Objective: Tinnitus-a common clinical symptom-can be categorized into pulsatile tinnitus(PT) and non-PT. Among these, PT is usually associated with sigmoid sinus symptoms, such as sigmoid sinus wall defect or divertic...Objective: Tinnitus-a common clinical symptom-can be categorized into pulsatile tinnitus(PT) and non-PT. Among these, PT is usually associated with sigmoid sinus symptoms, such as sigmoid sinus wall defect or diverticulum, for which various surgical treatments are available. We have discussed the clinical efficacy of surgery for sigmoid sinus-associated PT via the transmastoid approach in this study.Methods: We conducted a retrospective review of 4 patients who underwent surgery for sigmoid sinusassociated PT via the transmastoid approach at Nanjing Drum Tower Hospital from January to December2020. Of these, 2 patients had sigmoid sinus wall defect and 2 had sigmoid sinus diverticulum. Postoperative tinnitus grading and surgical efficacy were determined.Results: After surgery, PT dissolved in 3 patients, while tinnitus significantly decreased in 1 patient.During the follow-up period of 12-18 months, none of the 4 patients showed complications related to increased intracranial pressure or venous sinus thrombosis, and tinnitus symptoms disappeared in 3patients without recurrence, although 1 patient occasionally developed tinnitus. Postoperative thin-slice CTA of the temporal bone indicated that the sigmoid sinus bone wall defect or diverticulum was completely repaired with a thick soft tissue coverage.Conclusion: Surgical repair of sigmoid sinus-associated PT via the transmastoid approach deserves clinical promotion as it exhibited better efficiency while being relatively less invasive.展开更多
BACKGROUND Arteriovenous fistula of the sigmoid sinus is an abnormal connection of arteries with the sigmoid sinus.Endovascular treatments of such lesions are considered safe and with low rates of complications.CASE S...BACKGROUND Arteriovenous fistula of the sigmoid sinus is an abnormal connection of arteries with the sigmoid sinus.Endovascular treatments of such lesions are considered safe and with low rates of complications.CASE SUMMARY A 62-year-old female patient underwent endovascular treatment of an arteriovenous fistula of the right sigmoid sinus on February 7,2017,but her tinnitus was not cured.She was admitted to the Beijing Tiantan Hospital,Capital Medical University,on March 20,2017,and her pre-operative diagnosis,by digital subtraction cerebral angiography,was arteriovenous fistula of the sigmoid sinus.She underwent endovascular embolization of the distal occipital artery and posterior auricular artery using Onyx-18.The arteriovenous fistula of the sigmoid sinus was cured,and her tinnitus disappeared,but ischemia of the upper 2/3 of the right auricle occurred without hearing loss.The patient received treatment to improve microcirculation,in addition to fluid supplementation,analgesia,and hyperbaric oxygen,and the swelling due to ischemia in the right auricle did not progress further.The patient reported no tinnitus,and the right auricle had returned to normal 3 years later.CONCLUSION Ischemic complications of vital organs should be considered when performing embolization procedures for arteriovenous fistulas of cerebral sinuses.Compensation of the organs should be evaluated before the operation,and the related treatment regimens should be planned.展开更多
Background:When utilizing the retrosigmoid approach(RA),accurately identifying the transverse and sigmoid sinus transition(TSST)is a key procedure for neurosurgeons,especially in developing countries restricted by the...Background:When utilizing the retrosigmoid approach(RA),accurately identifying the transverse and sigmoid sinus transition(TSST)is a key procedure for neurosurgeons,especially in developing countries restricted by the lack of expensive devices,such as the neural navigation system and the three-dimensional volumetric image-rendered system.Before operations,a computed tomography scan is a common and cost-effective method of checking patients who suffer lesions located at the cerebellopontine angle.Therefore,we present a technique using only high-resolution computed tomography to identify the transverse and sigmoid sinus transition.Methods:This retrospective study included 35 patients who underwent retrosigmoid approach operations to resect an acoustic neurinoma with the assistance of our technique.In brief,our technique contains 4 steps:(1)All patients’1-mm,consecutive,high-resolution computed tomographic images that clearly displayed landmarks,such as the inion,lambdoid suture,occipitomastoid suture,and the mastoid emissary foramen,were investigated initially.(2)We selected two particular slices(A and B)among all of these high-resolution computed tomographic images in which scanning planes were parallel with the line drawn from the root of the zygoma to the inion(LZI).Slice A contained both the root of the zygoma and the inion simultaneously,and slice B displayed the mastoid emissary foramen.(3)Four points(α,β,γ,δ)were arranged on slices A and B,and pointαwas located at the inner surface of the skull,which represents the posterior part of the sulci of the sigmoid sinus.Pointβwas located at the outer surface of the skull,and the line connecting them was perpendicular to the bone.Similarly,on slice B,we labeled pointγas the point that represents the posterior part of the sulci of the sigmoid sinus at the inner surface and pointδas the point located at the outer surface of the skull,and the line connecting them was also perpendicular to the bone.The distances between pointβand the lambdoid suture/occipitomastoid suture and between pointδand the mastoid emissary foramen were calculated for slices A and B,respectively.(4)During the operation,a line indicating the LZI was drawn on the bone with ink when the superficial soft tissue was pushed away,and this line would cross the lambdoid suture/occipitomastoid suture.With both the crosspoint and the distance obtained from the high-resolution CT images,we could locate pointβ.We also used the same method to locate pointδafter revealing the mastoid emissary foramen.The line connecting pointβand pointδindicated the posterior border of the sigmoid sinus,and the intersection between the line and LZI indicated the inferior knee of the transverse and sigmoid sinus transition(TSST).Results:All 35 patients underwent the RA craniectomies that were safely assisted by our technique,and neither the sigmoid sinus nor the transverse sinus was lacerated during the operations.Conclusion:Our cost-effective technique is reliable and convenient for identifying the transverse and sigmoid sinus transition(TSST)which could be widely performed to guarantee the safety of RA craniectomy.展开更多
Background： During craniotomies using the transpetrosal-presigmoid approach, exposure of the sigmoid sinus remains an essential but hazardous step. In such procedures, accurate localization of the anterosuperior poin...Background： During craniotomies using the transpetrosal-presigmoid approach, exposure of the sigmoid sinus remains an essential but hazardous step. In such procedures, accurate localization of the anterosuperior point of the transverse-sigmoid sinus junction （ASTS） is very important lbr reducing surgical morbidity. This study aimed to create an accurate and practical method for identifying the ASTS. Methods： On the lateral surfaces of 40 adult skulls （ 19 male skulls and 21 female skulls）, a rectangular coordinate system was defined to measure the x and y coordinates of two points： the ASTS and the squamosal-parietomastoid suture junction （SP）. With the coordinate system, the distribution characteristics of the ASTS were statistically analyzed and the differences between the ASTS and SP were investigated. Results： For ASTS-x, significant differences were found in different sides （P =0.020）; the ASTS-x in male skulls was significantly higher on the right side （P =0.017）; there was no significant difference between the sides in female skulls. There were no significant differences in gender or interaction of gender and side for ASTS-x, and for ASTS-y, there were no significant differences in side, gender, or interaction of gender and side. For both sides combined, the mean ASTS-x was significantly higher than the mean SP-x （P = 0.003） and the mean ASTS-y was significantly higher than the mean SP-y （P = 0.011 ）. Conclusions： This reference coordinate system may be an accurate and practical method for identifying the ASTS during presigmoid craniotomy. The SP might be difficult to find during presigmoid craniotomy and, therefore, it is not always a reliable landmark for defining the ASTS.展开更多
Numerous factors may lead to pulsatile tinnitus （PT）, including atherosclerosis, benign intracranial hypertension, glomus tympanicum tumor, dural arteriovenous fistulas （dAVFs）, abnormalities of the sigmoid sinus ...Numerous factors may lead to pulsatile tinnitus （PT）, including atherosclerosis, benign intracranial hypertension, glomus tympanicum tumor, dural arteriovenous fistulas （dAVFs）, abnormalities of the sigmoid sinus （dehiscence and diverticulum）, and jugular bulb anomalies （glomus jugular tumor, diverticulum, high-riding or dehiscent jugular bulb）. However, exact causes often cannot be found in many patients even after a detailed physical examination and extensive auxiliary examinations. Moreover, no effective treatment is available for these patients. Patients with PT associated with multiple factors are seldom reported, and the condition is essentially intractable. Here, we reported three cases with PT involving multiple factors.展开更多
Background:There are some risk factors being more vulnerable to Lemierre's syndrome such as a hypercoagulable state.Methods:We report a rare case of Lemierre's syndrome with ethmoid and maxillary sinusitis,bil...Background:There are some risk factors being more vulnerable to Lemierre's syndrome such as a hypercoagulable state.Methods:We report a rare case of Lemierre's syndrome with ethmoid and maxillary sinusitis,bilateral mastoiditis,and sigmoid sinus thrombosis.Results:Genetic study revealed a double heterozygote status in the methylenetetrahydrofolate reductase gene including C677T and A1298C.Conclusion:It is suggested to screen patients with Lemierre's syndrome for a hypercoagulable state to consider anticoagulant therapy.展开更多
基金This study was supported by the National Natural Science Foundation of China(Nos.81870721)the Major Program of National Natural Science Foundation of China(Nos.82192862).
文摘Objective: Tinnitus-a common clinical symptom-can be categorized into pulsatile tinnitus(PT) and non-PT. Among these, PT is usually associated with sigmoid sinus symptoms, such as sigmoid sinus wall defect or diverticulum, for which various surgical treatments are available. We have discussed the clinical efficacy of surgery for sigmoid sinus-associated PT via the transmastoid approach in this study.Methods: We conducted a retrospective review of 4 patients who underwent surgery for sigmoid sinusassociated PT via the transmastoid approach at Nanjing Drum Tower Hospital from January to December2020. Of these, 2 patients had sigmoid sinus wall defect and 2 had sigmoid sinus diverticulum. Postoperative tinnitus grading and surgical efficacy were determined.Results: After surgery, PT dissolved in 3 patients, while tinnitus significantly decreased in 1 patient.During the follow-up period of 12-18 months, none of the 4 patients showed complications related to increased intracranial pressure or venous sinus thrombosis, and tinnitus symptoms disappeared in 3patients without recurrence, although 1 patient occasionally developed tinnitus. Postoperative thin-slice CTA of the temporal bone indicated that the sigmoid sinus bone wall defect or diverticulum was completely repaired with a thick soft tissue coverage.Conclusion: Surgical repair of sigmoid sinus-associated PT via the transmastoid approach deserves clinical promotion as it exhibited better efficiency while being relatively less invasive.
文摘BACKGROUND Arteriovenous fistula of the sigmoid sinus is an abnormal connection of arteries with the sigmoid sinus.Endovascular treatments of such lesions are considered safe and with low rates of complications.CASE SUMMARY A 62-year-old female patient underwent endovascular treatment of an arteriovenous fistula of the right sigmoid sinus on February 7,2017,but her tinnitus was not cured.She was admitted to the Beijing Tiantan Hospital,Capital Medical University,on March 20,2017,and her pre-operative diagnosis,by digital subtraction cerebral angiography,was arteriovenous fistula of the sigmoid sinus.She underwent endovascular embolization of the distal occipital artery and posterior auricular artery using Onyx-18.The arteriovenous fistula of the sigmoid sinus was cured,and her tinnitus disappeared,but ischemia of the upper 2/3 of the right auricle occurred without hearing loss.The patient received treatment to improve microcirculation,in addition to fluid supplementation,analgesia,and hyperbaric oxygen,and the swelling due to ischemia in the right auricle did not progress further.The patient reported no tinnitus,and the right auricle had returned to normal 3 years later.CONCLUSION Ischemic complications of vital organs should be considered when performing embolization procedures for arteriovenous fistulas of cerebral sinuses.Compensation of the organs should be evaluated before the operation,and the related treatment regimens should be planned.
文摘Background:When utilizing the retrosigmoid approach(RA),accurately identifying the transverse and sigmoid sinus transition(TSST)is a key procedure for neurosurgeons,especially in developing countries restricted by the lack of expensive devices,such as the neural navigation system and the three-dimensional volumetric image-rendered system.Before operations,a computed tomography scan is a common and cost-effective method of checking patients who suffer lesions located at the cerebellopontine angle.Therefore,we present a technique using only high-resolution computed tomography to identify the transverse and sigmoid sinus transition.Methods:This retrospective study included 35 patients who underwent retrosigmoid approach operations to resect an acoustic neurinoma with the assistance of our technique.In brief,our technique contains 4 steps:(1)All patients’1-mm,consecutive,high-resolution computed tomographic images that clearly displayed landmarks,such as the inion,lambdoid suture,occipitomastoid suture,and the mastoid emissary foramen,were investigated initially.(2)We selected two particular slices(A and B)among all of these high-resolution computed tomographic images in which scanning planes were parallel with the line drawn from the root of the zygoma to the inion(LZI).Slice A contained both the root of the zygoma and the inion simultaneously,and slice B displayed the mastoid emissary foramen.(3)Four points(α,β,γ,δ)were arranged on slices A and B,and pointαwas located at the inner surface of the skull,which represents the posterior part of the sulci of the sigmoid sinus.Pointβwas located at the outer surface of the skull,and the line connecting them was perpendicular to the bone.Similarly,on slice B,we labeled pointγas the point that represents the posterior part of the sulci of the sigmoid sinus at the inner surface and pointδas the point located at the outer surface of the skull,and the line connecting them was also perpendicular to the bone.The distances between pointβand the lambdoid suture/occipitomastoid suture and between pointδand the mastoid emissary foramen were calculated for slices A and B,respectively.(4)During the operation,a line indicating the LZI was drawn on the bone with ink when the superficial soft tissue was pushed away,and this line would cross the lambdoid suture/occipitomastoid suture.With both the crosspoint and the distance obtained from the high-resolution CT images,we could locate pointβ.We also used the same method to locate pointδafter revealing the mastoid emissary foramen.The line connecting pointβand pointδindicated the posterior border of the sigmoid sinus,and the intersection between the line and LZI indicated the inferior knee of the transverse and sigmoid sinus transition(TSST).Results:All 35 patients underwent the RA craniectomies that were safely assisted by our technique,and neither the sigmoid sinus nor the transverse sinus was lacerated during the operations.Conclusion:Our cost-effective technique is reliable and convenient for identifying the transverse and sigmoid sinus transition(TSST)which could be widely performed to guarantee the safety of RA craniectomy.
文摘Background： During craniotomies using the transpetrosal-presigmoid approach, exposure of the sigmoid sinus remains an essential but hazardous step. In such procedures, accurate localization of the anterosuperior point of the transverse-sigmoid sinus junction （ASTS） is very important lbr reducing surgical morbidity. This study aimed to create an accurate and practical method for identifying the ASTS. Methods： On the lateral surfaces of 40 adult skulls （ 19 male skulls and 21 female skulls）, a rectangular coordinate system was defined to measure the x and y coordinates of two points： the ASTS and the squamosal-parietomastoid suture junction （SP）. With the coordinate system, the distribution characteristics of the ASTS were statistically analyzed and the differences between the ASTS and SP were investigated. Results： For ASTS-x, significant differences were found in different sides （P =0.020）; the ASTS-x in male skulls was significantly higher on the right side （P =0.017）; there was no significant difference between the sides in female skulls. There were no significant differences in gender or interaction of gender and side for ASTS-x, and for ASTS-y, there were no significant differences in side, gender, or interaction of gender and side. For both sides combined, the mean ASTS-x was significantly higher than the mean SP-x （P = 0.003） and the mean ASTS-y was significantly higher than the mean SP-y （P = 0.011 ）. Conclusions： This reference coordinate system may be an accurate and practical method for identifying the ASTS during presigmoid craniotomy. The SP might be difficult to find during presigmoid craniotomy and, therefore, it is not always a reliable landmark for defining the ASTS.
文摘Numerous factors may lead to pulsatile tinnitus （PT）, including atherosclerosis, benign intracranial hypertension, glomus tympanicum tumor, dural arteriovenous fistulas （dAVFs）, abnormalities of the sigmoid sinus （dehiscence and diverticulum）, and jugular bulb anomalies （glomus jugular tumor, diverticulum, high-riding or dehiscent jugular bulb）. However, exact causes often cannot be found in many patients even after a detailed physical examination and extensive auxiliary examinations. Moreover, no effective treatment is available for these patients. Patients with PT associated with multiple factors are seldom reported, and the condition is essentially intractable. Here, we reported three cases with PT involving multiple factors.
文摘Background:There are some risk factors being more vulnerable to Lemierre's syndrome such as a hypercoagulable state.Methods:We report a rare case of Lemierre's syndrome with ethmoid and maxillary sinusitis,bilateral mastoiditis,and sigmoid sinus thrombosis.Results:Genetic study revealed a double heterozygote status in the methylenetetrahydrofolate reductase gene including C677T and A1298C.Conclusion:It is suggested to screen patients with Lemierre's syndrome for a hypercoagulable state to consider anticoagulant therapy.
