Sigmoid sinus diverticulum

Sigmoid sinus diverticulum (SSD, or sigmoid sinus dehiscence is found in 1.2% of asymptomatic patients ¹⁾

However, these abnormalities may be found ipsilaterally in up to 23% of patients with pulsatile tinnitus, presumably due to turbulent flow which may occur in these abnormalities ²⁾. SSD is more common in women.

When treatments such as masking noise generators fail, surgical intervention can be considered.

Surgical treatment options include:

● Endovascular coiling/stenting

● Transmastoid “resurfacing”

● Craniectomy with clip reconstruction Transmastoid “resurfacing” consists of partial mastoidectomy and subtotal obliteration of the area of the diverticulum (so-called sinus wall resurfacing) ³⁾. ⁴⁾ with e.g. bone chips, fibrin glue, or muscle.

¹⁾

Schoe S, Nicholas B, Mukherjee S, Kesser BW. Imaging prevalence of sigmoid sinus dehiscence among patients with and without pulsatile tinnitus. Otolaryngol Head Neck Surg. 2014; 150:841– 846

²⁾ , ³⁾

Song JJ, Kim YJ, Kim SY, An YS, Kim K, Lee SY, Koo JW. Sinus Wall Resurfacing for Patients With Temporal Bone Venous Sinus Diverticulum and Ipsilateral Pulsatile Tinnitus. Neurosurgery. 2015; 77:709–717

⁴⁾

Santa Maria PL. Sigmoid sinus dehiscence resurfacing as treatment for pulsatile tinnitus. J Laryngol Otol. 2013; 127 Suppl 2:S57–S59