Endovascular treatment of a transverse—sigmoid sinus aneurysm presenting as pulsatile tinnitus

Abstract

The authors report on the case of a 38-year-old woman who had experienced incapacitating pulsatile tinnitus in the left ear for 6 months. Angiographic studies revealed a wide-necked venous aneurysm of the left transverse-sigmoid sinus. Solitary stent placement across the aneurysm neck resulted in a slight modification in the lesion's characteristics. A second session, in which embolization with Guglielmi Detachable Coils was performed, resulted in a 100% occlusion of the aneurysm, with patency of the parent vessel and resolution of the tinnitus.

Endovascular Management of Sigmoid Sinus Diverticulum

“…We found seven case reports describing endovascular management of SSD as a treatment of PT (table 1) [1,7,8,9,10,11,12,13]. Three of these cases received a stent with or without coiling [7,8,12]. All patients needing sinus stenting will have to be premedicated with dual antiplatelet medication.…”

“…All patients needing sinus stenting will have to be premedicated with dual antiplatelet medication. In order to minimize procedural risks, risk of in-stent thrombosis and hemorrhagic complications, stents should be limited to cases requiring their use to adequately position coils in the diverticulum, as in our case and a previous one [8]. …”

Pulsatile Tinnitus

“…Like arterial aneurysms, a sigmoid-transverse venous aneurysm can be causally related to venous pulsatile tinnitus [95][96][97]. After coagulation of the aneurysm and reconstruction of the sinus wall [96], or after endovascular treatment [97], the pulsations can disappear.…”

“…After coagulation of the aneurysm and reconstruction of the sinus wall [96], or after endovascular treatment [97], the pulsations can disappear.…”

Occult pulsatile tinnitus in association with a prominent vein of hypoglossal canal: two case reports

“…This maneuver results in immediate resolution of tinnitus of venous origin but amplifies that of arterial origin. The venous causes of pulsatile tinnitus include diverticulum or aneurysm of the transverse-sigmoid sinus (7,11,12,18), prominent or stenotic sigmoid sinus (5,8,13,14,16), superficial lateral course of sigmoid sinus (10,17), jugular bulb diverticulum (5,14), high dehiscent jugular bulb (2), abnormal mastoid emissary vein and abnormal posterior condylar emissary vein (3,6). Although pathologic causes for the symptoms are always given strong consideration, normal variations should also be included in a possible differential diagnosis.…”