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

Eisenman, David J.; Raghavan, Prashant; Hertzano, Ronna; Morales, Robert E.

doi:10.1002/lary.27218

Cited by 83 publications

(158 citation statements)

References 45 publications

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“…[15][16][17] For SSWAs, it is more likely, although still unconfirmed, that TSS causes flow anomalies that directly result in the formation of a diverticulum or dehiscence. 9 The present data, which demonstrate that the majority of stenoses associated with SSWA are limited to or include the distal transverse sinus immediately proximal to the starting point of most SSWAs, support this hypothesis. A jet of narrowed, increased, and possibly turbulent flow distal to a stenotic segment would be expected to impact the lateral wall of the sigmoid sinus in the location of most SSWAs.…”

Section: Discussionsupporting

confidence: 80%

“…For IIH, there are conflicting data, some that support TSS as a cause of IIH and others that suggest TSS results from IIH . For SSWAs, it is more likely, although still unconfirmed, that TSS causes flow anomalies that directly result in the formation of a diverticulum or dehiscence . The present data, which demonstrate that the majority of stenoses associated with SSWA are limited to or include the distal transverse sinus immediately proximal to the starting point of most SSWAs, support this hypothesis.…”

Section: Discussionmentioning

confidence: 49%

“…SSWAs are more common in female patients with an elevated body mass index (BMI), the demographic most frequently affected by IIH. Subjects with SSWAs and PT also have an increased incidence of other radiographic findings known to be associated with IIH . Furthermore, in a small series of patients undergoing transtemporal sinus wall reconstruction for PT due to SSWAs, intraoperative lumbar puncture demonstrated elevated mean opening pressures in the majority of patients…”

Section: Introductionmentioning

confidence: 99%

“…Subjects with SSWAs and PT also have an increased incidence of other radiographic findings known to be associated with IIH. 8,9 Furthermore, in a small series of patients undergoing transtemporal sinus wall reconstruction for PT due to SSWAs, intraoperative lumbar puncture demonstrated elevated mean opening pressures in the majority of patients. 10 Transverse sinus stenosis (TSS) is strongly associated with IIH.…”

Section: Introductionmentioning

confidence: 99%

“…TSS is also strongly associated with SSWAs. 9 However, despite significant overlap in features of patients with IIH and SSWAs, it is unknown why certain patients preferentially develop one of these pathologies versus the other. Because SSWAs affect a patient population similar to that with IIH, and both groups of affected patients have an increased incidence of TSS, we sought to systematically describe the location and severity of TSS in a consecutive series of patients with SSWAs and then compare these findings to those previously described for patients with IIH.…”

Section: Introductionmentioning

confidence: 99%

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Pattern and severity of transverse sinus stenosis in patients with pulsatile tinnitus associated with sigmoid sinus wall anomalies

et al. 2019

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Objective Describe the location and severity of transverse sinus stenosis (TSS) in a consecutive series of patients with intraoperatively confirmed sigmoid sinus wall abnormalities (SSWA). Methods A retrospective review of imaging studies from patients undergoing sinus wall reconstruction for pulsatile tinnitus associated with SSWA “was performed.” Qualitative and quantitative analyses of the TSS, including the side, type, location, extent, and severity, were performed and compared with normal controls and historical controls with idiopathic intracranial hypertension (IIH). Results Twenty‐six of 36 subjects had adequate imaging data. The majority of subjects had some degree of bilateral TSS, and the majority of stenoses involved the distal transverse sinus. Subjects with diverticulum were significantly more likely than those with dehiscence to have ipsilateral distal TSS (16 of 16 vs. 4 of 10, P = 0.009). The mean minimum transverse sinus diameter, stenosis severity grade, and overall posterior venous sinus outflow were significantly worse in the subjects as compared to normal controls (P = 0.002), although not as severe as the comparable values in historical controls with IIH (P < 0.003). Conclusion Subjects with SSWA have a high incidence of TSS, with patterns differing between those with dehiscence and diverticulum. Severity of TSS and overall posterior fossa venous outflow are worse as compared to normal controls but not as severe as in subjects with IIH. These findings have implications for the pathophysiology and management of SSWA. Level of Evidence 4 Laryngoscope, 130:1028–1033, 2020

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pattern and severity of transverse sinus stenosis in patients with pulsatile tinnitus associated with sigmoid sinus wall anomalies

et al. 2019

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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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In Response to Letter to the Editor Regarding: Evaluation and Treatment of Pulsatile Tinnitus Associated With Sigmoid Sinus Wall Anomalies

et al. 2019

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

Abstract: 4 Laryngoscope, 128:S1-S13, 2018.

Cited by 83 publications

References 45 publications

Pattern and severity of transverse sinus stenosis in patients with pulsatile tinnitus associated with sigmoid sinus wall anomalies

Pattern and severity of transverse sinus stenosis in patients with pulsatile tinnitus associated with sigmoid sinus wall anomalies

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

In Response to Letter to the Editor Regarding: Evaluation and Treatment of Pulsatile Tinnitus Associated With Sigmoid Sinus Wall Anomalies

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