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目的分析突发性耳聋(sudden sensorineural hearing loss,SSNHL)患者椎-基底动脉系统DSA的表现特点及经椎动脉灌注前列地尔的疗效。资料与方法对30例SSNHL患者分别在两侧椎动脉行DSA检查,分析椎动脉、基底动脉、小脑前下动脉(AICA)、内听动脉的影像学表现,然后经导管在椎动脉灌注前列地尔(平均剂量5μg,灌注时间5min)。术后1周复查听力,观察听力改善情况。结果 30例均成功进行上述检查、治疗,无相关并发症出现。30例中,2例出现一侧椎动脉闭塞,5例椎动脉硬化。分别有23.3%(7/30)的右侧AICA和30.0%(9/30)的左侧AICA呈现缺失或细小改变,63.3%(19/30)的右侧内听动脉和73.3%(22/30)的左侧内听动脉呈现缺失或细小改变。术后纯音听阈测试显示听阈水平(500Hz、1000Hz、2000Hz、4000Hz听阈的平均值)平均升高28.2dBHL,其中痊愈2例,显效8例,有效15例,无效5例,总有效率83.3%。结论 SSNHL与内听动脉、AICA细小、缺失导致的内耳缺血有关,灌注扩张血管的药物能够改善症状,提高听力。
Objective To analyze the features of vertebrobasilar artery system DSA in patients with sudden sensorineural hearing loss (SSNHL) and the effect of periarterial perfusion of alprostadil. Materials and Methods Thirty patients with SSNHL underwent DSA on the bilateral vertebral arteries. The vertebral artery, basilar artery, anterior inferior cerebellar artery (AICA) and internal auditory artery were examined by DSA. (Average dose 5 μg, perfusion time 5 min). Review the hearing after 1 week and observe the hearing improvement. Results All 30 cases were successfully performed the above examination, treatment, no relevant complications. Of the 30 cases, 2 had occlusion of one side of the vertebral artery and 5 had vertebral artery sclerosis. There were 23.3% (7/30) of right AICA and 30.0% (9/30) of left AICA, respectively, with or without small changes, 63.3% (19/30) of the right internal auditory artery and 73.3% 30) of the left internal auditory artery showed missing or small changes. The pure tone hearing threshold test showed that the threshold level (average value of 500Hz, 1000Hz, 2000Hz and 4000Hz threshold) increased 28.2dBHL on average, of which 2 cases were cured, 8 cases markedly effective, 15 effective and 5 ineffective. The total effective rate was 83.3%. Conclusions SSNHL is related to the ischemia of the inner ear caused by the small and missing AICA, and the perfusion of vasodilators can improve the symptoms and improve the hearing ability.