Surgical Treatment of Pulsatile Tinnitus Caused by the Sigmoid Sinus Diverticulum

The sigmoid sinus diverticulum (SSD) is an increasingly recognized cause of pulsatile tinnitus (PT). Surgical reconstruction of the sigmoid sinus wall has been found to be highly effective for SSD; however, surgical techniques still need to be refined to reduce the incidenceof serious postoperative complications. Moreover, scrutinizing more cases of SSD is desirable for establishing the diagnostic criteria and standardizing the surgical technique. This study was retrospectively undertaken in 28 patients who were diagnosed with SSD upon computed tomography angiography (CTA) and digital subtraction angiography findings at Beijing Tongren Hospital in China. A majority of patients (20/28) presented with SSD and accompanying sigmoid sinus wall dehiscence (SSWD). Twentyfive patients opted to undergo sigmoid sinus wall reconstruction, and 3 patients refused surgery. Following surgery, 17 patients experienced complete resolution of PT, 3 patients experienced partial resolution, and 5 patients experienced no change in PT. No serious complications were found postoperatively. A comparative analysis of the preoperative and postoperative CTA findings suggested that completely resolving SSD and the accompanying SSWD resulted in the elimination of PT. In conclusion, SSD is generally accompanied by SSWD. Sigmoid sinus wall iao-Bo Ma, MD, Z MD, hu-Sheng Gong, MD, PhD (Medicine 94(21):e882) Abbreviations: BMI = body mass index, CTA = computed tomography angiography, DSA = digital subtraction angiography, PT = pulsatile tinnitus, SSD = sigmoid sinus diverticulum, SSWD = sigmoid sinus wall dehiscence, THI = Tinnitus Handicap