Silencing Pulsatile Tinnitus: A Novel Technique of Periosteal Flap Obliteration for Sigmoid Sinus Diverticulum Variants

Objective Review of a sigmoid sinus diverticuli (SSDi) variants surgically managed with a novel technique using an inferior periosteal flap. Study Design Case series. Setting Tertiary referral center. Patients Patients presenting with pulsatile tinnitus to a tertiary referral center between January 1, 2015, and June 31, 2021, who were diagnosed with SSDi variants on CT temporal bone and who received surgical management for these SSDi variants. Intervention(s) Obliteration of SSDi variants using a novel technique with an inferiorly based periosteal flap. Main Outcome Measure(s) Pure-tone audiometry, Tinnitus Handicap Inventory score, and visual analogue scale score for tinnitus severity (loudness, awareness, annoyance, and effect on life). Results Include statistical measures as appropriate. Conclusions We would like to propose the use of an inferiorly based periosteal flap as an option for obliteration and concomitant hemostasis of more sizeable or complex (e.g., bifid) SSDi. Further study of this technique with a long-term follow-up will be needed to evaluate its long-term safety and efficacy.