis of studies involving management of dilated MEV on January 14, 2022, and describe a case of PT secondary to an enlarged MEV treated via coil embolization.
A total of 13 studies were selected for full review. Reports identified MEV presenting as PT in 60% (12 of 20) of cases, intraoperative hemorrhage in mastoid surgery in 15% (3 of 20), a compressive scalp mass in 10% (2 of 20), and thrombophlebitis, facial swelling, or an incidental finding in 5% (1 of 20) each. Forty-five percent (9 of 20) underwent treatment, with all experiencing symptom resolution or improvement. Surgery included transvenous coil embolization in 33.3% (3 of 9), flap reconstruction in 22.2% (2 of 9), and surgical packing, ligation, and thrombectomy in 11.1% (1 of 9) each. Dilated MEV was reported concurrently with impeded drainage pathways in 35% (7 of 20) of reports.
Dilated MEV has been reported as an etiology of pulsatile tinnitus and appears amenable to treatment via open and endovascular means. Endovascular coil embolization appears to offer effective symptom resolution, however, available literature exists only in case reports and small series. Further investigation is highly warranted.
摘要：
乳突使者静脉（MEV）描述了乙状硬脑膜静脉窦和枕下静脉丛之间的跨骨连接。在流出道狭窄或畸形的情况下，MEV可能会扩张，并且可以治疗搏动性耳鸣（PT）。我们描述了通过血管内线圈栓塞成功治疗的MEV继发PT病例，并对文献进行了系统回顾。
我们在2022年1月14日对涉及扩张MEV管理的研究进行了系统评价，没有进行荟萃分析，并描述了一例通过线圈栓塞治疗的扩大MEV继发PT病例。
总共选择了13项研究进行全面审查。报告确定MEV在60％（20个中的12个）的病例中表现为PT，乳突手术的术中出血占15％（20个中的3个），10%的压缩头皮质量（20个中的2个），和血栓性静脉炎,面部肿胀,或偶然发现5%(20个中的1个)。百分之四十五（20人中有9人）接受了治疗，与所有经历症状解决或改善。手术包括33.3％的经静脉线圈栓塞（9个中的3个），皮瓣重建占22.2%（9个中的2个），和手术包装，结扎,和血栓切除术各占11.1％（9个中的1个）。在35％（20个中的7个）的报告中，同时报告了扩张的MEV和阻塞的引流途径。
已经报道了扩张的MEV作为搏动性耳鸣的病因学,并且似乎可以通过开放和血管内手段进行治疗。血管内线圈栓塞似乎提供有效的症状解决，然而,现有文献仅存在于病例报告和小系列中。进一步的调查是非常必要的。
我们在2022年1月14日对涉及扩张MEV管理的研究进行了系统评价，没有进行荟萃分析，并描述了一例通过线圈栓塞治疗的扩大MEV继发PT病例。
总共选择了13项研究进行全面审查。报告确定MEV在60％（20个中的12个）的病例中表现为PT，乳突手术的术中出血占15％（20个中的3个），10%的压缩头皮质量（20个中的2个），和血栓性静脉炎,面部肿胀,或偶然发现5%(20个中的1个)。百分之四十五（20人中有9人）接受了治疗，与所有经历症状解决或改善。手术包括33.3％的经静脉线圈栓塞（9个中的3个），皮瓣重建占22.2%（9个中的2个），和手术包装，结扎,和血栓切除术各占11.1％（9个中的1个）。在35％（20个中的7个）的报告中，同时报告了扩张的MEV和阻塞的引流途径。
已经报道了扩张的MEV作为搏动性耳鸣的病因学,并且似乎可以通过开放和血管内手段进行治疗。血管内线圈栓塞似乎提供有效的症状解决，然而,现有文献仅存在于病例报告和小系列中。进一步的调查是非常必要的。
