Incidence of Vascular Anomalies and Variants Associated with Unilateral Venous Pulsatile Tinnitus in 242 Patients Based on Dual-phase Contrast-enhanced Computed Tomography

Abstract

Background:A comprehensive assessment of various vascular anomalies and variants associated with venous pulsatile tinnitus (PT) by radiography is essential for therapeutic planning and improving the clinical outcome. This study evaluated the incidence of various vascular anomalies and variants on the PT side and determined whether these lesions occurred as multiple or single entities.Methods:The dual-phase contrast-enhanced computed tomography images of 242 patients with unilateral venous PT were retrospectively reviewed. The vascular anomalies and variants on the symptomatic and asymptomatic sides were analyzed, and the incidences of anomalies or variants on each side were compared. The number of anomalies and variants on the symptomatic side in each patient was calculated.Results:(1) A total 170 patients (170/242) had more than one anomaly or variant on the symptomatic side, and 58 patients (58/242) had a single lesion on tomography. (2) There was a statistically significant difference in the incidence of dehiscent sigmoid plate (P = 0.000), lateral sinus stenosis (P = 0.014), high jugular bulb (P = 0.000), sigmoid sinus diverticulum (P = 0.000), jugular bulb diverticulum (P = 0.000), dehiscent jugular bulb (P = 0.000), and a large emissary vein (P = 0.006) between the symptomatic and asymptomatic sides. (3) Dehiscent sigmoid plate (86.4%) was the most frequent lesion on the symptomatic side, followed by lateral sinus stenosis (55.8%), high jugular bulb (47.1%), sigmoid sinus diverticulum (34.3%), jugular bulb diverticulum (13.6%), dehiscent jugular bulb (13.6%), large emissary vein (4.1%), sinus thrombosis (1.2%), and petrosquamosal sinus (0.8%).Conclusions:Various vascular anomalies and variants occur more frequently on the venous PT side. Preliminary findings suggest that venous PT patients may have multiple vascular anomalies or variants on the symptomatic side.

The Prevalence of Persistent Petrosquamosal Sinus and Other Temporal Bone Anatomical Variations on High-Resolution Temporal Bone Computed Tomography

“…Recent data suggest that patients with venous pulsatile tinnitus may have multiple vascular anomalies or variants on the symptomatic side [8]. Furthermore some variations can be misinterpreted as pathological conditions and, as a result, contribute to further unnecessary diagnostic tests or examinations [9].…”

“…Different vascular variations, including a prominent jugular bulb with dehiscence of the bony margins (Figure 2), anteriorly located sigmoid sinus, or dehiscent ICA of the TB region, were reported to be a cause of intraoperative complications associated with profuse bleeding during surgery [2,6–8]. We observed one case with perioperative complications arising from profuse bleeding from a PSS that was considered by the surgeon to have been caused by damage to the anteriorly located sigmoid sinus (Figure 3).…”

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

“…Pulsatile tinnitus can be caused by abnormal sound perception of a normal internal stimulus, such as in third mobile window syndromes, or by abnormal sound production, such as with acquired dural vascular lesions or temporal bone paraganglioma . Venous etiologies of PT have been described and identified with increasing frequency . A common nonpulse‐synchronous cause of objective tinnitus is the rhythmic clicking or fluttering associated with middle ear or palatal myoclonus .…”

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

“…It can be caused by abnormal sound production such as from acquired dural vascular lesions or temporal bone paragangliomas, or it can be caused by abnormal sound perception, for example from third mobile window syndromes such as superior semicircular canal dehiscence. Venous etiologies of abnormal sound production are being recognized with increasing frequency …”