Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2021; 9(10): 2320-2325
Published online Apr 6, 2021. doi: 10.12998/wjcc.v9.i10.2320
Bone remodeling in sigmoid sinus diverticulum after stenting for transverse sinus stenosis in pulsatile tinnitus: A case report
Xiao-Yu Qiu, Peng-Fei Zhao, He-Yu Ding, Xiao-Shuai Li, Han Lv, Zheng-Han Yang, Shu-Sheng Gong, Long Jin, Zhen-Chang Wang
Xiao-Yu Qiu, Peng-Fei Zhao, He-Yu Ding, Xiao-Shuai Li, Han Lv, Zheng-Han Yang, Zhen-Chang Wang, Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Shu-Sheng Gong, Department of Otolaryngology-Head & Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Long Jin, Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Qiu XY and Zhao PF reviewed the literature and contributed to manuscript drafting; Ding HY and Li XS provided the images; Lv H and Yang ZH analyzed and interpreted the imaging findings; Gong SH and Jin L gathered detailed clinical information; Wang ZC conceived of and directed the project; Zhao PF, Lv H, and Wang ZC provided funds to support this study; all authors issued final approval for the version to be submitted.
Supported by The Beijing Scholar 2015; and the National Natural Science Foundation of China, No. 61931013, No. 81701644, and No. 61801311.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest related to this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen-Chang Wang, MD, PhD, Chief Doctor, Professor, Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing 100050, China. cjr.wzhch@vip.163.com
Received: October 16, 2020
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Pulsatile tinnitus; Transverse sinus stenosis; Stents; Bone remodeling; Follow-up; Case report

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.