基于影像学评估的乙状窦骨壁缺损相关搏动性耳鸣患者手术疗效分析

Imaging evaluation and surgical efficacy analysis of patients with venous pulsating tinnitus receiving sigmoid sinus dehiscence resurfacing

目的基于乙状窦骨壁重建术前、术后影像学改变及疗效分析,探讨乙状窦骨壁缺损相关搏动性耳鸣作用机制。方法选取我院乙状窦骨壁重建术治疗的搏动性耳鸣(PT)患者17例,回顾性分析患者术前、术后患侧颞骨高分辨率CT表现,明确相关临床病史,对比术前、术后颞骨CT的影像学改变,分析手术治疗效果相关影像学特征差异。结果手术治疗17例患者均为女性,平均年龄(42.9±9.9)岁,病程平均(1.94±1.93)年,右侧11例(64.71%)。手术治愈11例(64.71%),症状缓解3例(17.65%),治疗无效3例(17.65%)。所有患者缺损骨壁均得到修复,术后与术前相比耳鸣程度减低差异具有统计学意义(P<0.05)。耳鸣治愈及缓解患者乳突蜂房均存在大幅度的含气程度降低,而手术治疗无效患者的乳突蜂房含气状态与术前相比无明显改变。结论乙状窦骨壁重建术的疗效可能与术后乳突蜂房的含气状态改变密切相关。

Objective To investigate the mechanism of pulsatile tinnitus(PT)associated with bone wall defect of sigmoid sinus based on the computed tomography(CT)images of patients receiving sigmoid sinus dehiscence resurfacing surgery.MethodsSeventeen patients with PT who underwent sigmoid sinus dehiscence resurfacing were included in this study.The imaging findings of high-resolution temporal CT before and after the operation were retrospectively compared and analyzed while clarifying the relevant clinical history.Results The included patients were all female,with an average age of 42.94±9.93 and disease duration of 1.94±1.93 years.11 cases(64.71%)were on the right side.Postoperative tinnitus was cured in 11 cases(64.71%),markedly effective in 3 cases(17.65%)and ineffective in 3 cases(17.65%),among which 1 case of tinnitus type changed.The bone wall defects of all patients were repaired.The tinnitus level decreased significantly after operation compared with that before operation(P<0.05).The air content in the mastoid was substantially reduced in the relieved patients after surgery,while no significant change was observed in the ineffective patients after surgery.Conclusion The effect of sigmoid sinus dehiscence resurfacing may be closely related to the air filling status of mastoid.