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Abstract
Introduction Venous anomalies are being increasingly acknowledged as causes of pulsatile tinnitus (PT). Often, patients present with multiple anomalies, complicating the identification of the vessel responsible. Venous Balloon Occlusion Testing (vBOT) uses a temporarily inflated balloon to occlude a vessel, proving especially useful in identifying the culprit vein in venous-related PT cases. Here we present several cases in which vBOT facilitated the determination of causative veins associated with PT, thereby enabling targeted and effective treatment.
Methods Retrospective chart review
Results Case 1: A 74-year-old male presented with bilateral tinnitus for 10 years. Diagnostic venography demonstrated multiple venous anomalies including a high-riding jugular bulb, a jugular bulb diverticulum, and prominent mastoid emissary veins. He initially underwent coiling of a high-riding jugular bulb with no resolution in symptoms. vBOT of the right mastoid emissary Vein (MEV) resulted in the resolution of symptoms on the right and partial resolution on the left. He underwent elective coiling of the right MEV. Following this, he returned with increased left-sided tinnitus and near-complete resolution of the right-sided tinnitus. He then underwent coiling of the left MEV.
Case 2: A 52-year-old female presented with left-sided tinnitus, which progressed to also involve her right side. CT revealed bilateral high-riding jugular bulbs. Catheter venography with vBOT in each internal jugular (IJ) bulb resulted in partial improvement of PT symptoms on the left and complete resolution of PT symptoms on the right. She underwent right IJ bulb stent-assisted coiling which resulted in the resolution of right-sided PT.
Case 3: A 53-year-old male with a past medical history of idiopathic intracranial hypertension (IIH) treated previously with a VP shunt presented with near-constant bilateral tinnitus, requiring television sound to dampen the sound of tinnitus to sleep. MR venography revealed a high-riding left jugular bulb and a prominent right mastoid emissary vein. Catheter venography with vBOT of a prominent left PCV showed a reduction in his left-sided tinnitus. He underwent coil embolization of the left PCV with reduction in the left-sided PT.
Conclusion Venous Balloon occlusion (vBOT) testing effectively identifies culprit vessels in venous pulsatile tinnitus, aiding in targeted treatment, especially in patients with multiple venous anomalies.
Disclosures S. Lingam: None. A. Brake: None. V. Galate: None. M. Abraham: None.