迷路-血管性耳囊裂开（II型）的血管内治疗：一种不同的治疗途径。
Endovascular management of labyrintho-vascular otic capsule dehiscence (type II): A different therapeutical approach.
文献信息
| PMID | 42855334 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | P Reynard |
| 作者单位 | Department of Audiology and Otoneurological Explorations, Civil Hospitals of Lyon, 69003 Lyon, France; Laboratoire Vibrations Acoustique, Insa Lyon, Villeurbanne, France. Electronic address: pierre.reynard@chu-lyon.fr. |
| 期刊 | European annals of otorhinolaryngology, head and neck diseases |
| SCI 分区 | Q2 |
| IF | 1.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
引言： 耳囊裂开（OCD）涵盖了一系列第三窗活动障碍，其中II型变异以膜迷路与邻近血管结构之间的直接界面为特征。这些迷路-血管性裂开（IIa型：上半规管-岩上窦（SPS）；IIb型：颈内静脉-前庭结构）可能引起搏动性耳鸣、眩晕和听力损失。血管内治疗已成为传统手术的一种微创替代方案，旨在减少血管搏动向内耳的传递。本研究评估了此类方法的关注度、临床结局和局限性。
方法： 我们进行了一项回顾性病例系列研究，纳入经高分辨率影像学确诊为单侧II型OCD且根据DHI和THI评估存在致残性症状的患者。所有患者均接受了全面的听力学-前庭评估和多模态影像学检查。血管内治疗策略包括SPS支架置入术（IIa型）或颈静脉球/颈内静脉的支架辅助弹簧圈栓塞术（IIb型）。在随访时通过临床、听力学和影像学评估结局。
结果： 共纳入8例患者（4例IIa型，4例IIb型）。血管内治疗在大多数病例中可行，出现1例技术失败和1例因静脉解剖不利而转为手术。在6个月时，7/7例可评估患者均显示出显著的临床改善，THI和DHI评分显著降低。大多数病例的搏动性耳鸣和眩晕得到改善。听力学结局不一，4例患者的气骨导差闭合。前庭功能基本保留，仅1例出现短暂的术后损害。随访影像学未观察到重大并发症或静脉血栓形成。
结论： 对于经过选择的患者，尤其是血管相关症状的患者，II型OCD的血管内治疗似乎是一种安全有效的微创替代方案。结局在很大程度上取决于静脉解剖和细致的术前影像学检查。虽然临床结局令人鼓舞，但局限性包括技术可行性和听力学结果不一。当解剖条件合适时，血管内方法可被视为一线选择，手术则保留用于经过选择或治疗失败的病例。
英文摘要
INTRODUCTION: Otic capsule dehiscence (OCD) encompasses a spectrum of third mobile window disorders, including type II variants characterized by a direct interface between the membranous labyrinth and adjacent vascular structures. These labyrinthine-vascular dehiscences (type IIa: superior semicircular canal-superior petrosal sinus (SPS); type IIb: internal jugular vein-vestibular structures) may induce pulsatile tinnitus, vertigo, and hearing loss. Endovascular treatment has emerged as a minimally invasive alternative to conventional surgery, aiming to reduce vascular pulsatility transmission to the inner ear. This study evaluates the interest, clinical outcomes and limitations of such approaches.
METHODS: We conducted a retrospective case series including patients with unilateral type II OCD confirmed by high-resolution imaging and presenting with disabling symptoms as assessed by the DHI and the THI. All patients underwent comprehensive audio-vestibular assessment and multimodal imaging. Endovascular treatment strategies included stenting of the SPS (type IIa) or stent-assisted coiling of the jugular bulb/internal jugular vein (type IIb). Outcomes were assessed clinically, audiometrically, and radiologically at follow-up.
RESULTS: Eight patients were included (4 type IIa, 4 type IIb). Endovascular treatment was feasible in most cases, with one technical failure and one conversion to surgery due to unfavorable venous anatomy. At 6 months, 7/7 evaluable patients showed marked clinical improvement, with significant reductions in THI and DHI scores. Pulsatile tinnitus and vertigo improved in the majority of cases. Audiometric outcomes were variable, with closure of the air-bone gap in 4 patients. Vestibular function remained largely preserved, with only transient postoperative impairment in one case. No major complications or venous thrombosis were observed on follow-up imaging.
CONCLUSION: Endovascular management of type II OCD appears to be a safe and effective minimally invasive alternative in selected patients, particularly for vascular-related symptoms. The outcomes depend heavily on venous anatomy and meticulous preoperative imaging. While clinical outcomes are encouraging, limitations include technical feasibility and variable auditory results. Endovascular approaches may be considered a first-line option when anatomically suitable, with surgery reserved for selected or failed cases.