乙状窦缩窄术治疗乙状窦相关静脉源性搏动性耳鸣的疗效分析

Effect of sigmoid sinus plasty in sigmoid sinus original pulsatile tinnitus

目的探讨乙状窦缩窄术对乙状窦相关静脉源性搏动性耳鸣的治疗效果。方法回顾性分析12例乙状窦相关静脉源性搏动性耳鸣患者的临床资料，比较手术前后耳鸣严重程度和磁共振静脉造影成像上的改变，初步评价乙状窦缩窄术对搏动性耳鸣的治疗效果。结果12例患者中女11例，男1例，年龄21～61岁；左侧1例，右侧11例。颞骨高分辨率CT检查，12例均有乙状窦外突，3例同时出现乙状窦憩室。10例行磁共振血管造影检查，9例术前显示右侧颈内静脉与静脉窦优势引流，1例为左侧颈内静脉与静脉窦优势引流，患侧乙状窦的横截面积是健侧的2～3倍。12例患者均在局部麻醉下行乳突探查＋乙状窦缩窄术。术前耳鸣严重程度评估V级3例，Ⅳ级7例，Ⅲ级2例；术后3个月复查，I级11例，Ⅱ级1例。术后4—40个月随访耳鸣的治疗效果，11例有效，1例无效。治疗有效的患者术后磁共振静脉造影乙状窦缩窄程度在46％一83％之间。结论乙状窦缩窄术对静脉源性搏动性耳鸣是一种可以尝试的有效治疗手段。

Objective To discuss the diagnosis and management of venous original pulsatile tinnitus associated with sigmoid sinus. Methods A retrospective study was conducted on 12 patients who were diagnosed with venous original pulsatile tinnitus associated with sigmoid sinus, and treated with sigmoid sinus constriction surgery. The diagnostic evidences for venous original pulsatile tinnitus associated with sigmoid sinus were re-evaluated, the pulsatile tinnitus improvements and MRV study results before and after surgeries associated with sigrnoid sinus were compared. Results Eleven patients got relief of tinnitus within three months after the surgeries, while one patient had no relief. There were ten patients underwent MRV study, the cross-sectional area of the sigmoid sinus in the healthy side was about two times in the tinnitus side. Constriction sigmoid sinus was performed on the twelve patients. The cross-sectional area of the sigmoid sinus of relieved tinnitus patients were compressed by forty-six percent to eighty-three percent. None of the cases complained of any serious complications. Conclusions Sigmoid sinus constriction is an available therapy for pulsatile tinnitus at present. More cases and longer follow-up are necessary to evaluate its treatment effect accurately.