以脑鸣为主要症状的头颈部静脉狭窄CT静脉成像分型研究  

Study on the classification of symptomatic tinnitus caused by head and neck venous stenosis based on CT venography

作　　者：董健[1,4] 任海燕 朱广通 毛贝贝 关峰 黄辉 肖智勇 胡志强 吉训明 Dong Jian;Ren Haiyan;Zhu Guangtong;Mao Beibei;Guan Feng;Huang Hui;Xiao Zhiyong;Hu Zhiqiang;Ji Xunming(Department of Radiology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Neurosurgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Capital Medical University Brain Disorders Research Center,Beijing Institute of Brain Disorders,Beijing 100069,China;Department of Radiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京世纪坛医院放射科,北京100038 [2]首都医科大学附属北京世纪坛医院神经外科,北京100038 [3]首都医科大学脑重大疾病研究中心,北京脑重大疾病研究院,北京100069 [4]首都医科大学附属北京天坛医院放射科,北京100070

出　　处：《中华神经外科杂志》2024年第8期810-814,共5页Chinese Journal of Neurosurgery

基　　金：中国国家铁路集团有限公司科技研究开发计划(J2022Z616)。

摘　　要：目的探讨以脑鸣为主要症状的头颈部静脉狭窄的CT静脉成像(CTV)分型特点及不同分型患者部分临床资料的差异。方法2020年9月至2022年12月首都医科大学附属北京世纪坛医院基于CTV确诊43例头颈部静脉狭窄患者,患者均以脑鸣为主要症状。根据CTV表现将头颈部静脉狭窄分为颅内静脉窦型、颈内静脉型和复合型(同时存在颅内静脉窦和颈内静脉狭窄),回顾性分析3种分型患者的影像学特点及部分临床资料的差异。结果43例患者中,颅内静脉窦型14例(32.6%),其中10例狭窄位于横窦,为蛛网膜颗粒增生压迫所致;4例为窦汇与横窦移行部的线性狭窄。颈内静脉型16例(37.2%),狭窄均位于寰椎横突节段,其中6例为寰椎横突增生压迫狭窄,10例为颈内静脉走行于寰椎横突与茎突夹角之间,导致局部管腔受压狭窄。复合型13例(30.2%),狭窄位于横窦和寰椎横突节段,其中3例为窦汇与横窦移行部狭窄,10例为蛛网膜颗粒增生压迫横窦;有3例患者单侧颅内静脉窦及颈内静脉全程细小。颅内静脉窦型的女性患者占比高于颈内静脉型和复合型,而病程短于颈内静脉型和复合型,差异均有统计学意义(均P<0.05)。3种分型患者的年龄和狭窄侧别的差异均无统计学意义(均P>0.05)。结论基于CTV显示,以脑鸣为主要症状的头颈部静脉狭窄的3种分型构成比接近,其中蛛网膜颗粒压迫是颅内静脉窦型狭窄的常见原因;骨质增生压迫是颈内静脉型的常见原因;部分患者的静脉狭窄可能与先天发育因素有关。3种分型的头颈部静脉狭窄患者的临床特点可能存在差异。Objective To investigate the classification and clinical characteristics among different types of symptomatic tinnitus caused by head and neck venous stenosis based on CT venography(CTV).Methods From September 2020 to December 2022,a total of 43 patients were diagnosed as head and neck venous stenosis based on CTV imaging at Beijing Shijitan Hospital,Capital Medical University.All patients had tinnitus as the main symptom.According to CTV imaging,venous stenosis of the head and neck was divided into intracranial venous sinus type,internal jugular vein type and composite type(intracranial venous sinus-internal jugular vein combined stenosis type).Differences in the imaging demonstrations and some clinical characteristics of the patients with those 3 types were retrospectively analyzed.Results Among the 43 patients,14(32.6%)belonged to the intracranial venous sinus type,of which 10 cases had stenosis located in the transverse sinus,caused by arachnoid granule hyperplasia and compression;4 cases had linear stenosis at the transition between the confluence of sinuses and the transverse sinus.There were 16 cases(37.2%)of internal jugular vein type,and the stenosis was all located in the transverse process segment of the atlas.Among them,6 cases were caused by hyperplasia of the transverse process of the atlas and compression stenosis,and 10 cases were caused by the internal jugular vein running between transverse process of the atlas and the styloid process,resulting in local lumen compression and stenosis.There were 13 cases(30.2%)of the composite type.The stenosis was located in the transverse sinus and the transverse process segment of the atlas.Among them,3 cases had stenosis at the confluence of sinuses and the transitional part of the transverse sinus.Ten cases had arachnoid granule hyperplasia compressing the transverse sinus.Among them,3 cases had a single stenosis.The lateral intracranial venous sinuses and internal jugular veins were small throughout.The proportion of female patients with intracranial sinus

关 键 词：颈静脉 颅内静脉窦 CT静脉成像 狭窄 脑鸣 分型 

分 类 号：R743[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]