搏动性耳鸣乙状窦骨壁缺损与病程相关性研究

Association between sigmoid sinus with focal dehiscence and the natural history of pulsatile tinnitus

目的探讨乙状窦骨壁缺损(SSD)所致搏动性耳鸣(PT)颞骨影像学特点,以及SSD与病程关系。方法纳入乙状窦骨壁重建术治愈PT患者13例,回顾性分析患侧术前颞骨高分辨率CT(TB-HRCT)影像学表现,明确相关临床病史。在多平面重建图像上观察SSD位置并测量最大长度,是否伴有乙状窦憩室、颈静脉球高位及乳突导静脉畸形,并统计学分析SSD与病程关系。结果 13例研究对象均为女性,平均(34.31±11.56)岁,PT病程4个月~10年,平均(4.44±3.28)年,右侧11例,左侧2例,乙状窦憩室8例。患侧SSD长度平均为(5.32±2.28)mm,均位于横窦-乙状窦交界区前外侧壁。多因素分析SSD主要由病程决定(P=0.007<0.05)。SSD长度与PT病程具有明显相关性(r=0.825,P=0.001<0.05)。观察者间测量SSD长度一致性良好。结论本研究表明SSD可能具有进展性,相关PT病程越长,SSD长度可能越大。通过TB-HRCT可以充分显示SSD位置并准确、可重复测量其长度,对术前指导具有重要意义。

Objective To investigate the temporal bone CT characteristics of pulsatile tinnitus（ PT） because of sigmoid sinus with focal dehiscence（ SSD）,as well as the relationships between SSD and the natural history. Methods 13 cases cured by sigmoid sinus wall reconstruction were recruited,a retrospective analysis of the preoperative temporal bone high resolution CT imaging（ TB-HRCT） and the related clinical history was performed. We determined the position of SSD and measured the maximum length on the multiplanar reconstruction image,and determined whether with sigmoid sinus diverticulum,high jugular ball and mastoid guide venous malformations,and analyzed the relationship between SSD and the course. Results All the cases were female,with a mean age of（ 34. 31 ± 11. 56） years,natural history of（ 4. 44 ± 3. 28） years（ range 4 months ~ 10 years）,11 cases were on the right side,and 2 cases on the left. 8 cases presented with sigmoid sinus diverticulum. SSD located in the anterolateral wall of transverse-sigmoid sinus,average length was（ 5. 32 ± 2. 28） mm. Multiple factor correlation analysis indicated that the length of SSD mainly determined by the history of PT（ P = 0. 007 0. 05）. The length of the SSD was highly associated with natural history of PT（ r = 0. 825,P = 0. 001 0. 05）. SSD was demonstrated a good interobserver agreement. Conclusion SSD may be progressive,the natural history of PT is longer,the length of the SSD is bigger. Via the TB-HRCT,the SSD can be fully displayed that will be meaningful for the preoperative guidance.