Endovascular Treatment of Transverse-Sigmoid Sinus Dural Arteriovenous Malformations Presenting as Pulsatile Tinnitus

Abstract

Transverse-sigmoid sinus dural arteriovenous malformations (DAVM) are uncommon vascular lesions for which complete cure may be difficult to obtain. A wide variety of treatments for these lesions include observation, arterial compression, surgical resection, and endovascular embolization. We propose that transverse-sigmoid sinus DAVM can be completely cured by occluding the ipsilateral dural sinus with detachable balloon and Guglielmi detachable coils (GDC) coils before arterial feeder embolization with histoacryl. Three patients who presented with pulsatile tinnitus and normal magnetic resonance imaging (MRI) studies underwent angiography, which demonstrated transverse-sigmoid sinus DAVM. All three patients were treated with retrograde transvenous sinus embolization with complete occlusion of the transverse-sigmoid sinus with detachable balloons and GDC coils with preservation of the vein of Labbe. Subsequently, the various feeders from the external carotid artery were embolized. The tentorial arteries arising from the ipsilateral internal carotid arteries were not embolized in any of the cases, which were still contributing to the DAVM. Complete cure with thrombosis of the tentorial branch of the internal carotid artery (ICA) was seen on follow-up angiogram 1 day after embolization in one patient and on 4-week and 6-week follow-up angiograms in the other two patients. Complete occlusion of the transverse sinus proximal to the vein of Labbe, in spite of incomplete arterial feeder embolization, can result in complete cure of the transverse 13

Treatments for Tinnitus

“…Appropriate surgery has been reported as able to address such a cause and remove the auditory experience (e.g., Duvillard, Ballester, Redon, & Romanet, 2004;Shownkeen, Yoo, Leonetti, & Origitano, 2001). It is a tenable argument I n this article, the focus is necessarily on people seeking help for tinnitus; otherwise they would not be engaging in one or other form of treatment.…”

Endovascular Management of Intracranial Dural Arteriovenous Fistulas

“…Several unique transvenous embolization options have been reported for cavernous sinus dAVFs and include access via the pterygoid plexus, 45 puncture after surgical exposure of the superior ophthalmic vein, 46-50 direct puncture of the superior 51 and inferior ophthalmic veins, 52-54 facial vein puncture, and access via a frontal vein. 55 Detachable balloons were previously used for both transvenous 35,47,56,57 and transarterial embolization of low-flow dAVFs 6 but are no longer available in the United States. Percutaneous embolization of the cavernous sinus via the superior orbital fissure was first reported by Teng and colleagues.…”

Pulsatile tinnitus in perimenopausal period

“…Unlike other types of tinnitus, the cause of this disorder can be identified and a good therapeutic outcome can be achieved [1]. Surgical therapy [2,3] and endovascular intervention [4][5][6] have been reported. However, due to the small number of cases encountered in clinical practice this disorder is not well characterized in terms of its etiology or the relationship between hearing loss and tinnitus.…”

“…Sigmoid sinus diverticulum-induced pulsatile tinnitus, a type of vein-derived tinnitus [1], is a rare medical problem [2][3][4][5][6]. Unlike other types of tinnitus, the cause of this disorder can be identified and a good therapeutic outcome can be achieved [1].…”