Endovascular coiling of large mastoid emissary vein causing pulsatile tinnitus

The association of large mastoid emissary veins and pulsatile tinnitus has been reported. However, therapeutic options for this condition remain limited. We report a case of endovascular coiling of a large mastoid emissary vein in a patient with disabling pulsatile tinnitus with significant improvement of symptoms. To our knowledge, endovascular coiling of large mastoid emissary vein causing pulsatile tinnitus has not been reported.

Selective embolization of the mastoid emissary vein for pulsatile tinnitus treatment: when is it indicated?

BackgroundVenous pulsatile tinnitus (PT) can be caused by the perception of blood flow through the mastoid emissary vein (MEV). However, the causal relationship of this anomaly has not been established as selective occlusion of this vein has never been performed. The aim of this study was to report on a small series of patients suspected of having PT caused by an MEV, who underwent MEV embolization as treatment for PT, and to identify the correct indications for this procedure.MethodsThis was a single center retrospective study (CNIL 2215065) including six patients with isolated disabling PT treated by embolization of the MEV, recruited between December 2017 and August 2019. Patient charts were systematically reviewed. All patients underwent non-contrast temporal bone CT and MRI.ResultsMean age of the patients (five women, one male) was 56.3 years (range 40–71 years). Two patients presented with venous PT and four had neutral PT. The MEV was in direct contact with the mastoid air cells on temporal bone CT in all patients. Based on clinical examination, two patients presented with venous PT while four patients had neutral PT. In all cases of venous PT, selective embolization of the MEV caused the tinnitus to disappear, suggesting technical success. In contrast, embolization of the MEV had no effect in patients with neutral PT.ConclusionsWe demonstrated that MEV could be a source of venous PT. Embolization of the MEV was effective only in cases of clinical venous PT.