Article Text
Abstract
Introduction Pulsatile tinnitus (PT) is a debilitating condition with substantial morbidity related to quality of life. Venous sinus stenosis (VSS) has recently emerged as the dominant cause of PT, either in the setting of concurrent idiopathic intracranial hypertension (IIH) or due to primary venous stenosis. However, most studies are limited to small retrospective series, thereby limiting generalizability of VSS in patients with PT. Likewise, it is unclear if outcomes are different between patients with primary venogenic PT and IIH associated PT.
Methods A systematic literature review and pooled analysis was completed to evaluate the clinical outcomes of PT in patients undergoing cerebral VSS. Outcome measures included: Improved PT, complete resolution of PT, PT recurrence at follow up. Subgroup analysis was completed to compare outcomes between patients with PT due to IIH versus primary venous stenosis. Pooled rates were determined using a random effects model.
Results In total, 26 studies were identified with 600 patients. The proportion of improved PT symptoms after VSS was reported in 24 studies with 341 patients, with an overall pooled rate of 92.7% (CI: 89.3% to 96.1%; I2=57%, P<0.001). Subgroup analysis demonstrated that cerebrovascular PT as the primary indication (n=76) had a significantly higher rate of symptomatic improvement (98.3%; CI: 95.5% to 100%; I2=0%, P=0.87) compared to IIH patients (n=509) (91.1%; CI: 86.9% to 95.4%; I2=57.3%, P=0.001) (P=0.03). Complete resolution after VSS was reported in 20 studies with 469 patients, with an overall pooled rate of 88.4% observed (CI: 83.4 to 93.3; I2=65%, P<0.001), with no significant difference in outcomes between IIH and primary PT patients (P=0.17). Rates of PT recurrence at follow up were described in 7 studies with 289 patients. Recurrent PT after stenting occurred in 6.9% of cases (CI: 1.2% to 12.6%; I2=71%, P=0.002). Furthermore, subgroup analysis demonstrated that IIH patients had a significantly higher recurrence rate (10.6%; CI: 5.2% to 16.1%; I2=26%, P=0.26) compared to patients treated with venous stenting for PT as the primary indication (1.8%; CI: 1.3% to 4.9%; I2=27%, P=0.36) (P<0.0001).
Conclusion Venous stenting in patients with pulsatile tinnitus results in a substantial decrease and often complete resolution of symptoms. In patients with primary venogenic pulsatile tinnitus, stenting may result in a higher rate of durable symptomatic improvement compared to patients with concurrent IIH.
Disclosures D. Schartz: None. A. Finkelstein: None. S. Akkipeddi: None. N. Ellens: None. P. Valdes Barrera: None. Z. Williams: None. E. Vates: None. M. Bender: None.