Association between idiopathic intracranial hypertension and sigmoid sinus dehiscence/diverticulum with pulsatile tinnitus: a retrospective imaging study

Liu, Zhaohui; Dong, Cheng; Xiao, Wang; Xiaoyi, Han; Zhao, Peng; Lv, Han; Wang, Zhenchang

doi:10.1007/s00234-015-1517-5

Cited by 38 publications

(14 citation statements)

References 32 publications

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“…More recently, sigmoid sinus diverticulum and/or dehiscence (SSDD) has been shown to be associated with PT. 1,[11][12][13][14][15][16] This association has been noted to be particularly frequent in patients with elevated body mass indices and those with imaging features of IIH, 1,14,15 leading some authors to suggest that SSDD may reflect a manifestation of subclinical IIH. 2,14 Interventional studies have revealed that endovascular stenting of TSS or surgical correction of SSDD may resolve PT 5,7,8,13,[17][18][19] ; however, these procedures are not without complications.…”

Section: Resultsmentioning

confidence: 99%

“…28 Patients with PT and SSDD have been found to have clinical and imaging characteristics of IIH. 1,12,15 A number of mechanisms have been proposed to explain this association. It is possible that the impact of pulsatile, turbulent blood flow on the sinus wall could cause the formation of SSDD.…”

Section: Discussionmentioning

confidence: 99%

“…It is possible that the impact of pulsatile, turbulent blood flow on the sinus wall could cause the formation of SSDD. 15,18 Alternatively the presence of SSDD may be a direct result of raised CSF pressures. 12,16,29 It has also been postulated that sigmoid sinus dehiscence could cause PT in these patients due to increased transmission of turbulent flow to the inner ear after loss of the insulating properties afforded by cortical bone.…”

Section: Discussionmentioning

confidence: 99%

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Sigmoid Sinus Diverticulum, Dehiscence, and Venous Sinus Stenosis: Potential Causes of Pulsatile Tinnitus in Patients with Idiopathic Intracranial Hypertension?

Lansley

Tucker

Eriksen

et al. 2017

AJNR Am J Neuroradiol

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While our data corroborate previous studies demonstrating increased prevalence of sigmoid sinus diverticulum/dehiscence and transverse sinus stenosis in idiopathic intracranial hypertension, we did not establish an increased prevalence in patients with idiopathic intracranial hypertension with pulsatile tinnitus compared with those without. It is therefore unlikely that these entities represent a direct structural correlate of pulsatile tinnitus in patients with idiopathic intracranial hypertension.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Sigmoid Sinus Diverticulum, Dehiscence, and Venous Sinus Stenosis: Potential Causes of Pulsatile Tinnitus in Patients with Idiopathic Intracranial Hypertension?

Lansley

Tucker

Eriksen

et al. 2017

AJNR Am J Neuroradiol

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“…SSWD is likely to occur during pneumatization of the mastoid in older adolescence or the early adult years. And PT may arise when blood flow turbulence occurs, which can be generated by the increased irregularity of the vessel diameter or ipsilateral dominance of the drainage system [14, 31, 32]. Mechanical compression of the sigmoid sinus is an efficient method to correct the blood flow turbulence and cure PT [21, 25]; however, it may cause increased intracranial pressure following surgery if extensive compression is performed [26].…”

Section: Discussionmentioning

confidence: 99%

“…This demographic feature resembles that of patients with idiopathic intracranial hypertension (IIH). Furthermore, several IIH imaging features occur more frequently in PT patients with SSD and/or SSWD than in non-PT individuals [32], indicating that IIH may be an underlying cause in some PT patients with sigmoid sinus anomalies. Possible reasons for this could be that the elevated intracranial pressure gradually erodes the osseous wall of the sigmoid sinus, resulting in wall dehiscence and diverticulum, or that the elevated intracranial pressure causes blood flow turbulence and leads to PT.…”

Section: Discussionmentioning

confidence: 99%

Sigmoid Sinus Wall Reconstruction for Pulsatile Tinnitus Caused by Sigmoid Sinus Wall Dehiscence: A Single-Center Experience

et al. 2016

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ObjectiveTo evaluate clinical characteristics and present surgical outcomes of PT caused by sigmoid sinus wall dehiscence (SSWD)MethodsThis study retrospectively reviewed 34 patients with PT who were diagnosed with SSWD in our institution between December 2008 and July 2013. Among them, 27 patients underwent sigmoid sinus wall reconstruction (surgery group) and 7 patients refused surgery (non-surgery group). Preoperative data were obtained from the patients’ medical records. All patients were followed up regularly for at least 25 months. Preoperative and postoperative computed tomography angiography (CTA) images were compared. Student’s t-tests were used to compare age, body mass index (BMI) and preoperative Tinnitus Handicap Inventory (THI) scores between the surgery and the non-surgery groups and to compare pre- and follow-up THI scores.ResultsThere was no significant difference in age, body mass index, or preoperative THI scores between groups. Following surgery, 14 patients had complete resolution, 5 had partial resolution, 7 experienced no change and PT was aggravated in 1 patient. The difference between preoperative and postoperative THI scores was significant. No severe complications were found postoperatively. Comparison of the preoperative and postoperative CTA images revealed that remnant unrepaired dehiscences were the cause of unsatisfactory outcomes following surgery. In the non-surgery group, PT remained largely unchanged.ConclusionsSigmoid sinus wall reconstruction is an effective and safe treatment for PT caused by SSWD. It is imperative that all regions of the dehiscence are sufficiently exposed and resurfaced during surgery.

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Effects of different morphologic abnormalities on hemodynamics in patients with venous pulsatile tinnitus: A four‐dimensional flow magnetic resonance imaging study

Qiu

Ding

et al. 2021

Magnetic Resonance Imaging

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The effects of morphologic abnormalities, including sigmoid sinus wall dehiscence (SSWD), transverse sinus stenosis (TSS), and sigmoid sinus diverticulum (SSD), on hemodynamics in venous pulsatile tinnitus (PT) patients have not been established. The aim of this study was to evaluate the effects of SSWD, TSS, and SSD on the hemodynamics of transverse‐sigmoid sinus in venous PT patients. This was a prospective study with 44 venous PT patients and 12 healthy controls. A 3 T/four‐dimensional (4D) flow magnetic resonance imaging with fast field echo was used. Computed tomography arteriography/venography was used to assess ipsilateral SSWD, TSS, and SSD. Maximum velocity (Vmax), average velocity (Vavg), and average flow (Flowavg) were measured. Blood flow patterns were independently assessed by three neuroradiologists. One‐way analysis of variance or Kruskal–Wallis test was also used. On the symptomatic side, all patients had SSWD, 33 patients had TSS, and 22 patients had SSD. Compared with healthy controls, patients with TSS, without TSS, with SSD, and without SSD all showed higher Vmax (all p < 0.050), Vavg (all p < 0.050), and Flowavg (all p < 0.050). Patients with TSS showed higher Vmax (p < 0.050) and Vavg (p < 0.050) than those without TSS, and no significant difference in Flowavg was found between the two groups (p = 0.408). No significant differences in Vmax, Vavg, and Flowavg were found between patients with and without SSD (all p = 1.000). Jet‐like flow in the stenosis and downstream of the stenosis was observed in all patients with TSS. Vortex in SSD was observed in 15 patients with SSD (68%). High blood velocity and flow may be characteristic markers of venous PT. SSWD may be a necessary condition for venous PT. TSS may further increase the blood velocity and form a jet‐like flow. SSD may be related to vortex formation but had no significant effect on blood velocity and flow. Level of Evidence 2 Technical Efficacy Stage 3

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Association between idiopathic intracranial hypertension and sigmoid sinus dehiscence/diverticulum with pulsatile tinnitus: a retrospective imaging study

Abstract: Several IIH imaging features occur more frequently in PT patients with SSDD than in healthy individuals, which suggests a potential correlation between SSDD with PT and IIH.

Cited by 38 publications

References 32 publications

Sigmoid Sinus Diverticulum, Dehiscence, and Venous Sinus Stenosis: Potential Causes of Pulsatile Tinnitus in Patients with Idiopathic Intracranial Hypertension?

Sigmoid Sinus Diverticulum, Dehiscence, and Venous Sinus Stenosis: Potential Causes of Pulsatile Tinnitus in Patients with Idiopathic Intracranial Hypertension?

Sigmoid Sinus Wall Reconstruction for Pulsatile Tinnitus Caused by Sigmoid Sinus Wall Dehiscence: A Single-Center Experience

Effects of different morphologic abnormalities on hemodynamics in patients with venous pulsatile tinnitus: A four‐dimensional flow magnetic resonance imaging study

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