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Endovascular treatment of debilitating tinnitus secondary to cerebral venous sinus abnormalities: a literature review and technical illustration
  1. I-Hsiao Yang1,
  2. Vitor M Pereira2,
  3. Stephanie Lenck3,
  4. Patrick Nicholson4,5,
  5. Emanuele Orru4,
  6. Jesse M Klostranec6,
  7. Timo Krings7,
  8. Anderson Chun On Tsang8
  1. 1 Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  2. 2 Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
  3. 3 Division of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, University Paris Sorbonne, Paris, France
  4. 4 Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
  5. 5 Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland
  6. 6 Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
  7. 7 Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
  8. 8 Department of Surgery, The University of Hong Kong, Hong Kong
  1. Correspondence to Dr Anderson Chun On Tsang, Division of Neurosurgery, The University of Hong Kong, Hong Kong; acotsang{at}


Background and objective Pulsatile tinnitus (PT) can be debilitating and lead to significant morbidity. Cerebral venous sinus lesions, such as venous sinus stenosis, diverticula, and high-riding jugular bulb, are uncommon causes of PT, for which there is no standard treatment. Endovascular interventions have shown promising results for PT secondary to idiopathic intracranial hypertension, and may be a valid therapeutic option for isolated venous PT.

Methods We conducted a systematic literature review on the outcome and safety of endovascular treatment for patients with isolated, debilitating venous PT. The venous lesion characteristics, endovascular techniques, complications, and clinical outcomes were assessed. In addition, an illustrative case of endovascular stenting for PT caused by venous sinus stenosis was included.

Results A total of 41 patients (90.2% female) from 26 papers were included. The median age was 46 years (IQR 23; range 25–72 years). Focal venous sinus stenosis (20 patients) and sinus diverticula (14 patients) were the most common culprit lesions. Endovascular treatment included venous sinus stenting in 35 patients, 11 of whom had adjuvant coil embolization, and coil embolization alone in six patients. Complete resolution of the tinnitus was achieved in 95.1% of patients. There was one complication of cerebellar infarct, and no procedure-related mortality.

Conclusions In patients with debilitating PT secondary to venous sinus lesions, endovascular treatment by stenting and/or coil embolization appears to be safe and effective. Prospective randomized studies with objective outcome assessments are needed to confirm the treatment benefits.

  • intervention
  • stenosis
  • stent
  • vein

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  • Contributors I-HY, ACOT collected and analyzed the data and prepared the manuscript. VMP, ACOT conceptualized and supervised the study. SL, PN, EO, JMK provided input in the study design and data interpretation. All authors critically reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.