• Neurosurgery · Nov 2015

    Sinus Wall Resurfacing for Patients With Temporal Bone Venous Sinus Diverticulum and Ipsilateral Pulsatile Tinnitus.

    • Jae-Jin Song, Young-Jin Kim, So Young Kim, Yun Suk An, Kanghyeon Kim, Sang-Yeon Lee, and Ja-Won Koo.
    • *Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea; ‡Department of Otorhinolaryngology-Head and Neck Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea.
    • Neurosurgery. 2015 Nov 1; 77 (5): 709-17; discussion 717.

    BackgroundPulsatile tinnitus (PT) caused by venous sinus diverticulum is a relatively common, potentially incapacitating condition. Although treatment via an external approach or endovascular coiling has been reported, much remains unknown about the possible pathophysiological mechanisms and appropriate management of PT.ObjectiveTo review our case series of PT resulting from either sigmoid sinus diverticulum (SSD) or middle cranial fossa venous sinus diverticulum (MFD-VS) and to discuss the possible pathophysiological mechanisms and desirable treatment options.MethodsFour PT patients with either SSD or MFD-VS were treated with transmastoid resurfacing. In 1 case, a revision operation was performed as a result of recurrence of PT 4.5 years after the initial operation. The medical records and temporal bone imaging findings were retrospectively reviewed.ResultsPT was resolved in all cases immediately after transmastoid resurfacing, but 1 patient in whom bone wax was used for initial resurfacing experienced PT 4.5 years later. The PT was successfully managed with revision resurfacing with autologous bone chips/bone cement. In the other cases, the resolution of PT lasted throughout a median follow-up of 5.75 years. Notably, 2 of 4 cases had preoperative low-frequency hearing loss (LFHL) and experienced immediate postoperative improvement in LFHL.ConclusionPT resulting from either SSD or MFD-VS can be treated successfully with transmastoid resurfacing of the venous wall. Preoperative ipsilesional LFHL and the improvement of hearing threshold after surgical intervention may be preoperative and postoperative surrogate objective signatures of PT. To ensure the resolution of symptoms, secure reconstruction with firm materials and long-term follow-up are mandatory.

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