Pattern and severity of transverse sinus stenosis in patients with pulsatile tinnitus associated with sigmoid sinus wall anomalies

Abstract Objectives To investigate the correlation between transverse sinus stenosis (TSS) and transstenotic pressure gradient (TPG) in unilateral pulsatile tinnitus (PT) patients with sigmoid sinus wall anomalies (SSWA). Methods Fifty-seven patients with unilateral venous PT were retrospectively included. All of them underwent CT venography and catheter manometry, accompanied with SSWA. The degree, length, shape (intrinsic/extrinsic/dysplasia), location (proximal/middle/distal, referring to the relative position of TSS and the Labbé vein junction) of TSS, the types of SSWA (dehiscence/diverticulum), and the degree of transverse sinus outflow laterality were assessed, and the correlations with ipsilesional TPG were analyzed. Results The mean value of ipsilesional TPG was 7.61 ± 0.52 mmHg. The degree and length of ipsilesional TSS were positively correlated with TPG (p < 0.001, p’ < 0.001), respectively. TPG was significantly larger in patients with contralateral transverse sinus dysplasia than those without (p = 0.023) and significantly smaller in patients with ipsilesional sigmoid sinus diverticulum than those with isolated dehiscence (p = 0.001). No statistical difference in TPG was shown between ipsilesional TSSs of different shapes or locations (p > 0.05). No correlation was noted between the degree of ipsilesional transverse sinus outflow laterality and TPG (p = 0.051). Stepwise linear regression indicated that the degree (β = 9.207, 95% CI = 3.558–14.856), length (β = 0.122, 95% CI = 0.025–0.220) of ipsilesional TSS, and contralateral transverse sinus dysplasia (β = 1.875, 95% CI = 0.220–3.530) were significantly correlated with TPG (R2 = 0.471). Conclusions The degree, length of ipsilesional TSS, and contralateral transverse sinus dysplasia may be used to predict TPG in unilateral PT patients with SSWA. Key Points • CT venography may act as a screening tool to help low-probability unilateral pulsatile tinnitus (PT) patients with sigmoid sinus wall anomalies (SSWA) avoid invasive catheter manometry. • The degree and length of ipsilesional transverse sinus stenosis (TSS) are positively correlated with transtenotic pressure gradient (TPG) in unilateral PT patients with SSWA. • Ipsilesional TPG is larger in unilateral PT patients with contralateral transverse sinus dysplasia than those without and is smaller in unilateral PT patients with sigmoid sinus diverticulum than those with isolated dehiscence.

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Study on the correlation between hemodynamic status of the transverse sinus-sigmoid sinus and the clinical efficacy of sigmoid sinus wall reconstruction

Interventional Neuroradiology ◽

10.1177/15910199211062025 ◽

2021 ◽

pp. 159101992110620

Author(s):

Zhenfeng Li ◽

Long Jin

Keyword(s):

Blood Flow ◽

Pressure Distribution ◽

Flow Velocity ◽

Clinical Efficacy ◽

Blood Flow Velocity ◽

Transverse Sinus ◽

Sigmoid Sinus ◽

Pulsatile Tinnitus ◽

Sinus Wall ◽

Sinus Stenosis

Background and Purpose For patients with pulsatile tinnitus who have both transverse sinus stenosis and sigmoid sinus wall anomalies, sigmoid sinus wall reconstruction surgery is the first-choice treatment when the trans-stenotic pressure gradient less than 10 mmHg. However, not all patients are cured by surgery. We hypothesized the abnormal hemodynamics caused by transverse sinus stenosis is associated with the clinical efficacy of surgery. Methods Eight pulsatile tinnitus patients treated with surgery were retrospectively reviewed (4 rehabilitated, 4 nonrehabilitated). All patients had radiologically diagnosed transverse sinus stenosis and sigmoid sinus wall anomalies. A numerical simulation of the hemodynamics of the transverse sinus-sigmoid sinus was performed using computational fluid dynamics technology. Changes in the blood flow patterns before and after surgery were observed. The blood flow velocity at the stenosis, vorticity of blood flow in the sigmoid sinus and wall pressure distribution in the sigmoid sinus wall anomalies area were compared. Results The blood flow velocity in the stenosis (preoperative P = 0.04, postoperative P = 0.004) and vorticity in the sigmoid sinus (preoperative P = 0.02, postoperative P = 0.007) pre- and post-surgery were significantly higher in the non-rehabilitation group than in the rehabilitation group. No significant difference was found in the wall pressure distribution in the sigmoid sinus wall anomalies area (preoperative P = 0.12, postoperative P = 0.24). Conclusions There is a clear correlation between the abnormal hemodynamic status caused by transverse sinus stenosis and the clinical efficacy of surgery. The blood flow velocity at the stenosis and vorticity of blood flow in the sigmoid sinus are factors influencing the clinical efficacy of surgery.

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Bone remodeling in sigmoid sinus diverticulum after stenting for transverse sinus stenosis in pulsatile tinnitus: A case report

World Journal of Clinical Cases ◽

10.12998/wjcc.v9.i10.2320 ◽

2021 ◽

Vol 9 (10) ◽

pp. 2320-2325

Author(s):

Xiao-Yu Qiu ◽

Peng-Fei Zhao ◽

He-Yu Ding ◽

Xiao-Shuai Li ◽

Han Lv ◽

...

Keyword(s):

Case Report ◽

Bone Remodeling ◽

Transverse Sinus ◽

Sigmoid Sinus ◽

Pulsatile Tinnitus ◽

Sinus Stenosis

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Transmastoid Hydroxyapatite Resurfacing for Sigmoid Sinus Wall Anomalies Causing Pulsatile Tinnitus

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420987407 ◽

2021 ◽

pp. 000348942098740

Author(s):

Ian Newberry ◽

Julie Highland ◽

Alvin DeTorres ◽

Richard Gurgel

Keyword(s):

Case Series ◽

Sigmoid Sinus ◽

Pulsatile Tinnitus ◽

Retrospective Case ◽

Tertiary Referral Center ◽

Operative Outcomes ◽

Sinus Wall ◽

Objective Tinnitus ◽

Materials Used

Objective: Comprising 4% of tinnitus, pulsatile tinnitus (PT) can be particularly difficult for affected patients as well as surgeons looking to address their symptoms. Often the cause is not identified but can be secondary to turbulent flow in or near the sigmoid sinus, particularly if there is an identifiable sigmoid sinus dehiscence (SSDe) and/or diverticulum (SSDi). These sigmoid sinus wall anomalies (SSWA) may be treated with transmastoid sigmoid sinus resurfacing; however, this intervention remains relatively novel and its technique, materials used, resolution success, and complications need to be continuously reviewed. Methods: A retrospective case series of patients with PT due to SSWA at a tertiary referral center was reviewed. A total of 6 patients (7 ears) treated by transmastoid resurfacing using hydroxyapatite (HA) were retrospectively assessed. Pre-operative demographics and symptoms, pre- and post-operative hearing results, and post-operative outcomes were reviewed. Results: All patients were female with an average BMI of 32.9 (±5.4) and a mean age of 45.5 years (±15.3). Mean follow-up was 648 days. Objective tinnitus was noted in all ears with SSDi (100%); however, no objective tinnitus was noted with purely SSDe. In 100% of ears, PT was diminished with ipsilateral jugular compression and was amplified with contralateral head turn. Pre-operative symptoms of PT resolved in all patients, but delayed recurrence (>1 year) occurred in 1 ear (14%). No patient had pre- or post-operative hearing loss. No major complications were encountered. Conclusions: Transmastoid resurfacing for SSWA with HA bone cement is a safe, reliable intervention in properly identified PT patients.

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Physical and psychological outcomes of simple sigmoid sinus bony wall repair for pulsatile tinnitus due to sigmoid sinus wall anomalies

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-019-05380-1 ◽

2019 ◽

Vol 276 (5) ◽

pp. 1327-1334 ◽

Cited By ~ 5

Author(s):

Chen Zhang ◽

Qiang Li ◽

Shufeng Li

Keyword(s):

Psychological Outcomes ◽

Sigmoid Sinus ◽

Pulsatile Tinnitus ◽

Sinus Wall

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In Response to Letter to the Editor Regarding: Evaluation and Treatment of Pulsatile Tinnitus Associated With Sigmoid Sinus Wall Anomalies

The Laryngoscope ◽

10.1002/lary.27797 ◽

2019 ◽

Vol 129 (4) ◽

pp. E128-E128 ◽

Cited By ~ 1

Author(s):

David J. Eisenman ◽

Ronna Hertzano ◽

Prashant Raghavan ◽

Robert Morales

Keyword(s):

Sigmoid Sinus ◽

Pulsatile Tinnitus ◽

Letter To The Editor ◽

Sinus Wall

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Temporal bone contrast-enhanced high-resolution CT evaluation of pulsatile tinnitus after sigmoid sinus wall reconstruction

Acta Radiologica ◽

10.1177/0284185118773509 ◽

2018 ◽

Vol 60 (1) ◽

pp. 54-60 ◽

Cited By ~ 2

Author(s):

Heyu Ding ◽

Pengfei Zhao ◽

Han Lv ◽

Xuehuan Liu ◽

Rong Zeng ◽

...

Keyword(s):

Temporal Bone ◽

Short Interval ◽

Sigmoid Sinus ◽

Imaging Features ◽

Pulsatile Tinnitus ◽

Interval Group ◽

Sinus Wall ◽

Contrast Enhanced ◽

Air Cells ◽

Mastoid Air Cells

Background Sigmoid sinus wall reconstruction (SSWR) is a proven effective treatment for pulsatile tinnitus (PT) caused by sigmoid sinus wall dehiscence (SSWD) with or without sigmoid sinus diverticulum (SSD); however, comprehensive analysis of the postoperative imaging manifestations has not yet been reported. Purpose To analyze temporal bone computed tomography (CT) imaging features following SSWR in patients with PT. Material and Methods Following SSWR, temporal bone contrast-enhanced high-resolution CT (HRCT) images from 33 PT cases were retrospectively analyzed. Patients were divided into two groups based on follow-up interval: a short-interval group (≤18 months, 12 cases) and a long-interval group (>18 months, 21 cases). The mending material density and morphology was analyzed. Postoperative changes of the venous sinus were evaluated. Imaging manifestations of the normal temporal bone and mastoid air cells adjacent to the operative field were observed. Results The order of CT values of mending materials was significantly lower in the short-interval group than in the long-interval group (Z = −4.716, P < 0.001); the incidence of complete newly remodeled cortical bone on the rim of the mending materials was significantly higher in the long-interval group than in the short-interval group ( P < 0.001). Eleven patients (33.3%) showed varying degrees of remnant SSWD. The mending materials and normal mastoid bone structure showed complete fusion (n = 12, 36.4%), partial fusion (n = 16, 48.5%), or complete separation (n = 5, 15.2%). Conclusion Temporal bone contrast-enhanced HRCT can be used to observe imaging features of the mending materials, venous sinus, adjacent normal temporal bone and mastoid air cells following SSWR.

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