Occult pulsatile tinnitus in association with a prominent vein of hypoglossal canal: two case reports

BACKGROUND AND PURPOSE: Venous pulsatile tinnitus is a disabling condition mainly caused by a stenosis of the lateral sinus. Here, we aimed to report a novel cause of venous pulsatile tinnitus, stenosis of the marginal sinus. MATERIALS AND METHODS:We retrospectively analyzed patients with isolated venous pulsatile tinnitus for which the suspected cause was a stenosis of the marginal sinus, treated or not, between January 2017 and December 2020. Patient charts and imaging were systematically reviewed. All patients underwent noncontrast temporal bone CT and MR imaging.RESULTS: Eight patients (7 women; median age, 36 years) were included. Six patients (75%) were overweight, and 1 patient had idiopathic intracranial hypertension. All patients presented with a typical venous pulsatile tinnitus. The stenosis of the marginal sinus was detected using oblique reconstructions on postcontrast 3D MR imaging. There was no other pathologic finding except ipsilateral stenosis of the lateral sinus in 3 patients. Four patients underwent endovascular therapy with placement of a stent in the marginal sinus, leading to complete resolution of the pulsatile tinnitus for all of them. No complication occurred. Of note, the symptoms of intracranial hypertension also regressed after stent placement in that patient. CONCLUSIONS:Marginal sinus stenosis is a novel cause of venous pulsatile tinnitus, which can be easily detected on MR imaging. Marginal sinus stent placement is safe and efficient. We hypothesized that the marginal sinus stenosis pathophysiology is similar to that of lateral sinus stenosis, which is a common and well-known cause of venous pulsatile tinnitus, explaining the similar clinical presentation and endovascular management.ABBREVIATIONS: IIH ¼ idiopathic intracranial hypertension; LS ¼ lateral sinus; MS ¼ marginal sinus; OS ¼ occipital sinus; PT ¼ pulsatile tinnitus; SSS ¼ superior sagittal sinus; VAS ¼ visual analog scale P ulsatile tinnitus (PT) is an uncommon-but-disabling symptom, which has numerous causes, both vascular and nonvascular. 1 Venous etiologies of PT are suspected when the tinnitus disappears by compressing the ipsilateral internal jugular vein. Venous etiologies of PT are increasingly reported and are related to venous abnormalities like lateral sinus (LS) stenosis, 2 sigmoid sinus diverticulum, 3,4 dehiscence, 5 or a mastoid emissary vein. 6 It is paramount to recognize such anomalies because they are often manageable by endovascular treatment. 2,3,6 Here, we report the clinical and radiographic features as well as the therapeutic management of patients with PT caused by a stenosis of the marginal sinus (MS).

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Pulsatile Tinnitus Due to Stenosis of the Marginal Sinus: Diagnosis and Endovascular Treatment

Cortese

Eliezer

Guédon

et al. 2021

AJNR Am J Neuroradiol

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Occult pulsatile tinnitus in association with a prominent vein of hypoglossal canal: two case reports

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Pulsatile Tinnitus Due to Stenosis of the Marginal Sinus: Diagnosis and Endovascular Treatment

Pulsatile Tinnitus Due to Stenosis of the Marginal Sinus: Diagnosis and Endovascular Treatment

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