Article Text
PDF
Abstract
Introduction Intractable Pulsatile tinnitus (PT) has been linked to various pathologies of the cerebral venous sinuses, including high-riding jugular bulb (HRJB). Best treatment approach remains uncertain. There are reports of stent-assisted coil-embolization of HRJB with immediate resolution of PT. Use of stent-assisted WEB device embolization for this pathology has not been reported previously.
Methods This case series evaluates the feasibility and efficacy of stent-assisted WEB embolization in patients with HRJB and PT at our institution. We describe a case series of three patients who presented with long-standing debilitating PT in association with HRJB. All three patients with HRJB were treated with stenting of the right sigmoid venous sinus, and across the jugular bulb and ending in the right internal jugular vein with adjunctive Microvention WEB device embolization of the HRJB. All three patients were placed on dual anti-platelet therapy in anticipation for cerebral angiogram and cerebral venogram, and cerebral venous pressure monitoring, which was performed under general anesthesia.
Results We had total of three patients that underwent this treatment. All three cases were technically successful without complication and resulting in immediate resolution of PT and at 3- and 6-month follow-up. Patient 1. 41 yo F with no known PMH presented with a right-sided persistent intractable tinnitus for over 2 years and subjective hearing loss. Computed tomography temporal bone showed right HRJB. A Medtronic Protege 8×40 mm stent was deployed in the sigmoid sinus across the jugular bulb and ending in the right internal jugular vein. Next, the HRJB was embolized with a WEB SL 9 × 4 mm using a Via 33 microcatheter. Patient immediate relief of PT remained at 6-month follow-up.Patient 2. 61 yo M with no known PMH presented with debilitating-right sided pulsatile tinnitus for 3 years. Non contrast MRV head showed right HRJB. A Cordis Precise 8×40 mm stent was used, followed by WEB-embolization (11×8 mm) of the HRJB. Patient immediate relief of his PT remained at 3-month follow-up.Patient 3. 33 yo F with PMH for obesity and pseudotumor cerebri presented with persistent headaches and right-sided pulsatile tinnitus for 5 years. CTV head showed right HRJB and bilateral transverse sinus stenosis. A Cordis Precise 7×40 mm stent was deployed followed by WEB-embolization (10×6 mm) of the HRJB. Patient immediate relief of her PT remained at 3-month follow-up.
Conclusion In patients with PT secondary to HRJB, endovascular treatment by stent-assisted and WEB embolization of HRJB can be safe and effective.
Disclosures L. Ponce Mejia: 2; C; Microvention. H. Saber: None. K. Khatibi: None.