title: Sinus Wall Resurfacing for Patients With Temporal Bone Venous Sinus Diverticulum and Ipsilateral Pulsatile Tinnitus.
abstract: BACKGROUND
  Pulsatile tinnitus (PT) caused by venous sinus diverticulum is a relatively common, potentially incapacitating condition. Although treatment via an external approach or endovascular coiling has been reported, much remains unknown about the possible pathophysiological mechanisms and appropriate management of PT.
  
  
  OBJECTIVE
  To review our case series of PT resulting from either sigmoid sinus diverticulum (SSD) or middle cranial fossa venous sinus diverticulum (MFD-VS) and to discuss the possible pathophysiological mechanisms and desirable treatment options.
  
  
  METHODS
  Four PT patients with either SSD or MFD-VS were treated with transmastoid resurfacing. In 1 case, a revision operation was performed as a result of recurrence of PT 4.5 years after the initial operation. The medical records and temporal bone imaging findings were retrospectively reviewed.
  
  
  RESULTS
  PT was resolved in all cases immediately after transmastoid resurfacing, but 1 patient in whom bone wax was used for initial resurfacing experienced PT 4.5 years later. The PT was successfully managed with revision resurfacing with autologous bone chips/bone cement. In the other cases, the resolution of PT lasted throughout a median follow-up of 5.75 years. Notably, 2 of 4 cases had preoperative low-frequency hearing loss (LFHL) and experienced immediate postoperative improvement in LFHL.
  
  
  CONCLUSIONS
  PT resulting from either SSD or MFD-VS can be treated successfully with transmastoid resurfacing of the venous wall. Preoperative ipsilesional LFHL and the improvement of hearing threshold after surgical intervention may be preoperative and postoperative surrogate objective signatures of PT. To ensure the resolution of symptoms, secure reconstruction with firm materials and long-term follow-up are mandatory.
authors.affiliation: *Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea; ‡Department of Otorhinolaryngology-Head and Neck Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea.
authors.forename: Jae-Jin
authors.initials: JJ
authors.lastname: Song
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: So Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Yun Suk
authors.initials: YS
authors.lastname: An
authors.forename: Kanghyeon
authors.initials: K
authors.lastname: Kim
authors.forename: Sang-Yeon
authors.initials: SY
authors.lastname: Lee
authors.forename: Ja-Won
authors.initials: JW
authors.lastname: Koo
mesh_terms: D000328:Adult; D000368:Aged; D035301:Cranial Fossa, Middle / Q000000981:diagnostic imaging / Q000601:surgery; D003392:Cranial Sinuses / Q000000981:diagnostic imaging / Q000601:surgery*; D004240:Diverticulum / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D014012:Tinnitus / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*