Efficacy analysis of removal of the transverse process of the atlas for the treatment of cranial tinnitus caused by compression and stenosis of internal jugular vein
Objective To investigate the surgical method and efficacy of decompression of the internal jugular vein(IJV)by partially removing the transverse process of the atlas in the treatment of cranial tinnitus caused by compression and stenosis of the IJV.Methods A retrospective analysis was conducted on the clinical data of 32 patients with stenosis of the upper segment of the IJV admitted to the Department of Neurosurgery,Beijing Shijitan Hospital,Capital Medical University from September 2020 to September 2022.Before operation,the stenosis of IJV caused by the compression of transverse process of atlas was confirmed by using color Doppler ultrasound imaging and CT venography.Based on the characteristics of clinical symptoms,32 patients were divided into patients in the progressive stage(including early and middle stage of cranial tinnitus)(23 cases)and those in the continuous stage(9 cases).A total of 27 patients underwent unilateral partial grinding decompression of transverse process of atlas,and the other 5 patients underwent bilateral partial grinding decompression of transverse process of atlas.Surgery-related complications were documented.Postoperative clinical and imaging follow-up was performed,and the evaluation indicators included the symptom improvement,restoration of IJV morphology and improvement of blood flow at 1 week and 3 months post operation.Results Among the 32 patients,surgical complications included 1 case of intraoperative IJV injury,1 case of weakness of shrug and neck rotation,1 case of neck and shoulder discomfort,and 1 case of incision infection.Three months after surgery,the total improvement rate of postoperative tinnitus and accompanying symptoms,tinnitus only,IJV morphology,blood flow was 62.5％(20/32),28.1％(9/32),84.3％(27/32)and 75.0％(24/32),respectively.Improvement of the IJV blood flow after surgery was more significant in patients with tinnitus in the progressive stage(early and middle stage)than in those with sustained tinnitus(Z=2.06,P=0.039).Conclrision Decompression of IJV by partial grinding of transverse process of atlas can effectively relieve the compression stenosis of upper part of IJV,improve the IJV morphology and blood flow,alleviate the early symptoms and accompanying symptoms of patients with cranial tinnitus.The surgical complications are relatively mild.
Jugular veinsDecompression,surgicalCranial tinnitusTreatment outcomeComplicationsRemoval of the transverse process of the atlas
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