The Relationships Among Transverse Sinus Stenosis Measured by CT Venography, Venous Trans-stenotic Pressure Gradient and Intracranial Pressure in Patients With Unilateral Venous Pulsatile Tinnitus.

Xiaoyu Qiu,Xiaoshuai Li,Shusheng Gong,Zhenchang Wang,Long Jin,Zhenghan Yang,Han Lv,Guopeng Wang,Pengfei Zhao,Heyu Ding,Rong Zeng

doi:10.3389/fnins.2021.694731

Xiaoyu Qiu, Xiaoshuai Li + Show 9 more

Open Access

https://doi.org/10.3389/fnins.2021.694731

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Abstract

ObjectivesTo assess a non-invasive means of predicting a venous trans-stenotic pressure gradient (TPG) and intracranial pressure (ICP) as opposed to invasive examinations in unilateral venous pulsatile tinnitus (PT) patients.MethodsThirty patients with unilateral venous PT who presented symptomatic-sided transverse sinus stenosis (TSS) on computed tomography venography (CTV), ipsilateral TPG measured by digital subtraction angiography (DSA) and cerebrospinal fluid (CSF) pressure measured by lumbar puncture were included. The ratio of TSS was calculated by dividing the cross-sectional areas of the maximal stenosed transverse sinus by that of the adjacent normal transverse sinus on CTV. The correlations among and predictive values of TSS, TPG, and ICP were analyzed.ResultsIn patients with unilateral venous PT, the symptomatic-sided and average bilateral TSS values were 78 ± 11 and 77 ± 9%; ICP, 230.50 ± 55.75 mmH2O; and the TPG, 9.51 ± 5.76 mmHg. The symptomatic-sided TSS was linearly and positively correlated with TPG (R2 = 0.400), and the symptomatic-sided and bilateral average TSS both showed weak correlations with ICP (R2 = 0.288, R′2 = 0.156). When the degree of TSS increased by 10%, the TPG and ICP increased by approximately 3.3 mmHg and 25.8 mmH2O, respectively. The receiver operating characteristic curve showed the optimal threshold of ipsilateral TSS for a positive TPG was 0.75, while TSS had no significant predictive value for ICP (p > 0.05). TPG and ICP also exhibited a linear positive correlation (R2 = 0.552). When ICP increased by 10 mmH2O, the TPG increased by approximately 0.77 mmHg, and the optimal threshold of ICP for a positive TPG was 227.5.ConclusionTSS, TPG, and ICP are interrelated. TSS measured by CTV can predict TPG in patients with unilateral venous PT.

Highlights

Pulsatile tinnitus (PT) typically manifests as a pulse-synchronous sound in the ear, the long-term presence of which seriously reduces sufferers’ life and work quality
Thirty patients with unilateral venous PT who presented symptomatic-sided transverse sinus stenosis (TSS) on computed tomography venography (CTV), ipsilateral trans-stenotic pressure gradient (TPG) measured by digital subtraction angiography (DSA) and cerebrospinal fluid (CSF) pressure measured by lumbar puncture were included
When the degree of Transverse sinus stenosis (TSS) increased by 10%, the TPG and intracranial pressure (ICP) increased by approximately 3.3 mmHg and 25.8 mmH2O, respectively

Summary

Introduction

Pulsatile tinnitus (PT) typically manifests as a pulse-synchronous sound in the ear, the long-term presence of which seriously reduces sufferers’ life and work quality. Most cases are found to have a venous origin after comprehensive examinations (Schoeff et al, 2014). Transverse sinus stenosis (TSS) is a common feature of both venous PT and IIH (Markey et al, 2016; Hewes et al, 2020). The trans-stenotic pressure gradient (TPG) formed by TSS may be a common pathological basis for these conditions. Current studies suggest that PT may originate from strong and jet-like blood flow impacts caused by transverse sinus TPG (Amans et al, 2018; Li et al, 2018) and that it may cause obstruction of cerebrospinal fluid (CSF) drainage through arachnoid granules into sinuses, leading to IIH (Funnell et al, 2018; Dinkin and Oliveira, 2019)

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