Imaging Prevalence of Sigmoid Sinus Dehiscence among Patients with and without Pulsatile Tinnitus

Schoeff, Stephen S.; Nicholas, Brian D.; Mukherjee, Sugoto; Kesser, Bradley W.

doi:10.1177/0194599813520291

Cited by 94 publications

(74 citation statements)

References 19 publications

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“…First, local turbulence originating from acceleration or changes in blood flow may disrupt laminar flow and become the source of VPT. 8 Second, as previous studies have suggested, 19,20 when a pulse-synchronous sound is generated, that sound may be transmitted primarily through the bone conduction route to the inner ear if any discontinuity or weakness is present in the bony (normally) soundproof wall. Vascular PT caused by DSSD/T can be explained by the mechanisms summarized above.…”

Section: Possible Pathophysiological Mechanisms Of Vpt Perception In mentioning

confidence: 99%

“…SSD or diverticula are evident in 23% of patients with PT, and, among PT patients with definable etiologies, 33% had SSD or diverticula. 7,20 However, SSD is also found in as many as 12% of asymptomatic patients, 7 and a bone thickness of less than 0.6 mm over the SS can be falsely interpreted as dehiscence. 3,14 Also, when it is considered that iatrogenic dehiscence of the bony wall of the SS during mastoidectomy usually does not trigger PT, SSD alone may not always cause VPT.…”

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confidence: 99%

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Transmastoid reshaping of the sigmoid sinus: preliminary study of a novel surgical method to quiet pulsatile tinnitus of an unrecognized vascular origin

Kim

Choi

et al. 2016

JNS

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T inniTus can be subjective, i.e., when the sound is perceived by the individual alone, or objective, i.e., when an observer can recognize the tinnitus sound of the patient.2 Subjective tinnitus comes from the inner ear, ascending auditory pathway, or auditory/nonauditory cortical regions. 9,[22][23][24][26][27][28]30 The origin of objective tinnitus is vascular or nonvascular. Of them, vascular objective tinnitus is also known as pulsatile tinnitus (PT), featuring perception of a pulse-synchronous or rhythmical sound. obJective A dominant sigmoid sinus with focal dehiscence or thinning (DSSD/T) of the overlying bony wall is a commonly encountered, but frequently overlooked, cause of vascular pulsatile tinnitus (VPT). Also, the pathophysiological mechanism of sound perception in patients with VPT remains poorly understood. In the present study, a novel surgical method, termed transmastoid SS-reshaping surgery, was introduced to ameliorate VPT in patients with DSSD/T. The authors reviewed a case series, analyzed the surgical outcomes, and suggested the pathophysiological mechanism of sound perception. The theoretical background underlying VPT improvement after transmastoid SS-reshaping surgery was also explored. methods Eight patients with VPT that was considered attributable to DSSD/T underwent transmastoid SS-reshaping surgery between February 2010 and February 2015. The mean postoperative follow-up period was 9.5 months (range 4-13 months). Transmastoid SS-reshaping surgery featured simple mastoidectomy, partial compression of the SS using harvested cortical bone chips, and reinforcement of the bony SS wall with bone cement. Perioperative medical records, imaging results, and audiological findings were comprehensively reviewed. results In 7 of the 8 patients (87.5%), the VPT abated immediately after surgery. Statistically significant improvements in tinnitus loudness and distress were evident on numeric rating scales. Three patients with preoperative ipsilesional low-frequency hearing loss exhibited postoperative improvements in their low-frequency hearing thresholds. No major postoperative complications were encountered except in the first subject, who experienced increased intracranial pressure postoperatively. This subsided after a revision operation for partial decompression of the SS. coNclusioNs Transmastoid SS-reshaping surgery may be a good surgical option in patients with DSSD/T, a previously unrecognized cause of VPT. Redistribution of severely asymmetrical blood flow, reinforcement of the bony SS wall with bone cement to reconstruct a soundproof barrier, and disconnection of a problematic sound conduction route via simple mastoidectomy silence VPT.

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Section: Possible Pathophysiological Mechanisms Of Vpt Perception In mentioning

confidence: 99%

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confidence: 99%

Transmastoid reshaping of the sigmoid sinus: preliminary study of a novel surgical method to quiet pulsatile tinnitus of an unrecognized vascular origin

Kim

Choi

et al. 2016

JNS

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“…Sigmoid sinus dehiscence/ diverticulum (SSDD) is a recently described cause of up to 20 % of PT cases. The symptoms can be improved to some extent with surgical and endovascular interventions [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Three main theories have been proposed for the mechanism of SSDD, the idiopathic intracranial hypertension (IIH) theory [5], blood flow impacting theory [6,3,5], and osteoporosis theory [7]. According to the blood flow impacting theory, SSDD is caused Liu Zhaohui and Dong Cheng contributed equally to this work.…”

Section: Introductionmentioning

confidence: 99%

Association between idiopathic intracranial hypertension and sigmoid sinus dehiscence/diverticulum with pulsatile tinnitus: a retrospective imaging study

et al. 2015

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“…According to some reports, between 22% and 48% of patients clinically diagnosed with pulsatile tinnitus of venous origin have a diverticulum or dehiscence of the sigmoid sinus that is detectable on contrastenhanced CT. 6,12 Although treatment for sigmoid sinus wall abnormalities historically has been endovascular embolization, 13 more recently, the open transmastoid approach has become the norm.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Imaging Findings following Sigmoid Sinus Wall Reconstruction for Pulse Synchronous Tinnitus

Raghavan¹,

Serulle²,

Gandhi³

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Transmastoid sigmoid sinus wall reconstruction is a surgical technique increasingly used for the treatment of pulsatile tinnitus arising from sigmoid sinus wall anomalies. The imaging appearance of the temporal bone following this procedure has not been well-characterized. The purpose of this study was to evaluate the postoperative imaging appearance in a group of patients who underwent this procedure.

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Imaging Prevalence of Sigmoid Sinus Dehiscence among Patients with and without Pulsatile Tinnitus

Abstract: The prevalence of SSDD in patients with PT was 23%. Among patients with PT, those with SSDD were younger, exclusively female, and presented with objective tinnitus. The prevalence of SSDD among asymptomatic patients in 1 year was 1.2%.

Cited by 94 publications

References 19 publications

Transmastoid reshaping of the sigmoid sinus: preliminary study of a novel surgical method to quiet pulsatile tinnitus of an unrecognized vascular origin

Transmastoid reshaping of the sigmoid sinus: preliminary study of a novel surgical method to quiet pulsatile tinnitus of an unrecognized vascular origin

Association between idiopathic intracranial hypertension and sigmoid sinus dehiscence/diverticulum with pulsatile tinnitus: a retrospective imaging study

Postoperative Imaging Findings following Sigmoid Sinus Wall Reconstruction for Pulse Synchronous Tinnitus

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