Outcomes of venous sinus stenosis stenting in patients with pulsatile tinnitus and sigmoid sinus wall anomalies

BACKGROUND: Transverse sinus stenosis (TSS) and sigmoid sinus wall anomalies (SSWAs) are the most common causes of pulsatile tinnitus (PT). While these conditions may co-occur, they usually require different management approaches. This study aims to evaluate whether TSS stenting alone, without targeted treatment of SSWAs, is sufficient to resolve PT in patients presenting with PT, TSS, and SSWAs. METHODS: We conducted a retrospective study of consecutive patients diagnosed with PT, TSS, and SSWAs who underwent transvenous endovascular treatment between September 2020 and January 2024. The primary outcome was treatment success at 3 months, defined as complete resolution of baseline PT. Secondary outcomes included treatment success at 24 hours and 1 year, PT recurrence within 1 year, and major complications. RESULTS: Thirty-three patients with PT, TSS, and SSWAs underwent 38 procedures. Among these, 14 cases (36.8%) had dehiscence alone, 3 cases (7.9%) with diverticulum alone, and 20 cases (52.6%) involved both dehiscence and diverticulum. Stenting alone was performed in 25 cases (65.8%), stent-assisted coiling in 9 cases (23.7%), and coiling alone in 4 cases (10.5%). The primary outcome of complete resolution of PT at 3 months was achieved in 86.1% (31/36) of cases, with partial resolution in an additional 13.9% (5/36) of cases. There was no difference in outcomes between cases of isolated stenting and those involving coiling or stent-assisted coiling. CONCLUSION: Transverse sinus stenting alone, without dedicated treatment of SSWAs, resolves PT in patients with TSS and SSWAs. These results support the growing evidence that SSWAs are secondary to TSS in patients with PT and/or idiopathic intracranial hypertension, suggesting that additional interventions like coiling or surgery of SSWAs may be unnecessary.