目的:强调治疗憩室裂开在解决乙状窦壁异常(SSWAs)患者搏动性耳鸣(PT)中的手术重要性,并探讨解剖学差异。
方法:回顾性数据分析。
方法:多机构大学医学中心。
方法:50名参与者(裂开/憩室,29:21例)与SSWA相关的PT被纳入研究。所有21名憩室参与者均接受了手术干预。
方法:1)采用术中麦克风监测的新技术进行手术干预。2)放射和眼科成像方法。
方法:术前和术后PT的定量和定性改变以及裂开和憩室之间的解剖差异。
结果:解决憩室和乙状窦壁裂开的问题显着降低了视觉模拟评分和耳鸣障碍量表(p<0.01)。窦壁重建导致在20至1000Hz和20至500Hz的频率范围内PT声强大幅降低(配对样本t检验,p<0.01)。二倍体静脉分析显示,与裂开队列相比,憩室队列的85.7%呈显着正相关(p<0.01)。百分之八的参与者表现出乳头水肿,仅限于开裂队列。
结论:1)通过解决所有裂隙,可以有效降低PT,包括那些覆盖憩室的,不需要排除憩室。2)二倍体静脉可能参与憩室的形成,在SSWA位置观察到硬脑膜和血管壁厚度的损失。
OBJECTIVE: To emphasize the surgical importance of addressing dehiscence over diverticulum in resolving pulsatile tinnitus (PT) in patients with sigmoid sinus wall anomalies (SSWAs) and investigate anatomical differences.
METHODS: Retrospective data analysis.
METHODS: Multi-institutional tertiary university medical centers.
METHODS: Fifty participants (dehiscence/diverticulum, 29:21 cases) with SSWA-associated PT were included in the study. All 21 diverticulum participants underwent surgical intervention.
METHODS: 1) Surgical intervention with novel techniques monitored by intraoperative microphone. 2) Radiologic and ophthalmologic imaging methods.
METHODS: Quantitative and qualitative preoperative and postoperative alterations of PT and anatomical differences between dehiscence and diverticulum.
RESULTS: Addressing dehiscence overlying diverticulum and sigmoid sinus wall dehiscences significantly reduced visual analog score and Tinnitus Handicap Inventory ( p < 0.01). Sinus wall reconstruction led to substantial PT sound intensity reduction in the frequency range of 20 to 1000 Hz and 20 to 500 Hz (paired-sample t test, p < 0.01). Diploic vein analysis showed a significant positive correlation in 85.7% of the diverticulum cohort compared with the dehiscence cohort ( p < 0.01). Eight percent of the participants exhibited papilledema, which was limited to the dehiscence cohort.
CONCLUSIONS: 1) Effective reduction of PT can be achieved by addressing all dehiscences, including those overlying the diverticulum, without the need to exclude the diverticulum. 2) Diploic vein may involve in the formation of diverticulum, and loss of dura mater and vascular wall thickness are observed at the SSWA locations.