血管源性搏动耳鸣的介入诊断和治疗研究

Diagnosis and Interventional Therapy of Pulsatile Tinnitus Caused by Vascular

目的：回顾性探讨血管源性搏动耳鸣的影像学诊断、发病特点和经血管内介入治疗的可行性和临床效果。方法本组分析了82例动脉和静脉源性搏动耳鸣的DSA不同特征和可能的病理生理机制，对3例颅内动静脉瘘，16例自发性颅底脑膜动静脉瘘，5例外伤性颈动脉海绵窦瘘，2例锁骨下动脉狭窄，3例颈动脉狭窄，1例颅内动脉狭窄，2例椎-基底动脉迂曲延长，2例静脉窦憩室，46例优势引流侧的静脉窦狭窄，2例枕窦狭窄分别经股动脉和股静脉入路，选用螺旋圈、NBCA胶、Balt球囊、自膨式支架和颅内微支架性行栓塞与支架成形处理。结果82例介入手术均获成功，未发生与介入手术相关的并发症，术后搏动性耳鸣在2天内均消失。平均门诊随访5～36月，4例动脉源性耳鸣于介入术后3月复发搏动性耳鸣，经二次栓塞和对症处理后症状缓解；静脉源性搏动性耳鸣病例在支架成形和支架辅助螺旋圈栓塞后均未出现复发征像。结论应用经血管内的诊治方式可能对临床诊断和治疗顽固的搏动性耳鸣提供新的选择途径，有助于为鉴别和研究其他类型的耳鸣提供一定的理论和技术依据。

Objective To retrospective evaluate the imaging diagnosis and disease characteristics of pulsatile tinnitus caused by vascular, and to estimate the feasibility and clinical effect of interventional therapy. Methods The DSA characteris-tic and pathophysiological mechanisms of 82 cases pulsatile tinnitus caused by cerebral artery and venous sinus were ana-lyzed retrospectively. All the patients were treated by interventional therapy via femoral artery and venous with coil、NBCA glue、balt Balloon、self-expandable stent and intracranial micro-stent. The patients included 3 cases intracranial AVF、16 cas-es spontaneous skull base DAVF、5 cases TCCF、2 cases subclavian artery stenosis、3 cases internal carotid artery stenosis ,1 case intracranial artery stenosis、2 case vertebrobasilar artery circuity and extension、2 cases venous sinus diverticulum、46 cases venous sinus stenosis in drainage dominancy side、2 cases occipital sinus stenosis. Result Pulsatile tinnitus disap-peared in two days following the procedure in all 82 cases. There was not procedure related complication. During the 5 to 36 months follow-up, 5 cases pulsatile tinnitus caused by cerebral artery had recurrence 3 months after operation . The pulsatile tinnitus of 5 patients disappeared after secondly embolizaiton. The pulsatile tinnitus caused by venous sinus treated by stent and stent-assisted embolization had not recurrence. Conclusion Endovascular therapy could provide a new way for diagnosis and cure of stubborn pulsatile tinnitus, and endovascular therapy could provide theoretical and technical evidence for diagno-sis and study of other types of tinnitus.