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

Abstract

Objective Describe the location and severity of transverse sinus stenosis (TSS) in a consecutive series of patients with intraoperatively confirmed sigmoid sinus wall abnormalities (SSWA). Methods A retrospective review of imaging studies from patients undergoing sinus wall reconstruction for pulsatile tinnitus associated with SSWA “was performed.” Qualitative and quantitative analyses of the TSS, including the side, type, location, extent, and severity, were performed and compared with normal controls and historical controls with idiopathic intracranial hypertension (IIH). Results Twenty‐six of 36 subjects had adequate imaging data. The majority of subjects had some degree of bilateral TSS, and the majority of stenoses involved the distal transverse sinus. Subjects with diverticulum were significantly more likely than those with dehiscence to have ipsilateral distal TSS (16 of 16 vs. 4 of 10, P = 0.009). The mean minimum transverse sinus diameter, stenosis severity grade, and overall posterior venous sinus outflow were significantly worse in the subjects as compared to normal controls (P = 0.002), although not as severe as the comparable values in historical controls with IIH (P < 0.003). Conclusion Subjects with SSWA have a high incidence of TSS, with patterns differing between those with dehiscence and diverticulum. Severity of TSS and overall posterior fossa venous outflow are worse as compared to normal controls but not as severe as in subjects with IIH. These findings have implications for the pathophysiology and management of SSWA. Level of Evidence 4 Laryngoscope, 130:1028–1033, 2020

Effects of different morphologic abnormalities on hemodynamics in patients with venous pulsatile tinnitus: A four‐dimensional flow magnetic resonance imaging study

“…Previous studies proposed that anomalous blood flow may be the direct cause of the formation of sigmoid sinus wall abnormalities 11,14,26 . As jet‐like flow impacts the lateral wall of the sigmoid sinus over the long term, the local sinus wall may be gradually eroded and thinned, leading to dehiscence and formation of the diverticulum 7 . This mechanism is supported by the evidence that a jet‐like flow from TSS is directed toward the opening of SSD in 4D flow MRI imaging and CFD simulation studies 12 …”

CT venography correlate of transverse sinus stenosis and venous transstenotic pressure gradient in unilateral pulsatile tinnitus patients with sigmoid sinus wall anomalies

“…Sigmoid sinus wall abnormalities (SSWA) are currently recognized as the most common venous etiology [2,3], including sigmoid sinus wall dehiscence and sigmoid sinus diverticulum [4]. These patients are often accompanied with transverse sinus stenosis (TSS) [4][5][6][7], ipsilesional venous outflow dominance [8], high jugular bulb [8], empty sella [4,8], well-pneumatized temporal bone [8,9], jet-like flow [10][11][12], and intraluminal vortex/turbulence [10,11,13], suggesting the occurrence of PT may be the result of a multifactorial combination, including blood vessel, blood flow, bony wall, conduction, and increased intracranial pressure.…”

“…The transtenotic pressure gradient (TPG) of transverse sinus has been reported as a key factor for PT, which plays a role in generating jet-like flow and strong impact force toward the sigmoid sinus wall [14]. The long-term impact of abnormal blood flow that is related to TPG may be responsible for the progressive erosion of bony wall of the sigmoid sinus, which results in SSWA [6]. After then, the flow sound transmits to the inner ear through the dehiscent area [15].…”

Venous sinus stenting for the treatment of isolated pulsatile tinnitus: Results of a prospective trial

“…15 Transverse sinus stenosis causes flow anomalies that initially slowly erode the overlying bone, resulting in dehiscence, and then weaken the unprotected sinus resulting in the formation of a diverticulum. 16 Sigmoid sinus cortical plate dehiscence induces pulsatile tinnitus through significantly amplifying the sound generated by flow in the venous sinus. 17…”