The Connection Between Pulsatile Tinnitus and Venous Diverticulum

In case you missed his lecture, here are some key points:

• Venous sinus diverticulum (VSD) is the outpouching of the lateral or sigmoid sinusTermed for its s-shaped anatomy, the sigmoid sinus is a long vessel that runs along the inside of the skull like a long winding road Click the term to read more wall, which is located next to the mastoid bone. This is important because this finding can be found in those with pulsatile tinnitusA whooshing or throbbing noise heard in one or both ears that can range from annoying to debilitating. Highly associated with venous sinus stenosis. Click the term to read more, venous sinus stenosis, and idiopathicThe term idiopathic is used when there is no detectable reason for something. Click the term to read more intracranial hypertension (IIH).
• Venous causes are the number one cause of pulsatile tinnitus and are often under-recognized and under-reported. Venous diverticulum falls under this category as a lateral sinus pathology.

• Anatomically, the sigmoid plate separates the middle ear from the sigmoid sinus. Thinning or missing of the plate or vascular flow issues near this area can cause pulsatile tinnitus.
• There is speculation that VSD is congenital. During embryonic development of the petrosquamous vein, there may be a remnant, presenting as a venous diverticulum.
• In patients who have venous sinus stenosis, a post-stenotic turbulence high velocity wall causes shear stress on the sigmoid plate, propagating a VSD.
• CT scanUses several X-ray images and computer processing to create cross sectional images. Click the term to read more of the brain with contrast, MRI with contrast and MRV can identify a venous sinus diverticulum.
• AbdalKadar presented a patient who had imaging over a decade earlier for a different reason, confirming a normal sigmoid plate. She presented with pulsatile tinnitus 13 years later with an MRI of brain showing a missing sigmoid plate, indicative of a venous diverticulum, evidence that her pathology was an acquired lesion.

• Management of venous sinus diverticulum can be treated with endovascular embolization (coiling) or stenting.
• Abdalkader also has experience in successful treatment of venous sinus diverticulum with diamox and with some no intervention indicated.
• In the patients Dr. AbdalKadar and his team treated, he performed follow up imaging and found bone regrowth of the sigmoid plate. In his unpublished report, this occurred in 87% of patients that received intervention for a VSD.

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