Tinnituslu hastalarda 3 boyutlu T2 ağırlıklı manyetik rezonans görüntüleme ile serebelopontin kenardaki vasküler değişikliklerin değerlendirilmesi

Yıl 2018, , 1 - 6, 17.04.2018

Fatma Beyazal Çeliker Engin Dursun , Suat Terzi , Metin Çeliker , Abdülkadir Özgür , Mehmet Beyazal , Arzu Turan , Mehmet Fatih İnecikli

https://doi.org/10.22312/sdusbed.349912

Öz

Amaç:
Serebelopontin köşe (CPA) vasküler ve nöral yapıların anatomik etkileşimleri
işitsel-vestibüler semptomlarla ilişkili olduğu düşünülmektedir. Manyetik
rezonans görüntüleme, bu karmaşık anatomik bölgeyi değerlendirmek için tercih
edilen bir yöntem haline gelmiştir. Bu çalışmada, 3-boyutlu T2 ağırlıklı MRI
ile tinnitus hastalarda CPA’da vasküler loop
varyasyon ilişkisini değerlendirmeyi amaçladık.

Materyal ve Metod:
Bu çalışmada, açıklanamayan tinnitus olan ve kulak MRI tetkiki yapılan 149
hasta yer almıştır. Hastaların tinnitusu olan kulakları çalışma grubunu,
şikâyet olmayan kulakları kontrol grubunu oluşturdu. Çift taraflı tinnitusu
olanlar iki taraf ayrı ayrı olarak çalışma grubuna dâhil edildi. MRI
taramaları, CPA’da vasküler varyasyon varlığına ilişkin olarak değerlendirildi.

Bulgular: Sol tarafta
tinnitusu olan hastalarda Tip 1 (CPA düzeyinde) (p=0.001) ve Tip A
(vestibüloklear ve/veya fasial ile temas) (p<0.001) vasküler loop anlamlı
derecede yüksekti. Sağ tarafta tinnitusu olan hastalarda, sadece Tip A vasküler loop anlamlı
derecede yüksekti (p=0.005). Çift taraflı tinnituslu hastalar için sağ kulakta
Tip 2 vasküler loop (internal akustik kanalı
proksimal [IAC]) (p=0.035) ve sol kulakta Tip A vasküler loop(p<0.001) anlamlı derecede yüksekti.

Sonuç: Bu çalışma, 3D T2W MRI kullanılarak tinnitus etyolojisini araştıran en
büyük ölçekli çalışmadır. CPA ve IAC’deki vasküler loop sıklığı öncelikle tanı tekniğine bağlıdır. Bulgularımız,
vasküler varyasyon nedenlerin yüksek çözünürlüklü görüntüleme yöntemleri
kullanılarak daha net gösterilebileceğini gösterdi. Buna göre, tedavi
seçenekleri etiyolojinin aydınlatılmasıyla daha iyi belirlenebilir.

Anahtar Kelimeler

Vasküler loop, serebelopontin köşe, internal akustik kanal, tinnitus, manyetik rezonans görüntüleme

Evaluation of vascular variations at cerebellopontine angle by 3-dimensional T2-weighted magnetic resonance imaging in patients with tinnitus

Öz

Objective: Anatomical interactions
of vascular and neural structures at cerebellopontine angle (CPA) are
considered related to auditory-vestibular symptoms. Magnetic resonance imaging
(MRI) has become the preferred method to visualize this complex anatomical
region. This study aimed to assess the relation of vascular loops at CPA with
clinical symptoms in patients with tinnitus using 3-dimensional (3D)
T2-weighted (T2W) MRI.

Materials and Methods: The study included 476 patients, grouped as those with and without
tinnitus, undergoing MRI for various clinical auditory symptoms. MRI scans were
assessed regarding the presence of vascular abnormalities at CPA.

Results: For the patients with
tinnitus on the left side, the frequencies of Type 1 vascular loop (at the CPA
level) (p=0.001) and Type A vascular loop (contact with the vestibulocochlear
and facial nerves) (p<0.001) vascular loops were significantly higher. For
the patients with tinnitus on the right side, only the frequency of Type A
vascular loop was significantly higher (p=0.005). For the patients with
bilateral tinnitus, Type 2 vascular loop (proximal to the internal auditory
canal [IAC]) on the right side (p=0.035) and Type A vascular loop on the left
side (p<0.001) were significantly higher.

Conclusion: This study is the largest scale study
investigating the tinnitus etiology using 3D T2W MRI. The frequency of vascular
loops at the CPA and IAC primarily depends on the diagnostic technique. Our
results indicated that vascular causes could be shown more clearly with the use
of high-resolution imaging methods. Accordingly, treatment options can be
better determined by the clarification of etiology.

Anahtar Kelimeler

Vascular loop, cerebellopontine angle, internal acoustic canal, tinnitus, magnetic resonance imaging

Kaynakça

• 1) Allen RW, Harnsberger HR, Shelton C, et al. Low-cost high-resolution fast spin-echo MR of acoustic schwannoma: an alternative to enhanced conventional spin-echo MR? AJNR Am J Neuroradiol 1996; 17(7): 1205-10.
• 2) Bachor E, Selig YK, Jahnke K, Rettinger G, Karmody CS. Vascular variations of the inner ear. Acta Otolaryngol 2001; 121(1): 35-41.
• 3) Balansard CF, Meller R, Bruzzo M, Chays A, Girard N, Magnan J. Trigeminal neuralgia: results of microsurgical and endoscopic-assisted vascular decompression. Ann Otolaryngol Chir Cervicofac 2003; 120(6): 330-7.
• 4) Brunsteins DB, Ferreri AJ. Microsurgical anatomy of VII and VIII cranial nerves and related arteries in the cerebellopontine angle. Surg Radiol Anat 1990; 12(4): 259-65.
• 5) De Carpentier J, Lynch N, Fisher A, Hughes D, Willatt D. MR imaged neurovascular relationships at the cerebellopontine angle. Clin Otolaryngol Allied Sci 1996; 21(4): 312-16.
• 6) Eggermont JJ, Roberts LE. The neuroscience of tinnitus: understanding abnormal and normal auditory perception. Front Syst Neurosci 2012; 6: 53.
• 7) Engineer ND, Riley JR, Seale JD, et al. Reversing pathological neural activity using targeted plasticity. Nature 2011; 470(7332): 101-4.
• 8) Gu JW, Halpin CF, Nam EC, Levine RA, Melcher JR. Tinnitus, diminished sound-level tolerance, and elevated auditory activity in humans with clinically normal hearing sensitivity. J Neurophysiol 2010; 104(6): 3361-70.
• 9) Hofmann E, Behr R, Neumann-Haefelin T, Schwager K. Pulsatile tinnitus: imaging and differential diagnosis. Dtsch Arztebl Int 2013; 110(26): 451-8.
• 10) Kanzaki J, Ogawa K. Internal auditory canal vascular loops and sensorineural hearing loss. Acta Otolaryngol Suppl 1988; 105(sup447): 88-93.
• 11) Kim HN, Kim YH, Park IY, Kim GR, Chung IH. Variability of the surgical anatomy of the neurovascular complex of the cerebellopontine angle. Ann Otol Rhinol Laryngol 1990; 99(4): 288-96.
• 12) Makins AE, Nikolopoulos TP, Ludman C, O'Donoghue GM. Is there a correlation between vascular loops and unilateral auditory symptoms? Laryngoscope 1998; 108(11): 1739-42.
• 13) Matsushima T, Rhoton AL, Jr., de Oliveira E, Peace D. Microsurgical anatomy of the veins of the posterior fossa. J Neurosurg 1983; 59(1): 63-105.
• 14) Møller AR. Pathophysiology of tinnitus. Otolaryngol Clin North Am 2003; 36(2): 249-66.
• 15) Nowé V, De Ridder D, Van de Heyning PH, et al. Does the location of a vascular loop in the cerebellopontine angle explain pulsatile and non-pulsatile tinnitus? Eur Radiol 2004; 14(12): 2282-9.
• 16) Panda A, Arora A, Jana M. Persistent primitive trigeminal artery: an unusual cause of vascular tinnitus. Case Rep Otolaryngol 2013; 2013: 275820.
• 17) Parnes LS, Shimotakahara SG, Pelz D, Lee D, Fox AJ. Vascular relationships of the vestibulocochlear nerve on magnetic resonance imaging. Am J Otol 1990; 11(4): 278-81.
• 18) Raybaud C, Girard N, Poncet M, Chays A, Caces F, Magnan J. Current imaging of vasculo-neural conflicts in the cerebellopontine angle]. Rev Laryngol Otol Rhinol (Bord) 1995; 116(2): 99-103.
• 19) Reisser C, Schuknecht HF. The anterior inferior cerebellar artery in the internal auditory canal. Laryngoscope 1991; 101(7): 761-6.
• 20) Schwaber MK, Hall JW. Cochleovestibular nerve compression syndrome. I. Clinical features and audiovestibular findings. Laryngoscope 1992; 102(9): 1020-9.
• 21) Sirikci A, Bayazit Y, Ozer E, et al. Magnetic resonance imaging based classification of anatomic relationship between the cochleovestibular nerve and anterior inferior cerebellar artery in patients with non-specific neuro-otologic symptoms. Surg Radiol Anat 2005; 27(6): 531-5.
• 22) Wahlig JB, Kaufmann AM, Balzer J, Lovely TJ, Jannetta PJ. Intraoperative loss of auditory function relieved by microvascular decompression of the cochlear nerve. Can J Neurol Sci 1999; 26(1): 44-7.
• 23) Warren FM, Shelton C, Hamilton BE, Wiggings RH. Neuroradiology of the Temporal Bone and Skull Base. In: Niparko JK (ed) Cummings Otolaryngology, 6th edn. Saunders, 2015: 2084-99.
• 24) Zealley IA, Cooper RC, Clifford KM, et al. MRI screening for acoustic neuroma: a comparison of fast spin echo and contrast enhanced imaging in 1233 patients. Br J Radiol 2000; 73(867): 242-7.