Evaluation Criteria, Diagnostic Criteria, Surgical Indications, and Establishment of Surgical Standards for "Cerebral Tinnitus Syndrome" Caused by Internal Jugular Vein Stenosis.

Overview

"Cerebral Tinnitus," also known as "cranial tinnitus," refers to the patient-reported perception of intracranial sounds. It often presents as "Cerebral Tinnitus Syndrome," which includes symptoms such as tinnitus with hearing loss, headaches, a heavy head sensation, blurred vision, neck and shoulder discomfort, sleep disturbances, anxiety, and depression. Due to limited awareness of cerebral tinnitus, patients frequently seek treatment across multiple facilities without success, severely impacting their and their families' lives and work. Xunming Ji and colleagues have pointed out that cerebral tinnitus results from stenosis of the cerebral or internal jugular veins (IJVS), which impairs cerebral venous outflow and the clearance of metabolic "waste," leading to chronic metabolic damage to brain cells. Currently, studies on the diagnosis and treatment of IJVS-induced cerebral tinnitus, both domestically and internationally, are primarily case reports, lacking systematic evaluation, diagnostic, and treatment standards, which significantly impacts patient outcomes. Our project team is the first to establish evaluation criteria, diagnostic standards, surgical indications, and surgical standards for "Cerebral Tinnitus Syndrome." In preliminary work, we performed internal jugular vein (IJV) decompression on 32 cerebral tinnitus patients, resulting in an IJV morphological improvement rate of 84.3%, a blood flow improvement rate of 75.0%, and a cerebral tinnitus syndrome improvement rate of 62.5%. To date, we have completed 88 IJV decompression surgeries, making ours the largest clinical center for such cases worldwide. We continue to refine these standards, notably introducing new intraoperative standards for IJV "release" and "high perfusion,". To validate and further study these standards, this project plans to perform IJV decompression surgery on 107 cerebral tinnitus patients affected by IJVS. We aim to establish a cerebral tinnitus database and develop a cerebral tinnitus evaluation scale to standardize evaluation criteria, diagnostic standards, surgical indications, and surgical standards, ultimately advancing clinical diagnosis and treatment of Cerebral Tinnitus Syndrome

"Cerebral tinnitus," also known as "cranial tinnitus," is a condition where patients perceive intracranial sounds, often described as complex noises like machinery, thunder, or sirens, and may occur intermittently or persistently. Clinically, cerebral tinnitus is typically not an isolated symptom but manifests as "Cerebral Tinnitus Syndrome." In addition to cerebral tinnitus, patients frequently experience symptoms such as tinnitus with hearing loss, headaches and dizziness, head fullness or heaviness, dry eyes with blurred vision, neck and shoulder discomfort, sleep disturbances, anxiety, depression, and cognitive or memory decline. A recent study published in the Journal of the American Medical Association: Neurology indicates that approximately 750 million people worldwide suffer from tinnitus. Due to the similarity between the symptoms of tinnitus and cerebral tinnitus, many tinnitus patients also experience cerebral tinnitus, making it difficult to distinguish between these symptoms accurately. Consequently, a substantial portion of the surveyed population may, in fact, be patients with "Cerebral Tinnitus Syndrome." The fast-paced nature of modern life, coupled with increased stress from work and daily responsibilities, has contributed to the rising incidence of cerebral tinnitus, which has now become a common condition impacting quality of life and overall health in China. Unfortunately, effective treatments for "Cerebral Tinnitus Syndrome" remain unavailable. With limited public awareness about cerebral tinnitus, many patients seek medical help without success; conventional medications yield limited results, and patients often rely on anti-anxiety or antidepressant medications to alleviate symptoms, which severely impacts their and their families' lives and work. Currently, the etiology of cerebral tinnitus remains unclear. Some studies suggest it may be related to alterations in blood flow within the dural sinuses or internal jugular veins (IJVs) caused by head and neck venous return obstruction or compensatory blood flow in collateral veins. Ji Xunming et al. proposed that cerebral tinnitus could result from stenosis of the cerebral or internal jugular veins, leading to impaired cerebral venous return, inadequate clearance of metabolic waste, and chronic metabolic alterations in brain cells. Specific causes may include cerebral venous thrombosis (CVT), cerebral venous sinus stenosis (CVSS), and internal jugular vein stenosis (IJVS). Unlike CVT and CVSS, IJVS is often caused by external compression, with the transverse process of the atlas and styloid process being primary contributors, affecting 40-70% of cases. Currently, treatment approaches for cerebral tinnitus are primarily symptom-focused, lacking effective interventions targeting the underlying cause. Medications such as antidepressants and anxiolytics are mainly used to alleviate emotional symptoms, while steroids may temporarily reduce inflammatory responses associated with tinnitus, yet do not address IJVS-induced cerebral tinnitus. Audiotherapy and psychotherapy may improve psychological responses to symptoms but fail to treat the root cause. Surgical interventions may offer symptom relief in some cases with clear etiology; however, there are only a few case reports. Most available treatments are symptomatic rather than causal, underscoring the need for standardized diagnostic and treatment protocols for IJVS-induced cerebral tinnitus. Systematic research on surgical interventions for IJVS has developed relatively recently. In 2021, Ji Xunming and colleagues summarized recent advancements in IJVS diagnosis and treatment, identifying the upper segment of the internal jugular vein as vulnerable to compression by the atlas transverse process and styloid process. For IJVS patients with distinct bony compression, surgical resection of the compressive bone has been reported to alleviate preoperative symptoms such as headaches, dizziness, and cognitive impairment. Dashti et al. reported on two IJVS patients with craniovertebral junction compression, whose symptoms improved after partial bone resection. Fritch et al. presented a case of IJVS with intracranial hypertension caused by compression from the C1 transverse process, which improved rapidly after resection. Higgins et al. examined 29 styloidectomy surgeries in IJVS patients, finding that of 23 patients undergoing the procedure for the first time without stenting, one achieved complete symptom resolution, four experienced symptom improvement, while the remaining 18 required stenting within two months. Yang et al. reported clinical improvement in 11 of 14 IJVS patients treated with condylar suboccipital lateral approach decompression. From the literature, only limited case studies and small clinical cohorts abroad focus on surgical treatment for IJVS, with no related literature from domestic studies. Additionally, there are no standardized evaluation, diagnostic, or treatment protocols for Cerebral Tinnitus Syndrome caused by IJVS. Our team is the first globally to establish evaluation criteria, diagnostic standards, surgical indications, and surgical protocols for "Cerebral Tinnitus Syndrome" induced by IJVS. In previous work, we performed internal jugular vein (IJV) decompression on 32 patients with cerebral tinnitus, achieving an IJV morphological improvement rate of 84.3% (27/32), a blood flow improvement rate of 75.0% (24/32), and a cerebral tinnitus syndrome improvement rate of 62.5% (20/32). To date, we have completed 88 minimally invasive surgeries for IJVS-induced cerebral tinnitus, establishing the largest clinical center for these cases worldwide. We continue to refine standards, notably introducing intraoperative IJV "release" and "high perfusion" as new surgical criteria. To further validate and expand upon these standards, this study plans to perform IJV decompression on 107 patients with IJVS-induced Cerebral Tinnitus Syndrome. Key surgical steps include: (1) standardized bony decompression, (2) soft tissue release, and (3) IJV high perfusion. Enrolled patients will undergo structured evaluation based on our established IJVS-induced Cerebral Tinnitus Syndrome assessment criteria, including "clinical symptom assessment, imaging assessment, and multidisciplinary collaborative evaluation." From these assessments, we will develop more precise diagnostic criteria and clinical classifications. Surgery will be guided by stricter surgical indications to ensure optimal patient selection, and intraoperative validation of the new techniques (standardized bony decompression, soft tissue release, and IJV high perfusion) will be conducted to achieve complete J3 segment decompression. This will set new surgical operation standards, establish a cerebral tinnitus database, create an evaluation scale for cerebral tinnitus, and examine key factors influencing clinical efficacy of IJV decompression. Through this research, we aim to enhance clinical diagnosis and treatment capabilities for IJVS-induced Cerebral Tinnitus Syndrome, relieving patient suffering and improving quality of life.