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Published on: May 23, 2021
Temporal Bone Remodeling After Transverse Sinus Stenting for Pulsatile Tinnitus: Patterns, Temporal Evolution and
Wen Qi1, Jinyuan Liu1, Shengmei Ma1
1From the Department of Radiology (W.Q., J.L., S.M., X.H., X.W., X.Q., Z.W., P.Z.), Precision and Intelligence Medical Imaging Lab (X.Q., Z.W., P.Z.), Interventional Radiology (L.J., Z.Z.), Otorhinolaryngology Head and Neck Surgery (G.W.), Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China and Beijing Key Laboratory of Innovation and Transformation of Specialized CT/MR Imaging Equipment (X.Q., Z.W., P.Z.), Capital Medical University, Beijing, China.
Background And Purpose:
Stent placement effectively relieves venous pulsatile tinnitus caused by transverse sinus stenosis with sigmoid sinus wall dehiscence. However, the spectrum of temporal bone remodeling remains poorly characterized.
Materials And Methods:
This retrospective cohort study included consecutive patients who underwent transverse sinus stenting for venous pulsatile tinnitus with ipsilateral sigmoid sinus wall dehiscence, with or without a diverticulum. Clinical outcomes were recorded. Preoperative and postoperative CT were obtained (median follow-up 7 months; 18 patients had serial scans). Bone regeneration (graded as complete, major >50%, minor <50%, or absent) and new dehiscence were evaluated bilaterally.
Results:
Ipsilateral bone regeneration occurred in 47/50 patients (94.0%): complete in 20.0%, major in 46.0%, minor in 28.0%, and absent in 6.0%. Contralateral bone regeneration was observed in 16/17 patients (94.1%). Among 18 patients with serial postoperative scans, 13 (72.2%) showed progressive regeneration. Follow-up duration correlated positively with regeneration degree (r = 0.51, P < 0.001). New bone dehiscence on the symptomatic side developed in 7 patients (14.0%): 3 adjacent to original sigmoid sinus wall dehiscence, 4 at jugular bulb. Complete resolution was achieved in 9/10 of complete regeneration (90.0%), 22/37 of partial regeneration (59.5%). Recurrence was observed in 5 of 37 patients (13.5%) with partial regeneration; notably, 3 of these 5 recurrences occurred among the 4 patients who had new jugular bulb dehiscence.
Conclusions:
Bone remodeling after stenting for venous pulsatile tinnitus is a dynamic, time-dependent process encompassing bilateral temporal bone regeneration and ipsilateral new dehiscence formation and correlates with clinical outcomes.
