Hydroxyapatite cement resurfacing the dehiscent jugular bulb: Novel treatment for pulsatile tinnitus

DeHart, Austin N.; Shaia, Wayne T.; Coelho, Daniel H.

doi:10.1002/lary.26711

Cited by 26 publications

(29 citation statements)

References 10 publications

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“…Dehiscent bulbs can also be resurfaced using hydroxyapatite cement. 8 Preoperative awareness of HRJB is also important in patients with cochlear implants as well as resection of giant cholesteatomas of the mastoid that require combined surgical approaches. 6,18,45 Miller et al described the usefulness of decompressing and retracting the jugular bulb to improve infralabyrinthine drainage of cholesterol granulomas.…”

Section: Typementioning

confidence: 99%

Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications

Manjila

Bazil

Kay

et al. 2018

Neurosurgical Focus

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OBJECTIVEThere is no definitive or consensus classification system for the jugular bulb position that can be uniformly communicated between a radiologist, neurootologist, and neurosurgeon. A high-riding jugular bulb (HRJB) has been variably defined as a jugular bulb that rises to or above the level of the basal turn of the cochlea, within 2 mm of the internal auditory canal (IAC), or to the level of the superior tympanic annulus. Overall, there is a seeming lack of consensus, especially when MRI and/or CT are used for jugular bulb evaluation without a dedicated imaging study of the venous anatomy such as digital subtraction angiography or CT or MR venography.METHODSA PubMed analysis of “jugular bulb” comprised of 1264 relevant articles were selected and analyzed specifically for an HRJB. A novel classification system based on preliminary skull base imaging using CT is proposed by the authors for conveying the anatomical location of the jugular bulb. This new classification includes the following types: type 1, no bulb; type 2, below the inferior margin of the posterior semicircular canal (SCC), subclassified as type 2a (without dehiscence into the middle ear) or type 2b (with dehiscence into the middle ear); type 3, between the inferior margin of the posterior SCC and the inferior margin of the IAC, subclassified as type 3a (without dehiscence into the middle ear) and type 3b (with dehiscence into the middle ear); type 4, above the inferior margin of the IAC, subclassified as type 4a (without dehiscence into the IAC) and type 4b (with dehiscence into the IAC); and type 5, combination of dehiscences. Appropriate CT and MR images of the skull base were selected to validate the criteria and further demonstrated using 3D reconstruction of DICOM files. The microsurgical significance of the proposed classification is evaluated with reference to specific skull base/posterior fossa pathologies.RESULTSThe authors validated the role of a novel classification of jugular bulb location that can help effective communication between providers treating skull base lesions. Effective utilization of the above grading system can help plan surgical procedures and anticipate complications.CONCLUSIONSThe authors have proposed a novel anatomical/radiological classification system for jugular bulb location with respect to surgical implications. This classification can help surgeons in complication avoidance and management when addressing HRJBs.

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Section: Typementioning

confidence: 99%

Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications

Manjila

Bazil

Kay

et al. 2018

Neurosurgical Focus

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“…In assessing risk of bias, 7 studies were assessed as low risk 5,8,14,24-27 and 13 as high risk 4,6,7,9,10,22,28-34 for selective outcome reporting. For incomplete outcome data, 8 studies were assessed as low risk 6-8,14,24-26,33 and 4 as high risk, 4,5,27,30 and 8 studies could not be assessed because they reported only 1 case 9,10,22,28,29,31,32,34 (Supplemental Table S1, available in the online version of the article).…”

Section: Resultsmentioning

confidence: 99%

“…8,14,15,22,23 We performed initial screening of these 576 records by titles and abstracts, yielding 72 that were assessed by full-text review for eligibility. Among these, 20 studies met inclusion criteria and were included [4][5][6][7][8][9][10]14,22,[24][25][26][27][28][29][30][31][32][33][34] ( Figure 4). Five publications 15,[35][36][37][38] were excluded due to overlapping cohorts with later follow-up studies.…”

Section: Resultsmentioning

confidence: 99%

“…3 Pulsatile tinnitus (PT) has been associated with major vascular wall anomalies in the temporal bone, affecting the sigmoid sinus, jugular bulb, and internal carotid artery (ICA). Specific associated anomalies include sigmoid sinus dehiscence, 4 sigmoid sinus diverticulum, 5 dehiscent high-riding jugular bulb, 6 jugular bulb diverticulum, 7,8 ICA dehiscence, 9 and ICA aberrancy. 10 Unfortunately, PT can considerably reduce quality of life in a subset of patients and be difficult to manage because of the lack of effective medications for reducing PT symptoms.…”

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confidence: 99%

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Systematic Review of Temporal Bone–Resurfacing Techniques for Pulsatile Tinnitus Associated with Vascular Wall Anomalies

Liu

Boursiquot

Blevins

et al. 2019

Otolaryngol.--head neck surg.

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Objective To systematically review literature evidence on temporal bone–resurfacing techniques for pulsatile tinnitus (PT) associated with vascular wall anomalies. Data Sources We searched PubMed, Embase, and the Cochrane Database. The period covered was from 1962 to 2018. Review Methods We included studies in all languages that reported resurfacing outcomes for patients with PT and radiographic evidence or direct visualization of sigmoid sinus wall anomaly, jugular bulb wall anomaly, or dehiscent or aberrant internal carotid artery. Results Of 954 citations retrieved in database searches and 5 citations retrieved from reference lists, 20 studies with a total of 141 resurfacing cases involving 138 patients were included. Resurfacing outcomes for arterial sources of PT showed 3 of 5 cases (60%) with complete resolution and 2 (40%) with partial resolution. Jugular bulb sources of PT showed 11 of 14 cases (79%) with complete resolution and 1 (7%) with partial resolution. Sigmoid sinus sources of PT showed 91 of 121 cases (75%) with complete resolution and 12 (10%) with partial resolution. Symptoms occurred more in females and on the right side. Most cases (94%) used hard-density materials for resurfacing. Material density did not appear to be associated with resurfacing outcomes. Use of autologous materials was associated with improved outcomes for arterial sources resurfacing. Major complications involving sigmoid sinus thrombosis or compression were reported in 4% of cases without long-term morbidity or mortality. Conclusions Resurfacing surgery is likely effective and well tolerated for select patients with PT associated with various vascular wall anomalies.

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“…32 Reconstruction of jugular bulb dehiscence with hydroxyapatite bone cement or bone pate is an emerging surgical option. 33 Sigmoid sinus dehiscence may also be seen in patients with idiopathic intracranial hypertension with or without concomitant stenosis at the transverse-sigmoid sinus junction and the more laterally placed sigmoid sinus. 34 Recently, transmastoid repair for sigmoid sinus dehiscence has been described.…”

Section: Jugular Bulb and Sigmoid Sinus Dehiscence Repairsmentioning

confidence: 99%

Beyond Tympanomastoidectomy: A Review of Less Common Postoperative Temporal Bone CT Findings

Carlson

Diehn²,

Lane³

2020

AJNR Am J Neuroradiol

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Hydroxyapatite cement resurfacing the dehiscent jugular bulb: Novel treatment for pulsatile tinnitus

Abstract: 4. Laryngoscope, 128:1186-1190, 2018.

Cited by 26 publications

References 10 publications

Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications

Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications

Systematic Review of Temporal Bone–Resurfacing Techniques for Pulsatile Tinnitus Associated with Vascular Wall Anomalies

Beyond Tympanomastoidectomy: A Review of Less Common Postoperative Temporal Bone CT Findings

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