Published online Apr 6, 2021. doi: 10.12998/wjcc.v9.i10.2320
Peer-review started: October 16, 2020
First decision: December 21, 2020
Revised: December 28, 2020
Accepted: January 25, 2021
Article in press: January 25, 2021
Published online: April 6, 2021
Processing time: 164 Days and 17.9 Hours
Pulsatile tinnitus (PT) is a potentially disabling symptom that has received increasing attention. Multiple causes of PT have been confirmed by targeted treatment. However, dynamic changes of related structures in PT patients with multiple causes after stenting for ipsilateral transverse sinus stenosis (TSS) have not been previously reported. We report such a case and present postoperative computed tomography venography (CTV) follow-up findings to demonstrate the decreased sigmoid sinus diverticulum and bone remodeling.
A 45-year-old man suffered from left-sided PT for 15 years that was occasionally accompanied by headache and dizziness. Pre-operative CTV revealed left-sided sigmoid sinus wall anomalies (SSWAs), TSS, outflow dominance, large posterior condylar emissary vein, and an empty sella turcica. A cerebrospinal fluid pressure of 270 mmH2O was further detected. The sound disappeared immediately after stenting for ipsilateral TSS, with no recurrence during 2 years of follow-up. After the procedure, the patient underwent four consecutive CTV examinations. The diverticulum decreased 6 mo after the procedure with new bone remodeling. The density of the remodeled bone was further increased 1 year later, and a hardened edge was formed 2 years later.
PT associated with SSWAs, TSS, and idiopathic intracranial hypertension can be cured by stenting for TSS alone. And bone remodeling around SSWAs is a more significant finding.
Core Tip: Pulsatile tinnitus is a potential disease that has attracted considerable attention recently. Multiple causes of pulsatile tinnitus have been identified by targeted treatment. However, the dynamic CT changes of related structures after stenting for transverse sinus stenosis have never been reported. In this case, four postoperative computed tomography venography examinations were performed to demonstrate the dynamic changes in the sigmoid sinus wall anomalies and transverse sinus stenosis. Stenting relieved transverse sinus stenosis, reduced intracranial pressure, and eliminated tinnitus. A decreased sigmoid sinus diverticulum and bone remodeling represent more significant findings.