Surgical management of pulsatile tinnitus secondary to jugular bulb or sigmoid sinus diverticulum with review of literature

Yeo, Wei Xin; Xu, Shuaishuai; Tan, Tiong Yong; Low, Yin Mei; Yuen, Heng-Wai

doi:10.1016/j.amjoto.2017.12.019

Cited by 22 publications

(22 citation statements)

References 29 publications

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“…9 Endovascular anatomy of the jugular bulb and its tributaries plays an important role in the clinicoradiological outcome of staged treatment of these lesions. 47 HRJB is not per se a contraindication for middle-ear surgery, however, there are reports of inadvertent intraoperative injuries and being aware preoperatively may minimize this risk. 32 The surgeon should be mindful of an HRJB when it is identified preoperatively, as these patients are at greater risk for complications during middle-ear surgery than patients with normal anatomy.…”

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 Hypotympanic resurfacing approaches were used ( Figure 2 ), except in 1 study that used a transmastoid approach to obliterate and resurface jugular bulb diverticulum. 7…”

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.…”

mentioning

confidence: 99%

“…Recent resurfacing techniques 5,15 have demonstrated promise in alleviating PT associated with 3 groups of vascular wall anomalies: sigmoid sinus wall anomalies (SSWAs), including sigmoid sinus dehiscence and sigmoid sinus diverticulum 4 ; jugular bulb wall anomalies, including jugular bulb dehiscence and diverticulum 6,7 ; and ICA dehiscence 9 and aberrancy. 10 The reported successes of applying similar resurfacing techniques to treat all 3 vascular causes of PT is remarkable given the potentially different mechanisms by which each vascular wall anomaly may cause PT.…”

mentioning

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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CT evaluation of unilateral pulsatile tinnitus with jugular bulb wall dehiscence

et al. 2023

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Surgical management of pulsatile tinnitus secondary to jugular bulb or sigmoid sinus diverticulum with review of literature

Cited by 22 publications

References 29 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

CT evaluation of unilateral pulsatile tinnitus with jugular bulb wall dehiscence

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