Novel Surgical Treatment of a Transverse-Sigmoid Sinus Aneurysm Presenting as Pulsatile Tinnitus

Abstract

This technical case report describes a novel definitive surgical treatment of venous sinus aneurysms. This technique does not necessitate long-term anticoagulation, has a low likelihood of reintervention, and provides immediate resolution of pulsatile tinnitus.

Stent-assisted coil embolization of a transverse-sigmoid sinus diverticulum presenting as pulsatile tinnitus

“…The vascular causes of pulsatile tinnitus are atherosclerotic carotid artery disease, idiopathic intracranial hypertension, dural arteriovenous fistulae, persistent stapedial artery and aberrant internal carotid artery (2,6,8,12).…”

“…It is easy to differentiate the arterial causes of pulsatile tinnitus from the venous causes by gently compressing the internal jugular vein ipsilateral to the tinnitus (2,14). This maneuver immediately improves the pulsatile tinnitus of venous origin (2,14), as in our patient. The U-clips were originally designed for rapid vascular anastomoses in cardiac applications and repair of a venous sinus with U-clips is often limited.…”

“…One of the rare causes of the pulsatile tinnitus is diverticulum of the transverse-sigmoid sinus (2,3). Some reports call this diverticulum as "sinus aneurysm" and these aneurysms were surgically treated in order to eliminate a possible cause of pulsatile tinnitus (1,2,5,9,14).…”

“…Some reports call this diverticulum as "sinus aneurysm" and these aneurysms were surgically treated in order to eliminate a possible cause of pulsatile tinnitus (1,2,5,9,14).…”

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.…”