Endovascular treatment of debilitating tinnitus secondary to cerebral venous sinus abnormalities: a literature review and technical illustration

Abstract

Background and objectivePulsatile tinnitus (PT) can be debilitating and lead to significant morbidity. Cerebral venous sinus lesions, such as venous sinus stenosis, diverticula, and high-riding jugular bulb, are uncommon causes of PT, for which there is no standard treatment. Endovascular interventions have shown promising results for PT secondary to idiopathic intracranial hypertension, and may be a valid therapeutic option for isolated venous PT.MethodsWe conducted a systematic literature review on the outcome and safety of endovascular treatment for patients with isolated, debilitating venous PT. The venous lesion characteristics, endovascular techniques, complications, and clinical outcomes were assessed. In addition, an illustrative case of endovascular stenting for PT caused by venous sinus stenosis was included.ResultsA total of 41 patients (90.2% female) from 26 papers were included. The median age was 46 years (IQR 23; range 25–72 years). Focal venous sinus stenosis (20 patients) and sinus diverticula (14 patients) were the most common culprit lesions. Endovascular treatment included venous sinus stenting in 35 patients, 11 of whom had adjuvant coil embolization, and coil embolization alone in six patients. Complete resolution of the tinnitus was achieved in 95.1% of patients. There was one complication of cerebellar infarct, and no procedure-related mortality.ConclusionsIn patients with debilitating PT secondary to venous sinus lesions, endovascular treatment by stenting and/or coil embolization appears to be safe and effective. Prospective randomized studies with objective outcome assessments are needed to confirm the treatment benefits.

Empty Sella Is a Sign of Symptomatic Lateral Sinus Stenosis and Not Intracranial Hypertension

“…We elected to exclude patients with associated sigmoid sinus wall anomalies in the current study because endovascular therapy can also be effective in dealing with this etiology of pulsatile tinnitus. 19 One of the limitations of our study lies in its retrospective nature. Discrimination between patients with IIH and IPT relied on retrospective chart review and on chart annotation or lumbar puncture opening pressures, ophthalmologic assessments, and clinical histories.…”

“…[14][15][16][17] When pulsatile tinnitus is disabling, stent placement for lateral sinus stenosis may be efficient for suppressing it. [18][19][20] We therefore hypothesized that an empty sella is a consequence not of the elevation of the intracranial pressure but of the venous sinus stenosis. This stenosis, when symptomatic, may present in the form of either IIH or isolated venous pulsatile tinnitus (IPT).…”

Torrents of torment: turbulence as a mechanism of pulsatile tinnitus secondary to venous stenosis revealed by high-fidelity computational fluid dynamics

“…10 In addition, in recent years there has been an increasing recognition of other venous sinus lesions and PT, including a strong association with intracranial idiopathic hypertension (IIH). 11 These venous lesions may include venous sinus stenosis, thrombosis, diverticulum, dilatations, giant arachnoid granulations or extrinsic compressions of the sinuses. 1 9 Despite reports of successful treatments of PT related to these venous lesions, [11][12][13] much controversy still exists regarding the role of these vascular lesions (especially venous lesions) in the etiology of PT.…”

Cerebral Venous Stenting for Pulsatile Tinnitus After Unsuccessful Jugular Ligation: Case Report and Literature Review

“…A few case reports, case series, and literature reviews have been published reporting high safety and good outcome of venous stenting in PT patients. 4,7,10,13 Due to its subjective nature, PT is likely underdiagnosed and the diagnostic evaluation of patient with this symptom has proven to be challenging. 15,16 It is also worth mentioning that the damage of tinnitus to quality of life can be significant.…”

“…Venous stenting for isolated PT has been reported but is not a well-established treatment. [9][10][11][12][13] Ligation of jugular bulb as a treatment for PT is also not well established. There are publications available on this topic, some of which report poor outcomes and unpredictable complications.…”