Degree of Sigmoid Sinus Compression and the Symptom Relief Using Magnetic Resonance Angiography in Venous Pulsating Tinnitus

Abstract

ObjectivesTo show that mechanical compression of sigmoid sinus is effective for treatment of pulsatile tinnitus caused by sigmoid sinus enlargement, and to evaluate the relationship between the compression degree of sigmoid sinus and the tinnitus symptom relief using magnetic resonance angiography.MethodsMedical records of twenty-four patients who were diagnosed with venous tinnitus caused by sigmoid sinus enlargement and underwent mechanical compression of sigmoid sinus were reviewed between April 2009 and May 2013. All these patients received computed tomography and magnetic resonance venography study before undergoing surgery and were followed for at least 4 months.ResultsTwenty-three patients felt relief from tinnitus three months after the surgery, and the cross-sectional area of the sigmoid sinus on the tinnitus side was compressed approximately by half (46%-69%) after the surgery. There were 4 patients whose tinnitus suddenly disappeared while lying on the operating table before operation, which may be a result of the patient's emotional tension or postural changes from standing. One of the four patients felt no relief from tinnitus after the surgery, with the cross-sectional area of the sigmoid sinus only compressed by 30%. And two patients of them had a recurrence of tinnitus about 6 months after the surgery. Seven patients had sigmoid sinus diverticula, and tinnitus would not disappear merely by eliminating the diverticulum until by compressing the sigmoid sinus to certain degree. There were 3 minor complications, including aural fullness, head fullness and hyperacusis. The preoperative low frequency conductive and sensorineural hearing loss of 7 subjects subsided.ConclusionMechanical compression of sigmoid sinus is an effective treatment for pulsatile tinnitus caused by sigmoid sinus enlargement, even if it might be accompanied by sigmoid sinus diverticulum. A compression degree of sigmoid sinus about 54% is adequate for the relief of tinnitus symptom. Cases in which patients' tinnitus suddenly disappeared before the surgery might be excluded to improve the efficacy of surgery.

Evaluation and treatment of pulsatile tinnitus associated with sigmoid sinus wall anomalies

“…Securing the soft tissue graft can be accomplished with bone cement, bone dust, suture, mini‐plate, or a combination of these. Some authors have recommended deliberate compression of the sinus wall with more rigid grafts such as cartilage . Transtemporal approaches have the advantage of direct, binocular visualization and confirmation of the pathology, which is particularly important in the case of isolated dehiscence.…”

“…Some authors have recommended deliberate compression of the sinus wall with more rigid grafts such as cartilage. 49 Transtemporal approaches have the advantage of direct, binocular visualization and confirmation of the pathology, which is particularly important in the case of isolated dehiscence. Long-term anticoagulation is not required, and depending on the technique and materials employed, complication rates should be very low.…”

Patients with pulse-synchronous tinnitus should be suspected to have elevated cerebrospinal fluid pressure

“…Some patients with pulsatile tinnitus have a treatable cause. 3,18 Establishment of the correct diagnosis of pulsatile tinnitus will prevent a potentially life-threatening underlying disorder and avoid disastrous consequences. Individual reports have mentioned that IIH is one of the most common causes of venous pulse-synchronous tinnitus and may even be the first or only clinical presentation.…”

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

“…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]. Studying the hemodynamic changes in the venous sinus of patients with SSWD may reveal mechanisms associated with the development of PT, and could be beneficial with regard to refining surgical techniques.…”

“…Third, unlike the attenuated wall of the SSD, which is fragile and bleeds easily, the exposed segment of the sigmoid sinus was generally normal in patients with SSWD. Since there was little breakage or bleeding during surgery, local anaesthesia may be advantageous because the surgeon is able to obtain valuable feedback from the patients[25]. …”