血管源性搏动耳鸣的介入诊断和治疗研究

目的回顾性探讨血管源性搏动耳鸣的影像学诊断、发病特点和经血管内介入治疗的可行性和临床效果。方法本组分析了82例动脉和静脉源性搏动耳鸣的DSA不同特征和可能的病理生理机制,对3例颅内动静脉瘘,16例自发性颅底脑膜动静脉瘘,5例外伤性颈动脉海绵窦瘘,2例锁骨下动脉狭窄,3例颈动脉狭窄,1例颅内动脉狭窄,2例椎-基底动脉迂曲延长,2例静脉窦憩室,46例优势引流侧的静脉窦狭窄,2例枕窦狭窄分别经股动脉和股静脉入路,选用螺旋圈、NBCA胶、Balt球囊、自膨式支架和颅内微支架性行栓塞与支架成形处理。结果 82例介入手术均获成功,未发生与介入手术相关的并发症,术后搏动性耳鸣在2天内均消失。平均门诊随访5³6月,4例动脉源性耳鸣于介入术后3月复发搏动性耳鸣,经二次栓塞和对症处理后症状缓解;静脉源性搏动性耳鸣病例在支架成形和支架辅助螺旋圈栓塞后均未出现复发征像。结论应用经血管内的诊治方式可能对临床诊断和治疗顽固的搏动性耳鸣提供新的选择途径,有助于为鉴别和研究其他类型的耳鸣提供一定的理论和技术依据。     

搏动性耳鸣:采用枕动脉结扎治疗动静脉瘘

报道3例,复习11例搏动性耳鸣的诊断及治疗经验。本文3例为老年患者,经颈动脉造影证实,表现为枕动脉扩张、侧窦静脉扩张、由枕动脉供应的大动静脉畸形、侧窦静脉充盈与枕动脉呈动静脉交通等。3例经手术结扎枕动脉后耳鸣消失。血管畸形致搏动性耳鸣,病变常累及枕动脉,形成之动静脉瘘多为先天性,可在50～70岁出现症状。检查时于患侧乳突部可闻杂音,     

颈静脉球憩室

颈静脉球腔有较大变化,通常有75%的病人右侧颈静脉球较左侧大。如二侧的体积差超过2cm认为不正常,标为颈静脉球憩室。憩室分为二型:①位于鼓室腔的外侧憩室。这类憩室常伴有搏动性耳鸣及传导性耳聋,另外,还会出现蓝鼓室。②位于颞骨岩部接近内耳的内侧憩室。这类憩室常侵犯内耳和/或内听道,症状有耳鸣、感音性聋、眩晕及耳痛等。作者报道了4例颈静脉球憩室(1例内侧憩室及3例外侧憩室)。认为外侧憩室可造成下鼓室底壁缺损或下鼓室底壁虽完整,但位置较高占据了圆窗,由于血管的搏动影响听骨链振动或阻塞圆窗而导致传导性耳聋及搏动性耳鸣,而内侧     

颈静脉孔区静脉窦开口的解剖学研究

目的探讨颈静脉孔区静脉窦开口的特点及与神经的毗邻关系。方法统计分析30例颅骨标本中颈静脉球及近颈静脉球的乙状窦、颈内静脉内静脉窦开口的位置、数量、最长径及其与颅神经的关系。结果全部标本均可观察到岩下窦开口,60%(18/30)为多个开口,90%(27/30)有一较大开口位于颈静脉球前内侧壁,且与第IX、X、XI颅神经关系密切。60%(18/30)标本中可见后髁导静脉的开口,94.4%(17/18)为单个开口,常位于颈静脉球底壁或静脉球与乙状窦交界处。颈静脉球内侧壁可见数量不等的边缘窦、枕窦及岩骨穿支静脉的开口。结论颈静脉球及近颈静脉球的乙状窦、颈内静脉内存在多个静脉窦的开口,行此区手术时应充分止血并仔细检查各个开口,避免肿瘤残留,处理前内侧岩下窦开口时应轻柔操作,避免损伤后组颅神经(IX、X、XI)。     

颈静脉孔的显微外科解剖研究

目的研究颈静脉孔的硬脑膜结构和孔内神经、血管结构的行程及形态特征。方法显微镜下模拟枕下极外侧入路、颈-乳突入路和Fisch颞下窝入路的手术操作，研究10例福尔马林及乳胶灌注头颈标本颈静脉孔的显微解剖特征。结果在颈静脉孔的颅内开口，舌咽神经与迷走、副神经间被纤维或骨性结构隔开。在颈静脉孔内，脑神经行于颈静脉球上方的内侧，舌咽神经位于最前方，所有神经束均可用显微外科技术分开，副神经的脑根同脊髓根一起进入颈静脉孔后又加入迷走神经。颈静脉球及临近颈内静脉接受来自乙状窦、岩下窦、椎静脉丛、舌下神经管静脉丛、髁导静脉及岩斜下静脉的静脉回流。结论颈静脉孔的颅内开口可分为岩部、颈内部(或神经部)和乙状窦部．颈静脉孔内脑神经的不同神经纤维束在整个行程中彼此独立，副神经仅由脊髓根构成。     

静脉源性搏动性耳鸣

耳鸣可分为搏动性耳鸣(pulsatile tinnitus,PT)和非搏动性耳鸣(non-pulsatile tinnitus,NPT),以非搏动性耳鸣为多见,搏动性耳鸣只占其中的一小部分[1]。搏动性耳鸣多由血管因素导致[2],主要是由于血管狭窄或不规则导致的血流紊乱引起,根据血管来源可分为动脉源性搏动性耳鸣和静脉源性搏动性耳鸣[3]。动脉源性致病因素包括动脉粥样硬化导致的血管狭窄和动脉瘤、颅底及颞骨血管性肿瘤、硬脑膜动静脉畸形、硬脑膜动静脉瘘、颅内及颅外动脉瘤、心输出     

12例颈静脉源性耳鸣诊治分析

目的:探讨颈静脉源性耳鸣的诊断及治疗。方法:回顾性分析12例诊断为颈静脉源性耳鸣患者的临床表现、诊断依据及治疗方案,对接受颈内静脉结扎术后患者的近期和远期临床效果进行评价,并对相关文献作一综述。结果:术后1周内,7例诉耳鸣明显减轻或消失,5例无明显改善。远期随访到5例近期明显减轻的患者,其中3例耳鸣无改善,2例耳鸣明显减轻(2/7);远期随访到2例近期耳鸣无明显改善者,其中1例耳鸣无改善,另1例加重,发展为啸鸣音。远期随访时间为术后1～5年。随访到的7例均无明显并发症。结论:颈静脉源性脉动性耳鸣为一排除性诊断,并无金标准,单纯依据脉动性耳鸣病史,按压颈内静脉耳鸣明显减轻或消失,以及耳部CT和颅脑MRI排除相关占位性病变并不足以诊断,联合CT动脉及静脉检查有助于排除硬脑膜动静脉瘘、乙状窦憩室等病变。通过颈内静脉结扎术治疗颈静脉源性耳鸣仍存争议。     

后颅底外科手术相关的解剖研究

随着侧进路颅底手术和颈静脉孔手术的开展，熟悉该部位的解剖结构已显得十分重要，以往教科书中所描述的远不能满足当今手术的需要。该作者对40个经福尔马林处理的及5个新鲜的，包括颞骨、中、下斜坡及颈上部神经、血管在内的颅底标本经侧进路进行解剖，测量颈静脉球与周围结构──后半规管壶腹、面神经、乙状窦之间的距离范围，观察和记录岩下窦向颈静脉球或／和颈内静脉的回流径路，岩下窦与第Ⅸ～Ⅺ颅神经间几种不同的解剖位置关系，舌下神经管的走向及管内静脉丛的引流途径，及与Ⅹ、Ⅺ颅神经的关系等。颈静脉孔一般被骨或纤维组织或结…     

经乳突径路乙状窦骨壁加固术治疗搏动性耳鸣的研究

目的探讨分析乙状窦骨壁菲薄所致搏动性耳鸣的手术方法及疗效。方法 2017年6月-2018年10月我科诊断为乙状窦骨壁菲薄导致的搏动性耳鸣患者13例,所有患者采用耳后乳突径路行乙状窦骨壁加固术,术中磨除乙状窦周围气房,充分显露乙状窦骨壁后用骨蜡加固乙状窦壁。对其临床资料和短期手术疗效进行回顾性总结和分析。结果 13例患者均为女性,单耳发病,左耳3例,右耳10例,术前颞骨CT检查及术中发现证实乙状窦骨壁存在局灶性菲薄。11例患者术后第一天搏动性耳鸣即完全消失,2例患者术后第二天开始改善,术后第六天诉耳鸣完全消失。随访2-18月,13例患者搏动性耳鸣无复发,无其他并发症。结论本文短期疗效观察表明,乙状窦骨壁局灶性菲薄是部分搏动性耳鸣患者的致病原因;用骨蜡行乳突径路乙状窦骨壁加固术是治疗这类搏动性耳鸣的简单易行、疗效可靠的方法。     

单侧颈静脉轰鸣1例报告

颈静脉轰鸣（cervical venous hum）是由于颈内静脉血流异常而引起的持续低调的搏动性耳鸣，患者和检查者均可听及，严重时可影响睡眠，甚至导致听力丧失，压迫颈内静脉及头转向同侧时耳呜可减弱或消失，头转向对侧时耳鸣增强，是血管性耳呜的一种。近年来逐渐被重视，但有关其治疗国内文献少有报道。现将我科收治的1例报道如下。     

Sinus Surgery: Does Mitomycin C Reduce Stenosis?

This experimental study investigates the effect of mitomycin C (MMC) on sinus mucosal healing. MMC has an antiproliferative action on fibroblasts. It is used in glaucoma surgery to prevent restenosis of fistulas. Antrostomies were drilled in rabbit maxillary sinuses. One side was used as a control and the other treated with MMC at a concentration of 0.04, 0.4, or 1 mg/mL. Two animals from each group were sacrificed at 1, 2, 4, and 12 weeks. The antrostomies in the control and 0.04-mg/mL groups had closed by 1 week; in the 0.4-mg/mL group by 4 weeks, and in the 1.0-mg/mL group by 12 weeks. Ciliary function was initially impaired but normalized within 1 week. Both light and scanning electron microscopy showed no permanent damage to the cilia. These results suggest that MMC can be used to delay closure of antrostomies in sinus surgery.     

Endoscopic Sinus Surgery for Inflammatory Maxillary Sinus Disease

Objective/Hypothesis The role of endoscopic sinus surgery for treating chronic maxillary sinusitis is well established. The purpose of the study is to determine the efficacy of endoscopic sinus surgery in the treatment of maxillary sinus inflammatory disease that includes mucoceles, retention cysts, and antrochoanal polyps. Study Design This is a retrospective review of 32 consecutive patients who underwent endoscopic sinus surgery for mucoceles (n = 21), retention cysts (n = 5), or antrochoanal polyps (n = 6). Methods The medical records were reviewed for patient demographics, presenting symptoms, and type of operation. Surgical outcome was determined by resolution of symptoms, recurrence of disease, and need for revision or additional surgery. Results Ethmoidectomy with middle meatal antrostomy was performed in all patients; 28 patients had additional middle turbinectomy. Postoperative follow‐up ranged from 6 months to 4 years. The operation resulted in resolution of symptoms and a patent antrostomy on long‐term follow‐up in all cases of mucoceles. No case required revision surgery. On the other hand, the disease recurred in three patients (60%) with retention cysts and three patients (50%) with antrochoanal polyps despite patent antrostomies. The recurrences occurred 3 to 6 months after the surgery. The recurrent cases of antrochoanal polyps required Caldwell Luc procedures. The three failures in cases of retention cysts were successfully managed with repeated office endoscopic marsupialization through a patent antrostomy. Conclusions Endoscopic sinus surgery is an effective treatment for mucoceles, with favorable long‐term outcome. Maxillary retention cysts commonly recur after endoscopic sinus surgery. However, the recurrence can be managed in the office through a patent antrostomy. Endoscopic sinus surgery may be offered as initial surgical treatment for antrochoanal polyps, but a Caldwell Luc operation may be needed for recurrent disease.     

Electron Microscopy Assessment of the Recovery of Sinus Mucosa after Sinus Surgery

Objectives—To determine the level of injury to the maxillary sinus mucosa due to chronic infection and the capacity of sinus mucosa to recover after sinus surgery. Material and Methods—Scanning and transmission electron microscopy (SEM and TEM, respectively) were used for examination of maxillary sinus mucosa at the time of endoscopic sinus surgery and 6 months postoperatively. Results—SEM showed non-ciliated cells, metaplasia, ciliary disorientation, abundant goblet cells, microvilli and compound cilia perioperatively. Six months postoperatively the numbers of non-ciliated cells and microvilli had increased but the degree of metaplasia and disorientation and the number of compound cilia had decreased. Perioperative TEM revealed metaplasia, disorientation, tubulus anomalies, compound cilia and one patient with short dynein arms. Conclusions—As a result of this study we conclude that sinus mucosa repairs slowly after surgery. There are still many pathological findings in the mucosa 6 months postoperatively and some of these findings may even be irreversible. Patients need frequent follow-up after their operation and we suggest that a follow-up time for sinus surgery patients of at least 1 year should be allowed before final evaluation of the operation and its outcomes is made.