Postoperative Imaging Findings following Sigmoid Sinus Wall Reconstruction for Pulse Synchronous Tinnitus

Abstract

BACKGROUND AND PURPOSE:Transmastoid sigmoid sinus wall reconstruction is a surgical technique increasingly used for the treatment of pulsatile tinnitus arising from sigmoid sinus wall anomalies. The imaging appearance of the temporal bone following this procedure has not been well-characterized. The purpose of this study was to evaluate the postoperative imaging appearance in a group of patients who underwent this procedure.

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

“…Postoperative imaging in the absence of concerning symptoms is not required, although a contrast‐enhanced CT of the temporal bones to assess the reconstruction and sinus patency may be considered. Typical postoperative imaging findings have been reported . Cases of asymptomatic extraluminal compression may be managed expectantly without complications.…”

“…The greatest risks of transtemporal sinus wall reconstruction, aside from the potential for persisting PT, relate to the disruption of venous outflow and elevation of intracranial pressure. Extraluminal compression and intraluminal thrombosis have both been described . Because the latter is typically a more concerning problem, a modest regimen of perioperative coagulation may be beneficial, using 325 mg of aspirin and 75 mg of clopidogrel daily starting the evening after surgery.…”

“…Extraluminal compression and intraluminal thrombosis have both been described. 19,50 Because the latter is typically a more concerning problem, a modest regimen of perioperative coagulation may be beneficial, using 325 mg of aspirin and 75 mg of clopidogrel daily starting the evening after surgery. Currently, clopidogrel is continued for 2 weeks after surgery and aspirin for 4 weeks.…”

“…Typical postoperative imaging findings have been reported. 50 Cases of asymptomatic extraluminal compression may be managed expectantly without complications.…”

Sigmoid Sinus Wall Reconstruction for Pulsatile Tinnitus Caused by Sigmoid Sinus Wall Dehiscence: A Single-Center Experience

“…Eisenman and colleagues describe a standardized surgical technique for SSD and/or SSWD. They reconstruct the bone defect of the sigmoid sinus wall with three layers: soft-tissue graft (temporalis fascia or neural acellular dermal matrix), hydroxylapatite cement, and autologous bone pate, from the innermost to outmost, and they obtain a higher success rate of surgery than that of our study [7, 8, 20, 21]. It indicates that the reconstruction method used in this study may not be creating an optimal sound barrier, resulting in some patients with partial or no resolution following surgery, and reconstruction with firm materials is recommended [24, 30].…”