case_images: PMC10877715_01
case_images: Preoperative evaluation and diagnostic imaging of the patient. (A, B) Pre-treatment MRV scans showed the stenosis at the junction of the right sigmoid sinus and the internal jugular vein, and a high jugular bulb (white arrow). (C) Pre-treatment non-contrast CT scans showed a branch of the mastoid vein emanating from the right sigmoid sinus. (D) Pre-treatment non-contrast CT scans demonstrated the right high jugular vein bulb invaded the inner ear structures. (E, F) Pre-treatment DSAs showed that a narrowing of the sigmoid sinus at its junction with the internal jugular vein, and a high jugular bulb (white arrow).
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case_images: F1
case_images: After admission, we performed neurological examinations: (1) intracranial pressure was normal; (2) otoscopy: bilateral external auditory canals were patent, tympanic membranes were intact, grayish-white in color, and no congestion or fluid flatness was seen; the hearing loss was observed in both ears by pure tone audiometry, and tympanic ventricular conductance mapping showed a pattern of 3C; (3) A computed tomography (CT) scan of the right ear showed: normal right sigmoid sinus wall and stenosis at the junction of the right internal jugular vein(IJV) and the sigmoid sinus, as well as a high JB on the right accompanied with Jugular bulb wall dehiscence (JBWD) (Figure 1). IJV (stenosis of approximately 50%-70%) and a high JB (Figure 1), and distal venous sinus manometry was performed. Initially, we thought that the PT in the right ear might be due to the SSS increasing the blood flow velocity creating a vortex in the high JB, so that the PT sound entered the inner ear.
case_images: Intraoperative and post-treatment follow-up DSAs of the patient. (A, B) Intraoperative DSA showed that the stenosis has been improved by placement of the SAB stent, but the high jugular bulb remains on Dec. 28, 2020. (C, D) Intraoperative DSA demonstrated the presence of the spring coils within the high jugular bulb, on Jan. 04, 2021. (E, F) The first follow-up DSA showed that the stent at stenosis and the high jugular bulb embolized by the spring coils, on Jan. 17, 2022. (G, H) The second follow-up DSA showed that the stent at stenosis and the high jugular bulb embolized by the spring coils, on Aug. 14, 2023.
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case_images: F2
case_images: DSA was performed under local anesthesia to confirm the presence of severe stenosis at the junction of the right sigmoid sinus and the IJV, including a right high JB as depicted in Figure 2. Post-stenting DSA revealed the disappearance of the stenosis, with contrast-medium observed in the right high JB as shown in Figure 2. The second DSA showed no thrombosis in the stent at the sigmoid sinus, good improvement of stenosis, and no recurrence of stenosis with smooth blood flow (Figure 2). Post-intervention DSA imaging revealed smooth blood flow within the stent and no contrast medium in the right high JB (Figure 2). Both DSA images demonstrated unobstructed blood flow within the stent and complete occlusion of the high JB (Figure 2).
case_images: The timeline of the present case.
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case_images: F3
case_images: The timeline of the present case (Figure 3).