CT venography correlate of transverse sinus stenosis and venous transstenotic pressure gradient in unilateral pulsatile tinnitus patients with sigmoid sinus wall anomalies

Zhao, Peng; Ding, Heyu; Lv, Han; Li, Xiaoshuai; Qiu, Xiaoyu; Zeng, Rong; Wang, Guo‐Peng; Wei, Jian; Jin, Long; Yang, Zhenghan; Gong, Shusheng; Wang, Zhenchang

doi:10.1007/s00330-020-07415-2

Cited by 21 publications

(17 citation statements)

References 21 publications

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“…Dinkin et al 18 proposed that fixed intraluminal structures that alter venous flow dynamics, such as fenestration and embryological remnant, may have an important impact on clinical courses. In the study by Zhao et al, 19 the length of ipsilesional TSS and alternative pathways were correlated with the CVPG. Considering these factors may be useful to improve the multivariate linear regression models.…”

Section: Discussionmentioning

confidence: 99%

Correlation Between Trans-Stenotic Blood Flow Velocity Differences and the Cerebral Venous Pressure Gradient in Transverse Sinus Stenosis: A Prospective 4-Dimensional Flow Magnetic Resonance Imaging Study

Ding

Zhao

et al. 2021

Neurosurg.

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BACKGROUND The relationship between trans-stenotic blood flow velocity differences and the cerebral venous pressure gradient (CVPG) in transverse sinus (TS) stenosis (TSS) has not been studied. OBJECTIVE To evaluate the hemodynamic manifestations of TSS and the relationship between trans-stenotic blood flow velocity differences and the CVPG. METHODS Thirty-three patients with idiopathic intracranial hypertension (IIH) or pulsatile tinnitus (PT) and TSS who had undergone diagnostic venography using venous manometry were included in the patient group. Thirty-three volunteers with no stenosis and symptoms were included in the control group. All the 2 groups underwent prospective venous sinus 4-dimensional (4D) flow magnetic resonance imaging (MRI). The average velocity (Vavg) difference and maximum velocity (Vmax) difference between downstream and upstream of the TS in 2 groups were measured and compared. Correlations between the CVPG and trans-stenotic Vavg difference/Vmax difference/index of transverse sinus stenosis (ITSS) were assessed in the patient group. RESULTS The differences in Vavg difference and Vmax difference between the patient and control groups showed a statistical significance (P < .001). The Vavg difference and Vmax difference had a strong correlation with CVPG (R = 0.675 and 0.701, respectively, P < .001) in the patient group. Multivariate linear regression using the stepwise method showed that the Vmax difference and ITSS were correlated with the CVPG (R = 0.752 and R2 = 0.537, respectively; P < .001). CONCLUSION The trans-stenotic blood flow velocity difference significantly correlates with the CVPG in TSS. As a noninvasive imaging modality, 4D flow MRI may be a suitable screening or complimentary tool to decide which TSS may benefit from invasive venous manometry.

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Section: Discussionmentioning

confidence: 99%

Correlation Between Trans-Stenotic Blood Flow Velocity Differences and the Cerebral Venous Pressure Gradient in Transverse Sinus Stenosis: A Prospective 4-Dimensional Flow Magnetic Resonance Imaging Study

Ding

Zhao

et al. 2021

Neurosurg.

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“…Its frequency is synchronized with the heartbeat, and it disappears when the blood vessels on the affected side are pressed. The pathological factors of PT can be classified as venous, arterial, or undetermined 1 . Patients with PT account for approximately 4% of all tinnitus patients, of which venous PT is approximately 40% 2 .…”

Section: Introductionmentioning

confidence: 99%

Multiphysics coupling numerical simulation of flow‐diverting stents in the treatment of patients with pulsatile tinnitus

Liu

Sun

et al. 2021

Numer Methods Biomed Eng

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Patients with pulsatile tinnitus (PT) have unstable treatment effects after resurfacing surgery. Flow‐diverting stents (FDS) are proposed as a potential method for the treatment of PT, but the therapeutic effect is not clear. This study aimed to investigate the efficacy of FDS in the treatment of patients with PT induced by sigmoid sinus diverticulum (SSD) and sigmoid sinus wall dehiscence (SSWD). In addition, we aimed to explore the treatment mechanism of PT. Transient‐state multiphysics coupling numerical simulation method based on computed tomography angiography of five patients was used to clarify the biomechanical and acoustic states before and after FDS placement. FDS was placed to prevent the blood flow from impacting the vessel wall in the SSD and SSWD areas. Low blood flow velocity (<0.0391 m/s), high relative residence time (>10 Pa−1), and low wall shear stress of SSD might lead to thrombosis after FDS placement. The average pressure on the SSWD area of each patient decreased by 13.77%, 18.82%, 29.23%, 19.03%, and 11.20%. The average displacement of the vessel wall on the SSWD area showed acute pulsation and decreased by 15.29%, 14.64%, 30.22%, 41.03%, and 21.28%. The average sound pressure level at the tympanum decreased by 14.01%, 9.33%, 17.66%, 18.88%, and 25.18%, respectively. In brief, FDS was placed to avoid blood flow impacting vessels and reduce the vibration of vessels in the short term, thereby attenuating the degree of PT. The long‐term prognosis was that the SSWD area was blocked after SSD thrombosis. Therefore, FDS might be an effective method for the treatment of PT induced by SSD and SSWD. This study would provide a theoretical basis for the treatment of PT and an exploration of FDS design in the treatment of PT.

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“…TSS is another prominent cause of turbulent flow that is often treated with stenting, and has a direct correlation with IIH and SSWAs (9,(11)(12)(13). While we did not pursue invasive diagnostic testing following the first seven patients, our cohort underwent adequate imaging to rule out TSS.…”

Section: Figmentioning

confidence: 99%

Transtemporal Sigmoid Sinus Decompression: A Novel Surgical Procedure for the Treatment of Idiopathic Pulsatile Tinnitus

Slater¹,

Duhon²,

Feldman³

2022

Otology &Amp; Neurotology

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Objective: Idiopathic pulsatile tinnitus (IPT) is associated with high patient morbidity although treatment methods remain unsatisfactory. In the present study, the transtemporal sigmoid sinus decompression is used in the treatment of idiopathic pulsatile tinnitus. Study Design: Retrospective case study. Setting: Tertiary referral center. Patients: From 2005 to 2020, 287 patients presented with a complaint of pulsatile tinnitus. After exclusion criteria, 25 patients were diagnosed with IPT. Those patients underwent treatment and were included in a retrospective study. Interventions: Following failed conservative therapies, the primary author performed a transtemporal sigmoid sinus decompression surgery on the patients under general anesthesia. Main Outcome Measures: Long-term resolution of IPT was measured using the Tinnitus Handicap Inventory (THI). Outcome measurements were taken preoperatively, immediately postoperatively, three months postoperatively, and the status of all 25 patients is known at the time of this study. Results: Transtemporal sigmoid sinus decompression was performed on 25 patients (mean age: 51.7 years, 80.0% female). Out of the 25 patients, 23 (92.0%) patients experienced complete resolution of their IPT. Statistically significant differences based on preoperative THI (mean THI: 4.19) were evident immediately after surgery (mean THI: 1.31; p < 0.001), at 3 months postoperatively (mean THI: 1.19; p < 0.001), and over a mean follow-up time of 68.7 months (range, 3 -168 months) (mean THI: 1.38; p < 0.001). Out of the two patients considered unsuccessful, Case 21 experienced a partial resolution. No major postoperative complications occurred. Conclusions: Transtemporal sigmoid sinus decompression is a safe and effective surgical procedure demonstrated to give near total resolution in properly selected patients and provides longterm relief for patients with IPT.

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CT venography correlate of transverse sinus stenosis and venous transstenotic pressure gradient in unilateral pulsatile tinnitus patients with sigmoid sinus wall anomalies

Cited by 21 publications

References 21 publications

Correlation Between Trans-Stenotic Blood Flow Velocity Differences and the Cerebral Venous Pressure Gradient in Transverse Sinus Stenosis: A Prospective 4-Dimensional Flow Magnetic Resonance Imaging Study

Correlation Between Trans-Stenotic Blood Flow Velocity Differences and the Cerebral Venous Pressure Gradient in Transverse Sinus Stenosis: A Prospective 4-Dimensional Flow Magnetic Resonance Imaging Study

Multiphysics coupling numerical simulation of flow‐diverting stents in the treatment of patients with pulsatile tinnitus

Transtemporal Sigmoid Sinus Decompression: A Novel Surgical Procedure for the Treatment of Idiopathic Pulsatile Tinnitus

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