Prevalence of Tinnitus in Patients Diagnosed with Cerebral Arteriovenous Fistula Treated with Endovascular Technique

Abstract

Introduction Tinnitus is characterized as the conscious and involuntary perception of sound, and it affects ∼ 30% of the population. Despite careful physical examination, the etiology of tinnitus can be established for only 30% of patients. Tinnitus is a common symptom of cerebral arteriovenous fistulas and results from increased blood flow through the dural venous sinuses, leading to turbulent arterial flow, mainly related to sigmoid and transverse sinus lesions. Objectives To analyze the frequency of tinnitus, patient profile, and endovascular treatment characteristics in individuals diagnosed with cerebral arteriovenous fistulas. Methods A retrospective and observational study based on reviewed data from medical records on the PHILIPS Tasy system (Philips Healthcare, Cambridge, MA, USA) at the neurosurgery and interventional neuroradiology service of Hospital Santa Isabel in Blumenau–state of Santa Catarina, Brazil. Results The profile of 68 individuals diagnosed with cerebral arteriovenous fistula who underwent endovascular treatment were analyzed. Most patients were female, aged 31 to 60. Tinnitus affected 18 individuals. Dural fistulas were the most prevalent in the sample, and computed tomography alone was the most used diagnostic method for initial investigation. Conclusion The prevalence of this symptom in patients diagnosed with cerebral arteriovenous fistula was found in 26.5% of this sample, mainly in women with associated comorbidities. Tinnitus remission was observed in all patients who underwent endovascular treatment to correct cerebral fistula.

Update on Management of Dural Arteriovenous Fistulas

“…The most consequential symptoms are NHND and ICH due to rupture [40, 41]; however, these are not the most common symptoms upon presentation. Patients with both low-and high-grade dAVF can present asymptomatically or most frequently with headache, followed by pulsatile tinnitus [23]. The low-grade dAVF are often considered benign, and treatment is conservative or reserved for symptom management to improve quality of life.…”

“…Briefly, low-grade fistulas are generally benign but can present with headache, pulsatile tinnitus, vertigo, bruits, and ophthalmologic abnormalities and visual changes [21,[23][24][25]. Symptom severity is variable and can be minor or severely affect the quality of life.…”

“…High-grade dAVF are defined by the presence of cortical venous drainage (CVD) and are associated with significant mortality and morbidity. They are aggressive lesions with elevated risks of intracranial hemorrhage (ICH) and non-hemorrhagic neurological deficits (NHND) [13,20,23,[28][29][30]. In high-grade dAVF, the risk of ICH is reportedly as high as 20% [13].…”